物诊常见症状腹泻黄疸意识障碍ppt课件.ppt

腹泻(Diarrhea)定义Definition分类Classify急性腹泻的病因Etiologyofacutediarrhea慢性腹泻的病因（1）Etiologyofchronicdiarrhea(1)慢性腹泻的病因（2）发病机制
Mechanism1分泌性腹泻1Secretorydiarrhea2渗出性腹泻3渗透性腹泻3Osmoticdiarrhea4动力性腹泻4Dynamicdiarrhea5吸收不良性腹泻5Malabsorptiondiarrhea临床表现Clinicalmanifestation临床表现临床表现伴随症状Accompaniedsymptom伴随症状问诊要点黄疸
(Jaundice)定义Definition23胆红素的正常代谢（1）胆红素的正常代谢（2）胆红素的正常代谢分类Classification病因、发生机制和临床表现
Etiology,pathogenesisandclinicaloccurrence溶血性黄疸HemolyticJuandice常见疾病溶血性黄疸代谢图溶血性黄疸HemolyticJuandice溶血性黄疸HemolyticJuandice肝细胞性黄疸HepatocellularJuandice肝细胞性黄疸代谢图肝细胞性黄疸常见疾病肝细胞性黄疸HepatocellularJuandice肝细胞性黄疸HepatocellularJuandice胆汁淤积性黄疸CholestasisJuandice胆汁淤积性黄疸代谢图胆汁淤积性黄疸CholestasisJuandice胆汁淤积性黄疸CholestasisJuandice胆汁淤积性黄疸CholestasisJuandice三种黄疸实验室检查的区别先天性非溶血性黄疸CongenitalUnhemolyticJuandiceInherentJaundiceGilbert综合征：
病因：
肝细胞摄取UCB障碍
葡萄糖醛酸转移酶不足
肝细胞摄取UCB障碍
UCB转化成CB障碍

血中UCB升高
肝活组织检查无异常Dubin-Johnson综合征
病因：
肝细胞排泄CB障碍

CB向毛细胆管排泄障碍

血中CB增高
肝脏外观呈绿黑色，活检见肝细胞内有特异的棕褐色素颗粒Crigler-Najjar综合征
病因：
葡萄糖醛酸转移酶缺乏

肝细胞不能将UCB转化成CB

血中UCB明显升高

核黄疸的产生Roter综合征辅助检查53辅助检查黄疸伴随症状小结意识障碍Disturbanceofconsciousness定义Definition病因Etiology病因Etiology发生机制Consciousnessreferstoasetofneuralprocessesthatallowanindividualtoperceive,comprehend,andactontheinternalandexternalenvironments.Itconsistsoftwocomponents:awarenessandarousal.
Awarenessreferstothehigher-levelintegrationofmultiplesensoryinputsthatpermitmeaningfulunderstandingselfandenvironment,residinginthecerebralcortex.
Arousalreferstoan“on-offswitch”forthecorticalawarenesssystembyascendingreticularactivatingsystem(ARAS),residinginthebrainstem.
Anyinjuriesinvolvingbothbilateraldiffusecerebralcortexand/orbrainstemcancausedisturbanceofconsciousness.临床表现Clinicalmanifestation临床表现Clinicalmanifestation4昏迷coma：严重的意识障碍，意识持续的中断或完全丧失It’stheseriousdisturbancesofconsciousness,consciousnessretainsinterruptedorevenlosescompletely.
(1)轻度昏迷mildcoma：无自主活动，对声光刺激无反应，对疼痛刺激有痛苦表情或肢体退缩等防御性反应；生理反射可存在。It’snospontaneousactivity,noresponsetothesound-opticstimulation,havingthedefensiveresponses(painfulexpressionorwith