Cook G C
Baillieres Clin Gastroenterol. 1991 Dec;5(4):861-86. doi: 10.1016/0950-3528(91)90024-u.
Significant differences exist in the prevalence of most gastroenterological emergencies in tropical compared with temperate countries. Both ethnic and environmental (often clearly defined geographically) factors are relevant. The major oesophageal lesions which can present acutely in tropical countries are varices and carcinoma; bleeding and obstruction are important sequelae. Peptic ulcer disease (and its complications), often associated (not necessarily causally) with Helicobacter pylori infection, has marked geographical variations in incidence. Emergencies involving the small intestine are dominated by severe dehydration, and its sequelae, resulting from secretory diarrhoea, most notably cholera. However, enteritis necroticans ('pig bel' disease), paralytic ileus (sometimes caused by antiperistaltic agents) and obstruction (secondary to luminal helminths, volvulus and intussusception) are other important problems, especially in infants and children. Enteric fever is occasionally complicated by perforation and haemorrhage; the former (which is notoriously difficult to manage) is accompanied by significant mortality. Ileocaecal tuberculosis is a major cause of right iliac fossa pathology--sometimes associated with malabsorption; amoeboma is an important clinical differential diagnosis. The colon can be involved in invasive Entamoeba histolytica infection (which, like complicated enteric fever, is difficult to manage if the fulminant form, with perforation, ensues), shigellosis, volvulus and intussusception. Acute colonic dilatation occasionally follows Salmonella sp., Shigella sp., Campylobacter jejuni, Yersinia enterocolitica and rarely E. histolytica infections. Acute hepatocellular failure is a major cause of morbidity and mortality in the tropics and subtropics. It usually results from viral hepatitis (HBV, sometimes complicated by HDV, and HCV), but there is a long list of differential diagnoses. Hepatotoxicity resulting from herbs, chemotherapeutic agents or alcohol also occurs not infrequently. Chronic liver disease and its sequelae (often long-term results of viral hepatitis) are commonplace. Haematemesis and hepatocellular failure are usually very difficult to manage due to a lack of sophisticated support techniques in developing countries. Invasive hepatic amoebiasis usually responds well to medical management; however, spontaneous perforation can occur and the consequences of this are serious. Pyogenic liver abscess, although far less common than amoebic 'abscess', carries a bad prognosis whatever the method(s) of management. Hydatidosis and schistosomiasis also involve the liver, and helminthiases are important in the context of biliary tract disease. Gall stones are unusual in most tropical settings. Acute pancreatitis is overall unusual, but chronic calcific pancreatitis can present as an acute abdominal emergency.
与温带国家相比，大多数胃肠急症在热带国家的患病率存在显著差异。种族和环境因素（通常在地理上有明确界定）都与此相关。在热带国家，可急性发作的主要食管病变是静脉曲张和癌症；出血和梗阻是重要的后遗症。消化性溃疡疾病（及其并发症）通常与幽门螺杆菌感染相关（不一定存在因果关系），其发病率在地理上有显著差异。涉及小肠的急症主要是由分泌性腹泻导致的严重脱水及其后遗症，最典型的是霍乱。然而，坏死性小肠炎（“猪霍乱”病）、麻痹性肠梗阻（有时由抗蠕动剂引起）和梗阻（继发于肠腔内寄生虫、肠扭转和肠套叠）是其他重要问题，尤其是在婴幼儿中。伤寒偶尔会并发穿孔和出血；前者（ notoriously difficult to manage ）会导致显著的死亡率。回盲部结核病是右下腹病理的主要原因——有时与吸收不良有关；阿米巴瘤是重要的临床鉴别诊断。结肠可发生侵袭性溶组织内阿米巴感染（与并发的伤寒一样，如果出现暴发性形式并伴有穿孔，就很难治疗）、志贺菌病、肠扭转和肠套叠。急性结肠扩张偶尔继发于沙门氏菌属、志贺菌属、空肠弯曲菌、小肠结肠炎耶尔森菌感染，很少由溶组织内阿米巴感染引起。急性肝细胞衰竭是热带和亚热带地区发病和死亡的主要原因。它通常由病毒性肝炎（乙肝，有时并发丁肝，丙肝）引起，但鉴别诊断范围很广。草药、化疗药物或酒精导致的肝毒性也并不少见。慢性肝病及其后遗症（通常是病毒性肝炎的长期结果）很常见。由于发展中国家缺乏先进的支持技术，呕血和肝细胞衰竭通常很难治疗。侵袭性肝阿米巴病通常对药物治疗反应良好；然而，可能会发生自发性穿孔，后果严重。化脓性肝脓肿虽然比阿米巴“脓肿”少见得多，但无论采用何种治疗方法，预后都很差。包虫病和血吸虫病也会累及肝脏，蠕虫病在胆道疾病中很重要。在大多数热带地区，胆结石并不常见。急性胰腺炎总体上不常见，但慢性钙化性胰腺炎可表现为急性腹部急症。
