临床大学院土曜讲义

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1、#1A36-year-oldmanisevaluatedfora6-monthhistoryofintermittentnauseaandvomiting.臨床大学院土曜講義Vomitingoccursatleastonceeveryotherday,andhehaslostapproximately9kg(20lb)inthepast2months.Thepatienthasa20-yearhistoryoftype1diabetesmellitus,KeyPoints病態生理whichiscomplicatedbyproteinuria,nephropathy,andr

2、etinopathy.Healsohasmildhypertension.Hismedicationsareaspirin,insulin,andlisinopril.石橋賢一Onphysicalexamination,heappearsill.Temperatureis37.0°C(98.6°F),blood•Themostappropriateinitialtreatmentofchronicpressureis130/84mmHgwithoutorthostaticchanges,pulserateis70/min,andBMIis２－７－０９20.Mucousmem

3、branesaremoist,andabdominalexaminationisnormal.Thereisdiabeticgastroparesisisanoralprokineticagent.evidenceofmildneuropathyinthefeet,withreducedsensationduringthemonofilamenttest.•Metoclopramideiscurrentlytheonlyoral•Gastroenterology&HepatologyLaboratoryStudiesHemoglobin11.1g/dL(111g/L)Glu

4、cose(random)164mg/dL(9.1prokineticagentavailableintheUnitedStates.mmol/L)HemoglobinA7%Creatinine1.6mg/dL(122µmol/L)•Rheumatology1cUpperendoscopyafteranovernightfastshowsretainedfluidandparticulatematterin•AbellTL,BernsteinRK,CuttsT,etal.Treatmentthestomach.Thepylorusandduodenumarenormal.Ga

5、stricemptyingscintigraphy•HematologyandOncologyshowsamarkeddelayat4hours,withmorethan75%oftheradioisotopestillretainedofgastroparesis:amultidisciplinaryclinicalinthestomach(normalislessthan30%retention).review.NeurogastroenterolMotil.•NeurologyWhichofthefollowingisthemostappropriatetreatme

6、ntatthistime?2006;18(4):263-83.[PMID:16553582]•NephrologyAIntravenouserythromycinBOralmetoclopramideCTotalparenteralnutritionDVentinggastrostomywithplacementofajejunalfeedingtube123•Thispatienthaschronicdiabeticgastroparesisthatis•Dietarymodificationsoftensuggestedforpatientswithdiabetic#2

7、gastroparesisincludeincreasingtheliquidcontentofthemealA42-year-oldmanisevaluatedfora1-monthhistoryofpainlessabdominalswelling.Heprobablycausedbyautonomicneuropathyinvolvingbecauseliquidemptyingoftenispreserved;reducingtheintakeisotherwisehealthyandtakesnomedi