腹瀉

Diarrhea

腹瀉

Definition

說明

Diarrhea is not a disease but a symptom. It is commonly used to denote an increase in stool frequency or volume and an increase in the looseness of stool.

腹瀉不是病，它只是一種癥狀，通常是指排便次數(shù)或量的增加及大便變得更為稀松。

Clinical Manifestations

臨床表現(xiàn)

Diarrhea may be acute or chronic. Acute diarrhea most commonly results from infection. Bacterial or viral infection of the intestine may result in explosive watery diarrhea, tenesmus (spasmodic contraction of anal sphincter with pain and persistent desire to defecate), and abdominal cramping pain. Perianal skin excoriation may also develop. Acute diarrhea is often self-limiting with symptoms continuing until the irritant or causative agent is excreted.

腹瀉可以分為急性和慢性。急性腹瀉多數(shù)是由感染引起的。腸道被細菌或病毒感染，引起暴發(fā)性水瀉、里急后重（肛門括約肌痙攣性收縮伴疼痛，一直想要排便)及腹部絞痛。還可能出現(xiàn)肛周表皮脫落。急性腹瀉通常是自限性的，在刺激物或病原體清除后癥狀就可消失。

Systemic manifestations may include fever, nausea, vomiting, and malaise. Leukocytes, blood, and mucus may be present in the stool, depending on the causative agent.

全身生癥狀可能包括發(fā)燒、惡心、嘔吐、不適感等。大便可能含白細胞、血和粘液，這要視引起腹瀉的原因而定。

Diarrhea is considered chronic when it persists for at least 2 week or when it subsides and returns more than 2 to 4 weeks after the initial episode. Severe diarrhea may be debilitating and life-threatening.

慢性腹瀉是指腹瀉時間至少持續(xù)2周或者在消退后2至4周又再次發(fā)作。嚴重的腹瀉可以導(dǎo)致人體虛弱甚至威脅性命。

A patient may have severe dehydration (water and sodium loss) and electrolyte disturbances. Malabsorption and malnutrition are also sequelae of chronic diarrhea.

病人可能出現(xiàn)嚴重脫水（水和鈉丟失)和電解質(zhì)紊亂。慢性腹瀉后遺癥包括吸收不良和營養(yǎng)不良。

Diagnostic Studies

診斷檢查

Accurate diagnosis and management requires a thorough history, physical examination, and, when indicated, laboratory tests.

作出準(zhǔn)確診斷需要徹底了解病史、進行體格檢查，必要時進行實驗室化驗。

A history of travel, medication use, diet, previous surgery, interpersonal contacts, and family history should be obtained.

病史包括：旅游、用藥、飲食、既往手術(shù)、人際接觸及家族史等。

Blood tests may be performed to identify anemia, elevated white blood cell (WBC) count, iron and folate deficiencies, liver enzyme increases, and electrolyte disturbances.

可以進行血液檢查以確認貧血、白細胞增多、鐵和葉酸不足、肝酶增加和電解質(zhì)紊亂。

Stools may be examined for blood, mucus, WBCs, and parasites. Stool cultures may help in identifying infectious organisms.

化驗大便看有無血便、粘液、白血球、寄生蟲等。

In a patient with chronic diarrhea, measurement of stool electrolytes, pH, and osmolality may help to determine whether diarrhea is related to decreased fluid absorption or increased fluid secretion (secretory diarrhea).

慢性腹瀉病人測定糞便電解質(zhì)、pH值、溶質(zhì)度，這有助于確定腹瀉是否與液體吸收減少或液體分泌增加（分泌性腹瀉)有關(guān)。

Measurement of stool fat and undigested muscle fibers may be indicative of fat and protein malabsorption conditions, including pancreatic insufficiency. Elevated serum levels of GI peptides such as vasoactive intestinal polypeptide (VIP) and gastrin may be present with secretory diarrhea.

檢查糞便脂肪及未消化肌纖維可以提示脂肪和蛋白吸收不良，包括胰功能不全。胃腸肽血清值升高，如腸血管活性多肽和胃泌素，可以提示患者為分泌性腹瀉。

Endoscopy may be used to examine mucosa and to obtain specimens for examination.醫(yī)學(xué)全在線www.med126.com

內(nèi)鏡檢查可用以檢查粘膜，提取檢查標(biāo)本。

Upper and lower barium studies may be helpful in detecting mucosal disease.

上下鋇檢查有助于發(fā)現(xiàn)粘膜病。

Therapeutic Management

治療措施

The treatment of diarrhea is based on the cause and is aimed at replacement of fluid and electrolytes and decreasing the number, volume, and frequency of stools. Oral solutions containing glucose and electrolytes are often sufficient to replace losses due to mild diarrhea. In severe diarrhea, parenteral administration of fluids and electrolytes is warranted.

根據(jù)病因?qū)Ω篂a進行治療，并以補充液體和電解質(zhì)、減少排便數(shù)量、容量和次數(shù)為目的。口服含有葡萄糖和電解質(zhì)類溶液一般足以補充輕度腹瀉所造成的液體丟失。嚴重的腹瀉，非腸道補液、電解質(zhì)較有保障。

Once the cause has been ascertained, antidiarrheal agents may be given to coat and protect mucous membranes, inhibit GI motility, decrease intestinal secretions, and decrease central nervous system (CNS) input to the GI tract.

一旦查明病因，就可以給服止瀉藥，以保護粘膜，抑制腸道運動，減少腸道分泌素，減少中樞神經(jīng)系統(tǒng)對腸道的信號傳輸。

Antiperistaltic agents are not given to a patient who has infectious diarrheal syndromes because of the potential for prolonging exposure to the infectious agent. Antidiarrheal medications should not be given over a prolonged time.

感染性腹瀉綜合癥病人不宜服用抗蠕動藥物，因為這可能延長感染源的接觸時間。止瀉藥不宜長期服用。

Antibiotics are usually not indicated in the treatment of diarrhea because they can cause diarrhea by altering normal bowel flora.

治療腹瀉通常不需用抗生素，因為它會改變腸道正常菌叢，導(dǎo)致腹瀉。

Nursing Management of Acute Infectious Diarrhea.

急性傳染性腹瀉的護理

Goals

目標(biāo)

The patient with diarrhea will not transmit the microorganisms causing the infectious diarrhea, will cease having diarrhea and resume normal bowel patterns, will have normal nutritional intake, and will have no perianal skin breakdown.

腹瀉病人不會傳播致傳染性腹瀉細菌，腹瀉停止，恢復(fù)正常排便，恢復(fù)正常營養(yǎng)攝入，無肛周皮膚破裂。

Nursing Diagnoses

護理診斷

Diarrhea related to acute infectious process

腹瀉　與急性感染有關(guān)

Acute pain and abdominal cramping related to increased GI motility

急性痛和腹部痙攣　與腸道運動增加有關(guān)

Fluid volume deficit related to excessive fluid loss and decreased fluid intake secondary to vomiting or diarrhea

液體容量缺乏　與繼發(fā)于嘔吐或腹瀉的液體過量丟失和液體攝入減少有關(guān)

Impaired skin integrity of perianal area related to contact with diarrhreal stools and inadequate perianal hygiene

肛周皮膚完受損　與接觸腹瀉大便和肛周衛(wèi)生不足有關(guān)

Risk for infection transmission related to lack of knowledge in prevention of reinfection or transmission of infectious disease

感染傳播危險　與預(yù)防重復(fù)感染或傳染病傳播知識不足有關(guān)

Nursing Interventions

護理措施

Adherence to infection control precautions is important because some cases of acute diarrhea are infectious. All cases of acute diarrhea should be considered infectious until the cause is determined.

堅持傳染病預(yù)防措施很重要，因為有些急性腹瀉是傳染性的。在病因確實之前，所有急性腹瀉都應(yīng)認為是傳染性的。

Handwashing is the most important measure in prevention of the transfer of microorganisms. Hands should be washed before and after contact with each patient and when excretions of any kind are handled.

洗手是防止細菌傳播的最重要手段，接觸病人前后及處理分泌物后都應(yīng)洗手。

The patient should be taught the principles of hygiene, infection control precautions, and potential dangers of an illness that is infectious to themselves and others. Proper handling, cooking, and storage of food should be discussed with the patient suspected of having infectious diarrhea.

應(yīng)對病人進行衛(wèi)生、傳染控制預(yù)防和傳染病對自己及他人的危害性方面的教育，對疑有傳染性腹瀉的病人，應(yīng)向其進行食品操作、烹飪和儲存教育。

Patient Teaching

病人宣教

Teach the patient to be alert for recurrence of diarrhea, fever, and other symptoms and for evidence of the same symptoms in family members.

教育病人警惕腹瀉、發(fā)燒及其他癥狀的復(fù)發(fā)及家族成員出現(xiàn)相同癥狀跡象。

Assist the patient in identifying factors that precipitated diarrhea to avoid causing reinfection of self or transmission to others.

幫助病人辨別腹瀉致病因素，避免自身再次感染或傳染他人。

Explain the importance of seeking medical care when diarrhea and other symptoms begin so early treatment can be initiated.

說明腹瀉或其他癥狀開始時尋求治療的重要性，以便盡早開始治療。