Diarrhea

腹泻

Definition

说明

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.

腹泻不是病，它只是一种症状，通常是指排便次数或量的增加及大便变得更为稀松。

Clinical Manifestations

临床表现

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.

腹泻可以分为急性和慢性。急性腹泻多数是由感染引起的。肠道被细菌或病毒感染，引起暴发性水泻、里急后重（肛门括约肌痉挛性收缩伴疼痛，一直想要排便)及腹部绞痛。还可能出现肛周表皮脱落。急性腹泻通常是自限性的，在刺激物或病原体清除后症状就可消失。

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

全身生症状可能包括发烧、恶心、呕吐、不适感等。大便可能含白细胞、血和粘液，这要视引起腹泻的原因而定。

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.

慢性腹泻是指腹泻时间至少持续2周或者在消退后2至4周又再次发作。严重的腹泻可以导致人体虚弱甚至威胁性命。

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

病人可能出现严重脱水（水和钠丢失)和电解质紊乱。慢性腹泻后遗症包括吸收不良和营养不良。

Diagnostic Studies

诊断检查

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

作出准确诊断需要彻底了解病史、进行体格检查，必要时进行实验室化验。

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

病史包括：旅游、用药、饮食、既往手术、人际接触及家族史等。

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

可以进行血液检查以确认贫血、白细胞增多、铁和叶酸不足、肝酶增加和电解质紊乱。

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

化验大便看有无血便、粘液、白血球、寄生虫等。

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).

慢性腹泻病人测定粪便电解质、pH值、溶质度，这有助于确定腹泻是否与液体吸收减少或液体分泌增加（分泌性腹泻)有关。

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.

检查粪便脂肪及未消化肌纤维可以提示脂肪和蛋白吸收不良，包括胰功能不全。胃肠肽血清值升高，如肠血管活性多肽和胃泌素，可以提示患者为分泌性腹泻。

Endoscopy may be used to examine mucosa and to obtain specimens for examination.医学全在线www.med126.com

内镜检查可用以检查粘膜，提取检查标本。

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

上下钡检查有助于发现粘膜病。

Therapeutic Management

治疗措施

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.

根据病因对腹泻进行治疗，并以补充液体和电解质、减少排便数量、容量和次数为目的。口服含有葡萄糖和电解质类溶液一般足以补充轻度腹泻所造成的液体丢失。严重的腹泻，非肠道补液、电解质较有保障。

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，就可以给服止泻药，以保护粘膜，抑制肠道运动，减少肠道分泌素，减少中枢神经系统对肠道的信号传输。

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.

感染性腹泻综合症病人不宜服用抗蠕动药物，因为这可能延长感染源的接触时间。止泻药不宜长期服用。

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

治疗腹泻通常不需用抗生素，因为它会改变肠道正常菌丛，导致腹泻。

Nursing Management of Acute Infectious Diarrhea.

急性传染性腹泻的护理

Goals

目标

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.

腹泻病人不会传播致传染性腹泻细菌，腹泻停止，恢复正常排便，恢复正常营养摄入，无肛周皮肤破裂。

Nursing Diagnoses

护理诊断

Diarrhea related to acute infectious process

腹泻　与急性感染有关

Acute pain and abdominal cramping related to increased GI motility

急性痛和腹部痉挛　与肠道运动增加有关

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

液体容量缺乏　与继发于呕吐或腹泻的液体过量丢失和液体摄入减少有关

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

肛周皮肤完受损　与接触腹泻大便和肛周卫生不足有关

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

感染传播危险　与预防重复感染或传染病传播知识不足有关

Nursing Interventions

护理措施

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.

坚持传染病预防措施很重要，因为有些急性腹泻是传染性的。在病因确实之前，所有急性腹泻都应认为是传染性的。

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.

洗手是防止细菌传播的最重要手段，接触病人前后及处理分泌物后都应洗手。

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.

应对病人进行卫生、传染控制预防和传染病对自己及他人的危害性方面的教育，对疑有传染性腹泻的病人，应向其进行食品操作、烹饪和储存教育。

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.

教育病人警惕腹泻、发烧及其他症状的复发及家族成员出现相同症状迹象。

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

帮助病人辨别腹泻致病因素，避免自身再次感染或传染他人。

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

说明腹泻或其他症状开始时寻求治疗的重要性，以便尽早开始治疗。