Tünetek és panaszok gastrointestinalis betegségekben I.
Table 4-1.Six Categories of Diarrhea Interpreted in Terms of the Average Severity (– to +++) of Six Features of Diarrhea
The Presence of
BloodHigh Stool
VolumeStool that
Suggests FatAbruptness
of OnsetNausea and
VomitingCramping Pain
Ingestive diarrhea – + – +++ – –
Toxic diarrhea ++ +++ – +++ +++ +++
Malabsorptive diarrhea – +++ +++ +– +– +–
Maldigestive diarrhea – + +++ +– +– +–
Hormonal diarrhea – +++ – +– +– +–
Colonic diarrhea +++ ++ – ++ – –
Overproduction jaundice•Intravascular hemolysis, including ineffective hematopoiesis•Extravascular hemolysis from hematomas•Competitive binding to albumin by certain drugsEponymic jaundice•Gilbert’s syndrome (idiopathic unconjugated hyperbilirubinemia)•Crigler-Najjar syndrome (congenital nangemolytic jaundice)•Dubin-Johnson syndrome (chromic idiopathic jaundice)•Rotor’s syndrome (familial chronic conjugated hyperbilirubinemia)Uptake-conjugation jaundiceDiffuse hepatocellular disease •Hepatitis due to infectious agents•Hepatocellular toxicity from alcohol, drugs and other toxinsDiffuse infiltrative disease of the liver•Malignant infiltrations, like carcinomas and lymphomas•Benign infiltrations, like sarcoidosis, amyloidosis, hemochromatosisExcretory jaundice•Drugs that interfere with bilirubin secretion, like 17-alpha alkylated steroids•Drugs that impair intrahepatic bile flow, like estrogen and phenothiazines•Disease of intrahepatic biliary radicals, like pericholangitis and primary biliary cirrhosisObstructive jaundice•Intraductal disease, like stones, strictures, sclerosing cholangitis, and cholangiocarcinoma•Extraductal disease, like pancreatic edema, pancreatic carcinoma, and malignant or inflammatory lymph nodes at the porta hepatis
Sárgaságok
Hányások differenciálása• Jellegzetessége• Reggeli
sugárban, hányinger nélkülétkezés után közvetlenül
• Epésfaeces (miserere)kávéalj-szerűvér
• Hasmenésselmeningismussal, fejfájássalcolicaszemfájdalom,látászavartudatzavaramenorrhoeakretininin emelkedéscukor magas
• Előfordulás• Terhes, alkoholista
agynyomás fokozódás?Pylorus stenosis
• Epebaj, odavezető kacssyileusgyomor-bél vérzésnyelőcsővérzés
• Gastroenteritismeningitis, agynyomásepekő, vesekőglaukómás rohammérgezésterhességuraemiadiabeteses ketoacidózis
Hányások kezelése
Oki
Folyadék, elektrolit (Na, K) pótlás
Antihisztamin, dopamin antagonista (Torecan, Cerucal, Motilium, Coordinax)
The various configurations of the abdominal silhouette. In all silhouettes, X is te xiphoid process, U is the umbilicus, and P is the pubis. (A) The configuration of the abdomen is obesity or gaseous distension: the umbilicus is inverted. (B) The configuration in ascites: the umbilicus is everted. (C) The scaphoid (boat-shaped) configuration of slender people. (D) The configuration in the presence of a lower abdominal mass, a distended bladder for example. (E) The configuration in the presence of an upper abdominal mass, an enlarged liver, for example
A has megtekintése
The configuration of the flanks in obesity (A) contrasted with that in distenesion from ascites or gas (B).
Hallgatózás a has felett
The absence of bowel sounds for a full 5 minutes strongly suggests the existence of intestinal atony or ileus, which has many causes.