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1、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DiarrheaDefinitionincreaseinthefrequencyofbowelmovementsincreaseinstoolliquidityinsomecasesincreaseindailystoolweight(>200g/d)Pathophysiologicalmechanismssecretorydiarrhea(increasedintestinalsecretion)OsmoticdiarrheaDecreasedintestinalsurfaceare
2、aand/orintestinalabsorptionInflammatarydiarrheaRapidtransitofintestinalcontents(shortenedtransittime)Pathophysiologicalmechanismssecretorydiarrhea(increasedintestinalsecretion)infections(choleratoxin,E-col,salmonella,staphylococcal)Hormonal(GutHormones,ZES,VIP),cancer(calciton
3、in,Prostaglandins)miscellaneous(laxativesabuse,villousadenomaoftherectum)agentsAdenylatecyclasecAMPsystemsecretorydiarrheaactivateNaClsecretorydiarrhoeainfectioncholerahormonalVerner-Morrisonsyndrome(VIPassociated)carcinoidsyndromegastrinomamedullarythyroidcancerphenolphthale
4、inabusebilesaltmalabsorptionCholera:thesimplifiedversionVerner-Morrisonsyndrome(VIPassociated)aprofuse,waterydiarrhoeathatresultsinmassiveintestinallossofwater,potassium,sodiumandbicarbonate,leadingtohypovolaemia,hypokalaemiaandreducedtotalbodypotassium,andachlorhydria(metabol
5、icacidosis).carcinoidsyndromeparoxysmalflushing-forexample,followingcoffee,alcohol,certainfoodsanddrugsbronchoconstrictiveepisodes,similartoasthmaright-sidedheartfailureepisodesofexplosivewaterydiarrhoeaabdominalpainpellagra-likelesionsoftheskinandoralmucosagastrinomaTheZollin
6、ger-Ellisonsyndromedescribestheassociationof:gastrin-producingtumoursgastrichypersecretionseverepepticulcerdiseasegastrinomahighfastingplasmagastrinhighgastricacidsecretiondiminishedresponsetopentagastrindemonstrablepancreaticorgastrointestinaltumour-byCTorvenoussamplingforgas
7、trinmorethan90%ofgastrinomashavesomatostatinreceptors,andsomatostatinreceptorscintigraphyhasbeenreportedtobeaespeciallysensitivemethodtoimagegastrinomasPathophysiologicalmechanismsOsmoticdiarrheaItcausedbyaccumulationofthefollowingsinthegutlumenwatersaltspoorlyabsorblesolutesm
8、aldigestionofingestedfoodfailuretotransportanosmoticallyactiv
