恶心呕吐临床诊断学

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1、健康快乐每一天！临床诊断学上海第二医科大学仁济临床医学院NauseaandVomitingAsthesymptoms症状学：恶心与呕吐GoalsBrieflydefineOutlinetheprominentdiseasestatesassociatedwithnauseaandvomiting.CharacterizeNauseaandVomitingcausedbytheprominentdisordersDiscriminatetheaccompanyingsymptoms.Suggestdiagnosticstrat

2、egiesofthesymptoms.DefinitionofNauseaandVomitingNausea：theinclinationorfeelingofimminentdesiretovomit,usuallyfeltinthethroatorepi-gastrum.Associatedwithdecreasedactivityofthestomach.Vomiting：theforcefuloralexpulsionofgastriccontentsviaretro-peristalsis.Nausea-Vomit

3、ing:simultaneityorseparateness恶心：紧迫欲吐，通常伴有上腹不适和迷走兴奋的临床征候群。呕吐：胃和/或小肠内容物经食管和口腔排除体外恶心和呕吐常伴随存在，也可单独出现！NauseaandVomiting1、恶心：咽部及上腹部不适，胃张力和蠕动减弱，幽门和贲门开放。2、干呕：胃窦部和腹壁肌肉收缩，腹压增加，食管及咽部开放。3、呕吐：胃和/或小肠内容物经食管和口腔排除体外。Definitionofemesis.(Threephases)呕吐反射过程（三个阶段）1.Nausea-theinclinati

4、onorfeelingofimminentdesiretovomit,usuallyfeltinthethroatorepigastrum.Associatedwithdecreasedactivityofthestomach.2.Retching-thelaboredrhythmiccontractionofrespiratoryandabdominalmusculaturethatfrequentlyprecedesoraccompaniesvomiting.3.Vomiting-theforcefuloralexpul

5、sionofgastriccontentsviaretroperistalsis.(Abdominaleffects).迷走兴奋表现恶心干呕呕吐发生机制呕吐区别于反食呕吐：多数情况有恶心的感觉和呕吐反射的协调动作。反食：无恶心的感觉和呕吐反射的协调动作。（儿童、饱餐）MechanismsofemesisCTZ&EmeticCenter(Vomitingcenter)CTZ化学感受器触发带（第四脑室底面）：外源性或内源性化学物质（阿片吗啡、洋地黄、代谢产物）EmeticCenter（延髓外侧网状结构背测）接受大脑皮质、消化器官

6、、心血管以及化学感受器触发带（CTZ）的冲动CTZ&EmeticCenter(Vomitingcenter)孤束核EmeticCenter内脏传入中脑ICP受体化学感受器触发带边缘系统前庭系统呕吐中枢（Vomitingcenter)ICP=InductivelyCoupledPlasma感应耦合等离子体NeurotransmittersinCTZ&EmeticCenterNeurotransmittersinvolvedinstimulatingtheemeticcenter,chemo-receptortriggerzon

7、eandGItractinclude;5-HT,acetylcholine,histamine,dopamine(opiatesandreceptorsforbenzodiazepinesarealsofoundhere)EmeticCenter1、分泌唾液中枢2、血管收缩中枢3、呼吸中枢4、中枢神经脊神经膈神经迷走神经nauseaandvomiting1.Reflectivevomiting反射性呕吐2.Centralvomiting中枢性呕吐3.Neurologicalvomiting神经性呕吐Reflectivevom

8、iting（反射性呕吐）咽部刺激胃十二指肠疾病胆道疾病肠道疾病肝胆疾病腹膜肠系膜全身性疾病（五官、心血管、泌尿、盆腔…）PharyngealMechanismsGastrointestinalMechanismsDiseaseofbiliarytractPeritonealandmesen