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腹泻(Diarrhea)定义Definition排便次数增多、粪质稀薄，或带有粘液、脓血，或未消化的食物。如解液状便，每日3次以上，或每日排便量超过200克，含水量＞80％。Diarrheaiscommonlyusedtodenoteanincreaseinstoolfrequencyorvolumeandanincreaseintheloosenessofstool,orwithmucus,pusandbloodorundigestedfood,suchasdischargingloosestoolsmorethanthreetimesperday,orweightofstoolsabove200gwithcontainingwaterabove80%.分类Classify急性腹泻(acutediarrhea)慢性腹泻(chronicdiarrhea)超过2个月morethan2month急性腹泻的病因Etiologyofacutediarrhea（1）肠道疾病：感染性肠炎、急性出血坏死性肠炎（1）Intestinaldiseases:infectiousenteritis,acutehemorrhagicenteritis（2）急性中毒(2)Acutepoisoning（3）全身性感染:败血症，伤寒(3)Systemicinfection:sepsis,typhoid（4）其他：变态反应性肠炎；内分泌疾病(4)Others慢性腹泻的病因（1）Etiologyofchronicdiarrhea(1)（1）消化系统疾病digestivesystemdiseases：胃部疾病stomachdisorder肠道感染intestinalinfection：肠结核、慢性菌痢、血吸虫病肠道非感染性疾病Non-infectiousintestinaldiseases：溃疡性结肠炎肠道肿瘤intestinaltumor：小肠结肠恶性肿瘤胰腺疾病pancreaticdiseases：慢性胰腺炎、胰腺癌肝胆疾病hepato-biliarydiseases：肝硬化(cirrhosis)、慢性胆囊炎、胆石症慢性腹泻的病因（2）（2）全身性疾病systemicdiseases内分泌及代谢障碍疾病Endocrineandmetabolicdisorders：甲亢、糖尿病性肠病、血管活性肠肽瘤、类癌综合征其他系统疾病othersystemicdiseases：尿毒症(uremia)、放射性肠炎药物副作用adverseeffects：利血平、甲状腺素、洋地黄类神经功能紊乱nervousdysfunction：肠易激综合征(irritablebowelsyndrome,IBS)发病机制Mechanism1分泌性腹泻1Secretorydiarrhea肠粘膜分泌过多的液体超过肠粘膜吸收能力所引起肠道非感染或感染性炎症：霍乱(cholera)阿米巴、细菌性、溃疡性结肠炎肠道内分泌肿瘤：胃泌素瘤(gastrinoma)2渗出性腹泻渗出大量粘液、脓血，如炎症性肠病、感染性肠炎、放射性肠炎3渗透性腹泻3Osmoticdiarrhea肠内容物渗透压增高，阻碍肠内水分与电解质的吸收而引起,常见于高渗性(hyperosmotic)药物、高渗性食物、胰腺病变、肝胆疾病4动力性腹泻4Dynamicdiarrhea肠蠕动亢进致肠内食糜停留时间缩短，未被充分吸收；常见于肠炎，甲状腺功能亢进、糖尿病、胃肠功能紊乱hyperactiveperistalsisresultinshortresidencetimeofchymewithoutfullyabsorbed;itcanbeseeninenteritis,hyperthyroidism,diabetes,gastrointestinaldysfunction5吸收不良性腹泻5Malabsorptiondiarrhea由肠粘膜的吸收面积减少或吸收障碍所引起，如小肠大部切除术，吸收不良综合征Intestinalabsorptionareadeclinedorabsorptiondysfunction,suchassmallIntestineresection,malabsorptionsyndrome临床表现Clinicalmanifestation1起病与病程Onsetandcourse起病急、病程短rashonset,shortcourse：感染或中毒infection,poisoning起病缓慢、病程长slowoncet,longcourse：慢性感染、非特异性炎症、吸收不良、肠道肿瘤、神经功能紊乱chronicinfection,nonspecificinflammation,malabsorption,intestinaltumor,nervousdysfunction临床表现2腹泻次数与粪便性质2Diarrheatimesandstoolproperties急性感染性腹泻acuteinfectiousdiarrhea:severaltimesorevendozensoftimesperday;pasteorwaterystools慢性腹泻chronicdiarrhea:severaltimesperday;loosestools阿米巴痢疾amoebicdysentery:darkredorlikejam肠易激综合征irritablebowelsyndrome(IBS):stoolswithmucusandwithoutpathologicalchanges临床表现3腹泻与腹痛的关系relationshipwithabdomenpain急性腹泻常有腹痛，以感染性腹泻为明显Acutediarrheausuallyhasabdomenpain,andinfectivediarrheaisthemostobvious.小肠疾病的腹泻疼痛常在脐周，便后腹痛缓解不明显Thepainofintestinaldiseasediarrheaisalwaysaroundnavel,anditrelievesun-...