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Deepak Atri ... 肿瘤 • 2018.01.04

本刊的这一栏目中,某真实患者的信息按阶段(粗体)呈现给一名临床专家,后者对这些信息做出回应并和读者分享其推理(普通字体)。作者随后做出评论。

 

一名70岁男性因腹泻3个月到急诊科就诊。腹泻的性质为半成便和液状便但从无血液或液。大多数时候,他在1218小时内每小时都会排便,但是能够安睡整不排便。腹泻伴随恶心、非血性呕吐和体重减轻5.9 kg(13 lb)。他自诉没有发热和出汗。腹泻发生3周,他间歇性发作持续数小时的重度无放射上腹痛。

慢性腹泻(定义为持续4周以上的稀便)可能由感染、非感染性炎症、吸收不良或功能障碍引起。粪便硬度可以提示腹泻的机制和原因。炎性肠病经常表现为血便和发热等全身症状。乳糜泻等吸收不良综合征可能引起脂肪泻。水样腹泻可由渗透(例如未消化的二糖)或分泌(例如镜下结肠炎)性机制引起。间歇性上腹痛可以反映消化性溃疡病、胃炎、胃食管反流病(GERD)或功能性消化不良,但这些病症均不会导致腹泻。在该病例中腹痛的持续时间显示患者不太可能是急性、危及生命的病程,例如穿孔、阻塞或缺血。





作者信息

Deepak Atri, M.D., David Furfaro, M.D., Gurpreet Dhaliwal, M.D., Kenneth R. Feingold, M.D., and Reza Manesh, M.D.
From the Department of Medicine, Johns Hopkins Hospital and Johns Hopkins University School of Medicine, Baltimore (D.A., D.F., R.M.); and the Department of Medicine, University of California, San Francisco, and the Medical Service, San Francisco Veterans Affairs Medical Center — both in San Francisco (G.D., K.R.F.). Address reprint requests to Dr. Manesh at the Division of General Internal Medicine, Johns Hopkins Hospital, 600 N. Wolfe St., Meyer 8-34D, Baltimore, MD 21287, or at rsedigh1@jhmi.edu.

 

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