药妆行业“十二五”规划调研与发展。。

交通大学医学院附属仁济医院消化科上海市消化疾病研究所范竹萍广州网站建设•increaseinthefrequencyofbowelmovements•increaseinstoolliquidity•insomecasesincreaseindailystoolweight(200g/d)Pathophysiologicalmechanisms•secretorydiarrhea(increasedintestinalsecretion)•Osmoticdiarrhea•Decreasedintestinalsurfaceareaand/orintestinalabsorption•Inflammatarydiarrhea•Rapidtransitofintestinalcontents(shortenedtransittime)Pathophysiologicalmechanismssecretorydiarrhea(increasedintestinalsecretion)infections(choleratoxin,E-col,salmonella,staphylococcal)Hormonal(GutHormones,ZES,VIP),cancer(calcitonin,Prostaglandins)miscellaneous(laxativesabuse,villousadenomaoftherectum)agentsAdenylatecyclasecAMPsystemsecretorydiarrheaactivateNaClsecretorydiarrhoeainfectioncholerahormonalVerner-Morrisonsyndrome(VIPassociated)carcinoidsyndromegastrinomamedullarythyroidcancerphenolphthaleinabusebilesaltmalabsorptionCholera:thesimplifiedversionVerner-Morrisonsyndrome(VIPassociated)•aprofuse,waterydiarrhoeathatresultsinmassiveintestinallossofwater,potassium,sodiumandbicarbonate,leadingtohypovolaemia,hypokalaemiaandreducedtotalbodypotassium,andachlorhydria(metabolicacidosis).carcinoidsyndrome•paroxysmalflushing-forexample,followingcoffee,alcohol,certainfoodsanddrugs•bronchoconstrictiveepisodes,similartoasthma•right-sidedheartfailure•episodesofexplosivewaterydiarrhoea•abdominalpain•pellagra-likelesionsoftheskinandoralmucosagastrinomaTheZollinger-Ellisonsyndromedescribestheassociationof:•gastrin-producingtumours•gastrichypersecretion•severepepticulcerdiseasegastrinoma•highfastingplasmagastrin•highgastricacidsecretion•diminishedresponsetopentagastrin•demonstrablepancreaticorgastrointestinaltumour-byCTorvenoussamplingforgastrin•morethan90%ofgastrinomashavesomatostatinreceptors,andsomatostatinreceptorscintigraphyhasbeenreportedtobeaespeciallysensitivemethodtoimagegastrinomasPathophysiologicalmechanismsOsmoticdiarrheaItcausedbyaccumulationofthefollowingsinthegutlumenwatersaltspoorlyabsorblesolutesmaldigestionofingestedfoodfailuretotransportanosmoticallyactivedietarynonelectrolyte(E:glucose)intestinalLumenbeingosmoticallyactivediarrheaosmoticdiarrhoea•disaccharidasedeficiencyprimarilylactasedeficiency•laxativeabuse(about20%ofpatientsCausesofdiarrheainenteralnutritionCalculationofosmoticgapPathophysiologicalmechanismsDecreasedintestinalsurfaceareaand/orintestinalabsorptionE:surgicalremoval;malabsorptionsyndromePathophysiologicalmechanismsRapidtransitofintestinalcontents(shortenedtransittime)E:irritablebowelsyndrome[Functionaldiarrhea]laxativesabusepostvagotomydiarrheapostgastrectomydumbingsyndromestoolvolumeliquiditycontacttimeincreasesmallbowelmucosacontentsincreaseinintestinalmotility(intestinalhurry)reduceEtiologyAcuteDiarrheainfection•FoodpoisoningSystematicdiseases(influenza,sepsis,etc)MiscellanousEtiologyAcuteDiarrheainfection1.viral2.bacterialcampylobacteriaShigellaE.ColiSalmoneilaetc3.fungal4.parasitic(amebicTrophozoites,Giardia)AcuteDiarrheaFoodpoisoningbacterial,plants,chemicalpoison(arsenic,...)Systematicdiseases(influenza,sepsis,measle,etc)MiscellanousAllergicdiseasesAllergicpurpura,enteropathy..endocronicdiseases(ZES,etc.)Drugs:laxatives,5-Fu,etc.foodpoisoning•bacterial•intrinsicallypoisonousfood,forexampledeadlynightshade,redkidneybeans•parasitesinthemeat,forexampleTaenia,Trichinella•chemicalsheavymetals,e.g.mercury,zincpesticides,e.g.rodenticides,insecticides•allergies•paralyticshellfishpoisoning•scombrotoxinhistamineintoxication•viralfoodpoisonining•chineserestaurantsyndrome-monosodiumglutamatechineserestaurantsyndrome•Excessingestionofmonosodiumglutamateresultsinasyndromethatincludesaburningsensationovertheneck,chestandarms,withtightnessoverthefaceandchest.Theremayalsobeheadache,flushing,weakness,nauseaandabdominalcramps.EtiologyChronicDiarrheaIntestinalGastric(chronicgastritis,subtotalgastrectomy,etc.)Pancreatic(ChronicPancreatitis,PancreaticCancer,etc.)Hepatobiliary(livercirrhosis,obstructivejaundice)functionalcausesEndocronic(Hyperthyroidscrisis,ZES,Carcinoids)Drugs(Reserpin,Ismelin,Laxatives,etc.)Others(uremia,hypogammaglobulemia,etc.)ChronicDiarrheaIntestinalinfections(T.B.,Chronicbacteriadysentery,etc.)parasitics(Amebiadysentery,Giardiasis,etc.)IBD(ulcerativecolitis,Chron’s,etc.)malabsorptionsynd.(lactasedeficiency,etc.)tumorsEndoscopicimage:infectiouscolitisin7-year-oldgirllowersmallboweldisease•Crohn'sdisease•tuberculosis•YersiniaenterocoliticaComplicationsoflowersmallboweldiseasecausingdiarrhoeainclude:•B12deficiency•bileacidwastinguppersmallboweldisease•coeliacdisease•Giardiasis•Whipple'sdisease•Theremaybesteatorrhoeaorawaterystool.Othercomplicationsinclude:•irondeficiency•folatedeficiency•calciumdeficiencylargeintestinecauses•dysentery•worms•inflammatoryboweldisease•coloniccarcinoma•irritablebowelsyndrome•faecalimpactionwithoverflow•radiationenteritis•diverticulardisease•mesentericischaemiagastriccauses•postgastrectomy•postvagotomy•gastrocolicfistulapancreaticcauses•cysticfibrosis•chronicpancreatitis•pancreaticcarcin