慢性腹泻的诊断和处理

病程在4周以上的腹泻定义为慢性腹泻.根据粪便性状特征,即水样、炎症性或脂肪性,作为诊断思路是一种实用和广泛应用的方法.本文阐述了根据粪便性状特征追踪慢性腹泻病因的决策,并对不明原因慢性腹泻的诊断和处理也进行了讨论.

Digestive manifestations of parathyroid disorders

The parathyroid glands are the main regulator of plasma calcium and have a direct influence on the digestive tract.Parathyroid disturbances often result in unknown long-standing symptoms.The main manifestation of hypoparathyroidism is steatorrhea due to a deficit in exocrine pancreas secretion.The association with celiac sprue may contribute to malabsorption.Hyperparathyroidism causes smooth-muscle atony,with upper and lower gastrointestinal symptoms such as nausea,heartburn and constipation.Hyperparathyroidism and peptic ulcer were strongly linked before the advent of proton pump inhibitors.Nowadays,this association remains likely only in the particular context of multiple endocrine neoplasia type 1/Zollinger-Ellison syndrome.In contrast to chronic pancreatitis,acute pancreatitis due to primary hyperparathyroidism is one of the most studied topics.The causative effect of high calcium level is confirmed and the distinction from secondary hyperparathyroidism is mandatory.The digestive manifestations of parathyroid malfunction are often overlooked and serum calcium level must be included in the routine workup for abdominal symptoms.

Diarrhea after bariatric procedures:Diagnosis and therapy

Diarrhea after bariatric procedures, mainly those with malabsorptive elements including Roux-Y Gastric Bypass and Biliopancreatic Diversion, is common and an essential determinant of quality of life and microand macronutrient deficiencies. Bariatric surgery is the only sustainably successful method to address morbid obesity and its comorbidities, particularly gaining more and more importance in the specific treatment of diabetic patients. Approximately half a million procedures are annually performed around the world, with numbers expected to rise drastically in the near future. A multitude of factors exert their influence on bowel habits; preoperative comorbidities and procedure-related aspects are intertwined with postoperative nutritional habits. Diagnosis may be challenging owing to the characteristics of postbariatric surgery anatomy with hindered accessibility of excluded segments of the small bowel and restriction at the gastric level. Conventional testing measures, if available, generally yield low accuracy and are usually not validated in this specific population. Limited trials of empiric treatment are a practical alternative and oftentimes an indispensable part of the diagnostic process. This review provides an overview of causes for chronic post-bariatric surgery diarrhea and details the particularities of its diagnosis and treatment in this specific patient population. Topics of current interest such as the impact of gut microbiota and the influence of bile acids on morbid obesity and especially their role in diarrhea are highlighted in order to provide a better understanding of the specific problems and chances of future treatment in post-bariatric surgery patients.

临床药师参与1例继发性糖尿病患者治疗过程的总结与体会

目的探讨临床药师在合理用药中的作用。方法临床药师深入临床,参与1例继发性糖尿病患者的治疗过程、药学服务与监护。结果临床药师对患者治疗方案进行药学监护,提供药学服务,提高了患者的治疗依从性和临床治疗效果,减少了药物的不良反应。结论临床药师深入临床,开展药学监护和指导,作为医师的助手,有助于形成"医药护"的整体治疗团队,在临床合理用药中发挥举足轻重的作用。

面部脂溢性疾病的综合治疗

目的总结面部脂溢性疾病的综合治疗方法及疗效。方法以硫酸锌溶液喷雾面部后,清除脓液及脂拴,再以0.5%甲硝唑溶液行超声波导入,之后以痤疮霜加冷模粉倒模。结果一个疗程治愈率达80%,总有效率93%。结论脂溢性疾病的综合治疗方法及疗效,较我们以往采用的治疗方法明显缩短了治愈时间,提高了治愈率,是一个较好的治疗方法。

自体毛发移植治疗脂溢性脱发60例

目的探讨使用自体毛发移植治疗脂溢性脱发的临床效果。方法对60例脂溢性脱发患者运用自体毛发移植术进行修复,其中23例进行1次移植,37例进行2次加密。结果60例患者术后随访6～24个月,外观较术前明显改善,无并发症。结论应用自体毛发移植术治疗脂溢性脱发,移植术后毛发存活率高,外观自然,因脱发区面积的大小及供发区密度的不同,移植后头发的密度不同。

Optimizing management of patients with pancreatic exocrine insufficiency

Pancreatic exocrine insufficiency(PEI)is related to decreased pancreatic enzyme availability and/or activity(1).Multiples underlying mechanisms can cause PEI,such as loss of functioning parenchyma(chronic pancreatitis,pancreatic resections,pancreatic cancer...),decreased secretion despite intact parenchyma(obstruction of the pancreatic duct,decreased endogenous stimulation,intraduodenal inactivation of pancreatic secretions),and asynchrony(gastric resections,Roux-en-Y gastric by-pass)(1).

慢性胰腺炎脂肪泻及其危险因素分析

目的探讨慢性胰腺炎（CP）患者脂肪泻发生情况及其危险因素。方法收集2000年1月至2008年12月在上海长海医院消化内科住院治疗的CP患者资料，用Kaplan-Meier法计算脂肪泻累积发生率，脂肪泻危险因素采用单因素分析及Cox比例风险模型逐步回归分析。结果591例CP患者随访率为85.62%，平均随访时间（10.6±6.3）年。发生脂肪泻152例（25.72%），男女比例为3.61∶1，病因以特发性慢性胰腺炎（ICP）为主，有120例（78.95%）。CP确诊后1、5、10年的脂肪泻累积发生率为20%、26%、29%，男女性别的差异无统计学意义（P＝0.143）。通过单因素分析筛选出发病年龄、确诊年龄、性别、酗酒、吸烟、遗传因素、胆管狭窄、胰腺假性囊肿、腹痛9个变量纳入Cox比例风险模型分析，其中发病年龄（RR＝1.055，P＝0.035）、胆管狭窄（RR＝1.943，P＝0.041）和腹痛（RR＝0.419，P＝0.006）为CP患者脂肪泻的独立危险因素。结论超过四分之一的CP患者在病程中发生脂肪泻，发病年龄大、胆管狭窄、腹痛为发生脂肪泻的独立危险因素。

胰腺外分泌功能不全诊治规范(2018,广州)

胰腺外分泌功能不全(pancreatic exocrine insufficiency,PEI)是指由于各种原因引起的胰酶分泌不足或胰酶分泌不同步,而导致患者出现营养消化吸收不良等症状[1]。中国医师协会胰腺病专业委员会慢性胰腺炎专委会牵头内科、外科、病理、影像等多学科专家,参照最新循证医学证据和多部国际权威指南,对2012年版《中国胰腺外分泌功能不全诊治规范(草案)》进行了修订,供临床诊疗参考。

玉女煎加减治疗面部脂溢性皮炎

脂溢性皮炎（SD），系发生于头面及胸背等皮脂溢出部位的一种慢性炎症性皮肤病，多发生于青壮年。本病运用玉女煎治疗临床报道较少，笔者跟从黄蜀教授学习过程中，常予以玉女煎加减治疗该病取得较好的疗效。