Differential Diagnosis of Acute Diarrhea

Acute diarrhea is a condition of increased water stool content, stool volume, and number of bowel movements that lasts less than 14 days. Mild diarrhea is usually self-limiting; however, undertreated moderate to severe diarrhea may cause severe dehydration and lead to hypovolemic shock. In order to prevent severe dehydration and treat patients appropriately, it is crucial for health care providers to determine the right diagnosis of patients with acute diarrhea. This article focuses on pathophysiology, general patient presentation, diagnostic tests and differential diagnosis lists of acute diarrhea to discuss which diagnosis should be made based on patient presentation and objective data.     

李东垣论治泄泻理论探讨

李东垣的升脾阳法对于泄泻的治疗具有重要价值。泄泻的基本病机是脾虚湿盛，脾虚为病机之核心，或兼肺虚，或兼湿盛，或兼寒积，脾虚则清阳不升，正所谓"清气在下，则生飧泄"。治疗以补脾健脾为本，根据不同的病机或补益脾肺，或燥湿健脾，或攻逐寒积，或健脾升阳。     

邱健主任从心小肠藏象系统论治腹泻型肠易激综合征的临床经验

邱健主任医师从事中医临床35年,临床治疗腹泻型肠易激综合征(IBS-D)有独到的见解,认为IBS-D的病因为先天禀赋不足和(或)后天失养、情志失调、饮食不节、感受外邪等,其发病关键在于心小肠藏象系统功能紊乱,心阳不足,不能温煦小肠,小肠泌别清浊失司而发为泄泻,以“桂枝荔芝汤”为基础方论治此病临床效果显著。     

Cytomegalovirus enteritis with intractable diarrhea in infants from a tertiary care center in China

Abstract

Background: Cytomegalovirus (CMV) is rarely thought to be the cause of significant gastrointestinal infection in immunocompetent children. CMV colitis is seldom observed in young infants. This study aims to examine the clinical features of CMV colitis in Chinese children.

Methods: Patients with infantile onset CMV colitis diagnosed in intestinal tissue at Children’s Hospital of Fudan University from 1st January 2017, to 31st January 2019 were enrolled. Clinical data were retrieved from medical records, and the literature on infant CMV colitis was also reviewed.

Results: Ten patients were included with a median age of 2.5?months [interquartile range 2.0, 6.3?months]. All 10 patients had diarrhea, 10 patients had anemia, seven patients reported hematochezia, five patients had hypoalbuminemia, five patients had retinitis, two patients had hearing impairment, and one patient had perianal abscess and anal fistula. The patients had punched-out ulcerations, longitudinal ulcerations or irregular ulcerations on the rectum and/or colon. Typical histologic evaluation showed crypt distortion and inflammatory infiltration. CMV inclusion bodies were noted in four patients. Immunohistochemistry on intestinal tissue was performed to diagnose CMV, with all patients positive. After follow-up, all patients are clinically recovered or in remission; six patients received antiviral therapy, and five patients had healed ulcers on endoscopic examination.

Conclusions: CMV colitis might be a rare cause of intractable diarrhea in immunocompetent children. Clinicians should be aware of the possibility of CMV colitis in patients with intractable diarrhea.     

基于数据挖掘探讨葛琳仪治疗慢性泄泻用药规律

目的:研究国医大师葛琳仪治疗慢性泄泻的用药规律,总结其相关学术思想。方法:利用Excel收集整理葛琳仪治疗慢性泄泻的处方数据,采用SPSS Clementine12.0进行关联分析,Apriori算法建立数据挖掘模型,用SPSS20.0对数据进行描述性分析及聚类分析。结果:共筛选出329个处方,包含216味中药,用药频次总计5 299次,使用频率较高的药物是陈皮、广木香、枳壳、生白芍、厚朴等,主要为理气药、补虚药、清热药、化湿药、消食药等,挖掘出药对或药物组合8组。结论:葛琳仪治疗慢性泄泻有立足脾胃,调畅气机;培补正气,标本同治;用药轻灵,思辨加减的特点,值得医者学习并传承。     

Changes in urinary titin N-terminal fragments as a biomarker of exercise-induced muscle damage in the repeated bout effect

ObjectivesMuscle damage symptoms induced by unaccustomed eccentric contraction exercise can be reduced by repeating the experience several times. This phenomenon is termed the repeated bout effect. Although traditional biochemical markers require invasive blood sampling, biochemical measurements have recently been developed that can be non-invasively performed using urinary titin N-terminal fragment (UTF). However, it is unclear whether UTF can reflect the repeated bout effect. Therefore, the aim of the present study was to clarify whether UTF decreased with the repeated bout effect.DesignThis study compared changes in muscle damage markers between bouts of exercise performed for the first and second time.MethodsEight young men performed 30 eccentric exercises of the elbow flexor on the first day of the first week (Bout 1). A second bout of eccentric exercises, same as the first, was performed 2 weeks later, (Bout 2). The dependent variables were muscle soreness (SOR), maximal voluntary isometric contraction (MVIC), range of motion (ROM), creatine kinase (CK), and UTF. All dependent variables were analyzed using two-way analysis of variance.ResultsNo significant difference was observed in workload or peak torque between the first and second exercise bouts. SOR as well as CK and UTF were significantly lower and ROM and MVIC were significantly higher in Bout 2 in comparison to Bout 1.ConclusionsThese results suggest that UTF sensitively reflects the repeated bout effect and exercise-induced muscle damage can be non-invasively measured.     

痛泻要方热奄包治疗脾虚湿困型小儿腹泻患儿的临床效果和价值体会

目的:探讨脾虚湿困型小儿腹泻患儿采用痛泻要方热奄包治疗的临床效果。方法:将2018年3月-2019年3月平度市中医医院收治的88例脾虚湿困型小儿腹泻患儿作为研究样本,遵从随机化原则分成参照组和研究组,参照组(44例)采用常规西医治疗,研究组(44例)采用痛泻要方热奄包治疗。比较两组治疗效果、中医症状积分和不良反应发生率。结果:治疗后,研究组总疗效高于参照组,中医症状积分小于参照组,有明显统计学意义(P <0.05);两组均未出现明显不良反应。结论:痛泻要方热奄包用于脾虚湿困型小儿腹泻患儿临床治疗中效果理想,安全可靠,建议大力推广。     

儿童慢性腹泻高营养风险情况及对预后的影响

目的 探讨儿童慢性腹泻高营养风险情况及对预后的影响。方法 选择2019年1～12月在我院诊断治疗的慢性腹泻患儿100例为研究对象,进行营养风险筛查,分析高营养风险患儿与非高营养风险患儿临床特征以及预后情况,分析性别、年龄、病因对慢性腹泻患儿高营养风险的影响。结果 (1)100例患儿24例患儿STAMP评分≥4分,为高营养风险组,占24.0%。(2)7～14岁患儿高营养风险发生率显著高于其他年龄段患儿(P0.05);炎症性肠病患儿高营养风险发生率显著其他病因的患儿(P0.05)。(3)炎症性肠病是慢性腹泻患儿发生高营养风险的独立危险因素(P0.05)。(4)高营养风险组白蛋白、前白蛋白水平显著低于非高营养风险组,差异有统计学意义(P0.05)。两组Hb水平比较差异无统计学意义(P0.05)。(5)非高营养风险组痊愈率显著高于高营养风险组,医院感染率显著低于高营养风险组,住院时间显著短于高营养风险组,差异均有统计学意义(P0.05)。结论 儿童慢性腹泻高营养风险发生率相对较高,病因会影响患儿高营养风险的发生,而高营养风险影响患儿的预后,延长住院时间。