恶心呕吐- 课件.ppt

文档介绍：临床诊断学
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Nausea and Vomiting
As the symptoms
症状学：恶心与呕吐
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Goals
Briefly define
Outline the prominent disease states associated with nausea and vomiting.
Characterize Nausea and Vomiting caused by the prominent disorders
Discriminate the accompanying symptoms.
Suggest diagnostic strategies of the symptoms.
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Definition of Nausea and Vomiting
Nausea ：the inclination or feeling of imminent desire to vomit, usually felt in the throat or epi-gastrum. Associated with decreased activity of the stomach.
Vomiting： the forceful oral expulsion of gastric contents via retro-peristalsis.
Nausea-Vomiting: simultaneity or separateness
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！
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Nausea and Vomiting
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1、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。
Definition of emesis. (Three phases)
呕吐反射过程（三个阶段）
1. Nausea - the inclination or feeling of imminent desire to vomit, usually felt in the throat or epigastrum. Associated with decreased activity of the stomach.
2. Retching - the labored rhythmic contraction of respiratory and abdominal musculature that frequently precedes or accompanies vomiting.
3. Vomiting - the forceful oral expulsion of gastric contents via retroperistalsis. (Abdominal effects).
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迷走兴奋表现
恶心
干呕
呕吐
发生机制
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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）
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Mechanisms of emesis
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CTZ & Emetic Center (Vomiting center)
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）
Emetic Center（延髓外侧网状结构背测）接受大脑皮质、消化器官、心血管以及化学感受器触发带（CTZ）的冲动
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