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Acute Gastroenteritis( AGE )急性腸胃炎
Vomting with epigastric pain and nausea, that's acute gastritis. Severe cramping pain with some bowel rumbbling sound beneath the umbilical area could be found and loose stool with a little watery,yellowish dark or even brown color, it depends what food you had taken. That's acute enteritis. Some sea food, meat,eggs etc. these could be spoiled when they were produced,carrying or even stored. They were contaminated by bateria.spirochate so on. Most common cases seen in those episodes of acute gastroenteritis were staphylococcus, or streptococcus, and some sea food was also contaminated by Cholerae vibro,that will cause health authority nervous. Acturally those infected enteritis needs special treatment. But those bateria like Staph. or Strep. will let you pain vomiting belching reflux and severe stomachache. This kind of gastritis need rest. So you better eat nothing(NPO). Even you are thirsty, starving,dizziness( too hungery!),you better let your digestive system rest until they return to normal. NPO at least two meals intervals is mandatory. Oral nutrition supplys were also suggested by some acadamic medical societies for those fluid losing, electrolyte imbalanced and hypoglycemic patients. Those were strongly suggested by some pediatrics, but fasting for digestive rest is still recomended at least 6-8 hours. In Asia many commercial use sports drinks, they are half saline,some electrolytes, sugar and flavors. Some doctors they thought drinks these may supply losing fluid, corrected imbalanced electrolytes and had some sugar for hypohlycemia if they have. In fact, the more you drink the more you loss, esp. those fluid and electrolytes.So the dehydration and electrolyte imbalance got worse. The period of gastroenteritis is prolonged. Some oriental patients in Australia, Canada and USA was suggested to take Yurgot or milk. They got worse when they followed the medical orders. Maybe that's differences of western and easternal digestive system.

急性腸胃炎又吐又拉時, 應該多喝電解水或是其他運動飲料嗎 ??

急性胃炎或腸胃炎應該多喝電解水或是其他運動飲料是否適當, 由於在急性期, 胃腸應該休息.所以禁食是必然重要之處置之一,如果過量之運動飲料,由於過多之水份與電解質, 會刺激已發炎之腸胃黏膜, 導致吸收不足但是排水更多, 可能引起更為厲害之腹瀉, 當然更加導致脫水.部份醫師在門診或急診時, 仍然建議病患多喝水或是電解質之飲料以補充流失之水份, 殊不知此舉可能引起更加厲害之脫水與電解質之失衡.故宜禁食至少兩餐以上配合藥物,以免腹瀉加劇. 幼兒之處置,可能不宜過長久之禁食,要避免低血糖, 故少量之米湯或是稀飯可以給予, 但是必要時仍然以4-6小時之禁食為宜.

Do I Have Hepatitis B?

我有 B 型肝炎嗎 ? 病例一 : 淑儀是一家庭主婦, 平時生活作息正常,不吸煙, 不喝酒, 不打牌, 不熬夜, 因為買保險健康檢查得知, 肝功能異常, GOT 54, GPT 86, 被告知是 B型肝炎, 是雙陽性. 仔細一回憶, 原來生產時婦產科醫師曾經提醒過B型肝炎, 不過事後也忘掉了醫師的叮嚀, 應該定期檢查. 不巧是娘家兄弟姐妹與媽媽都是B型肝炎帶原者. 病例二 : 石婷是一住校學生, 某日因為發燒, 咳嗽, 喉嚨痛, 嘔吐, 全身倦怠,有茶色尿, 經學校教官送醫檢查, 得知有急性肝炎, 是B型肝炎, GOT有831, GPT 高達1478, 而且 HbsAg 陽性 ( B 肝炎表面抗原 ), Anti-Hbs 陰性 ( B肝炎表面抗體 ), 由於同寢室有一B型肝炎之同學, 平日大家吃喝一起, 而且入學健康檢查皆正常, 無B型肝炎.
何謂肝炎
所謂肝炎, 是指肝臟細胞受到病毒, 藥物, 毒物, 酒精等等引起之傷害, 造成壞死發炎, 可由驗血檢查肝功能指數 GOT, GPT 得知, 正常值約 30-40之間, 如果是超過正常值2 倍, 是有輕度發炎, 如果大於 5 倍以上, 表示急性肝炎發作, 應該儘速就醫. 為什麼發生肝炎 ? 引起肝臟發炎, 如病毒性A, B, C, D, E, G等等, 或 藥物, 毒物, 酒精等等皆可引起之肝炎, 另一方面 因脂肪堆積造成之脂肪肝, 亦可能引起肝炎, 但是 GOT, GPT很少大於5倍以上.
B 型肝炎如何傳染?
B 型肝炎是經由血液傳染, 有垂直傳染, 如媽媽生產時候感染, 如病例一 的淑儀. 與水平傳染, 如同輩兄弟姐妹同學之間的 感染, 如病例二:的石婷. B 型肝炎結果會如何? B型肝炎帶原者, 會因為病毒發作, 引起慢性肝炎, 久而久之, 變成肝硬化, 而後便產生肝癌, 這就是 “肝病三部曲” , 所以B型肝炎帶原者, 應該定期追蹤檢查胎兒蛋白, GOT ,GPT和超音波, 以早期發現肝硬化或肝癌. 肝炎標記有那些?
B肝炎表面抗原, B肝炎表面抗體, B肝炎核心抗體, B肝炎e抗原, B肝炎e抗體
情況1. _ , _ , _ , _ , _
未曾感染B肝炎,而且無保護性,應打疫苗.
情況2. +, _ , + , + ,_
B肝炎帶原者,高傳染性.
情況3 + ,_ ,+ , _ , +
B肝炎帶原者,低傳染性.
情況4._, _ , +, + 或 _, _ 或 +
可能為(低效價)B肝炎帶原者.
情況5. _ ,+ ,+,_ ,+
曾感染B肝炎,已痊癒,有保護性.
情況6. _, +,_, _, _
曾注射B肝炎疫苗,有抗體,有保護性.

如上表B型肝炎標記 可以知道有否B型肝炎 :

情況 一 : 表示 從未被感染過B型肝炎, 應該注射B肝炎疫苗, 以產生抗體, 避免得到B型肝炎.

情況 二: 表示 有B型肝炎帶原, 而且 e 抗原 呈陽性反應, B型肝炎病毒活動力強, 傳染性高, 肝炎發作機會大,

情況 三 : 表示有B型肝炎帶原, 而且 e 抗原 呈陰性反應, 有 e抗體, B型肝炎病毒活動力弱, 傳染性較低, 肝炎發作機會不大.

情況 四 : 表示有B型肝炎帶原, 而且 e 抗原 呈陰性或陽性反應, 但是病毒效價低, 常常是健康的帶原者, 但是仍然有可能發作.

情況 五 : 表示有得過B型肝炎, 但是已經有表面抗體, 已痊癒, 不會再度感染, 也不會傳染給別人.

情況 六 : 表示從未感染B型肝炎, 因為曾經打過疫苗, 已經有表面抗體, 不會感染B型肝炎, 也不會傳染給別人. 但是此表面抗體非終生存在, 約 10-15年後會漸減, 應該再次補注射疫苗, 以免感染B型肝炎.

我有否B型肝炎?
病例三 : 洪先生是一上市公司主管 , 每年度醫務室護士必定通知要健康檢查, 由於自己家族有感染B型肝炎.之病史, 也特別注意肝炎狀況, 但是近年來的檢查結果是令人納悶, 護士小姐也說不出所以然, .就是更換檢查地點也是如. 87年 以前都是有B型肝炎帶原, 88年卻突然沒有B型肝炎.帶原, 也沒有B型肝炎表面抗體. 89年也是如此. 90年另外換一健診中心, 也是沒有B型肝炎帶原沒有表面抗體, 甚至於建議他打B型肝炎疫苗. 洪先生之情形應該是屬於情況四, 病毒濃度低之際, 所以檢查B肝炎表面抗原會是陰性, 因而以為是已消失或是好轉 ,其實檢查B肝炎核心抗體或B型肝炎病毒DNA 應該就可知道的, 仍然應該定期追蹤檢查. 理論上B型肝炎帶原者被感染之後半年後, 八成以上會出現B型肝炎表面抗體, 意思即已痊癒, 如情況 五. 但是有二成未出現表面抗體, 仍然有帶原, 變成情況 二或情況三. 不過不會是情況 一, 回到未曾感染狀況, 所以洪先生之情形應該再度檢查B肝炎核心抗體即可知道是屬於情況四. B型肝炎帶原者應注意事項? 一 生活作息正常, 不熬夜, 不吸煙, 不喝酒, 飲食均衡, 少油, 多蔬果. 二 定期檢查, 每6月超音波檢查, 每2-3月抽血驗 GOT, GPT. 三 避免不必要之輸血, 打針, 紋眉, 針灸,刺青, 穿耳 環, 鼻環, 舌環, 等等各種環. 四. 飲食宜公筷母匙, 避免共飲傳食, 不共用牙刷, 牙膏, 剃刀, 刮鬍刀. 五. 性行為也會傳染. 六. 不亂服成藥, 來路不明之偏方或草藥. 七. 如果無表面抗體未曾感染, 應該注射疫苗.
-----------新竹市 東區 民生路225號 03-5355811

李文華胃腸肝膽專科診所-------

CLINICAL MONITOR FOR CHRONIC VIRAL HEPATITIS IS MANDATORY 2006,NOV.10-13 WCIM,TAIPEI

W-H Lee

Y-N Kou

Dr. Lee's Clinic

Department of Internal Medicine, Provincial Hsin-Chu Hospital, Taiwan

BACKGROUND: Chronic viral hepatitis B (HBV) and C(HCV) were found at least 3.5 millions of cases in Taiwan. One seventh of pepole were carriers of HBV or HCV in Taiwan . HBV carrier rate has been declined by vaccination at fetal period during recent 3 decades. But sequential liver cirrhosis (LC) and hepatocellular carcinoma (HCC) were still an annoyance of these carriers. Aggressive, detailed monitoring with laboratory test and sonography is necessary for those victims.
METHODS: 14908 cases of HBV and HCV were reviewed in Hsin-Chu area. They were all regularly monitored with laboratory test,GOT,GPT,AFP and sonography at least every 6 months. Some of them even shorten to 2-3 months for closely monitoring because of fluctuation of these tests and/or flare up during antiviral treatment. 71 HCC were diagnosed and all proved by biopsies and/or surgical pathology. LC, 2259 were diagnosed by sonographgy with coarse echotexture, uneven surface, blunt margin, shrinkage liver size, spelnomegaly etc. and with clinical evidences of palmar erythema, spiderangioma, acites, low legs pitting edema and esophageal varices .
RESULTS: Definite carriers of HBV (3104) and HCV (824) were enrolled with positive of HbsAg, HBV-DNA PCR( Abbott), anti-HCV antibody and HCV-RNA PCR(Roche). 64 cases of sequential HCC were found during followed up interval. The occurrence rate of HCC is 1.63%. The LC has 2559 cases. 30 carriers (42.2%) with HCC were noted non-cirrhotic clinically.
DISCUSSION: To follow up these HBV and HCV carriers are mandatory during their residual life. 42.2% HCC were non-cirrhotic. For early detection LC and non-cirrhotic HCC, it's urgent for health taking care and frugality of health insurance resources. Since early detection is necessary, laboratory test including AFP and sonography are the adequate medical facility for regularly follow-up. Owing to the financial hardship of the health insurance more constricted gateway were instructed to clinical specialist during their medical performance. The majority expensive medical performance like CT scan, MRI were slumped and limited and it was flaunted its efforts and success of insurance expenditure. Since the average growth rate of HCC is 4.6 months per 1 centimeter ( ).The examinationof of liver condition should be done at least every 4-6 months.The laboratory blood test for GOT and GPT will be taken within 2-3 months, AFP and sonography should be done within 6 months.But limited budget of the insurence was not allowed this kind of freguency of examination. SO special budget is a necessity not just for exacerbated cases only, program has already worked for several years, but also for those carriers with high risk of HCC, such as high viral load, HBeAg positive, pre-S mutant carriers and even familyt history HCC. Minute budget may be just a drop of the basket in the health insurance expenditure but it offers tremendous benefit for monitoring their liver condition, and reduces the numbers of bereaved families.
Key Words: Chronic viral hepatitis, clinical monitor, budget
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