Holtz Lori R, Neill Marguerite A, Tarr Phillip I
Department of Pediatrics, Division of Gastroenterology and Nutrition, Washington University School of Medicine, St Louis, Missouri 63110, USA.
Gastroenterology. 2009 May;136(6):1887-98. doi: 10.1053/j.gastro.2009.02.059. Epub 2009 May 7.
Acute bloody diarrhea should be considered a medical emergency. Its causes are frequently serious or actionable or both and are usually identified. However, acute bloody diarrhea as a stand-alone clinical presentation has received little scholarly attention in the past several decades. Although the range of possible causes of acute bloody diarrhea is broad, infectious considerations are paramount and should always be prioritized in the evaluation of such patients. History, examination, and laboratory testing should be focused on minimizing time to diagnosis (and, by extension, to implementing appropriate therapy). Strategically chosen tests and imaging, avoidance of extraneous diagnostic pursuits, and provision of supportive care while awaiting diagnostic clarity are central to the adroit management of patients with acute bloody diarrhea. Diagnostic considerations differ somewhat between adults and children but have many elements in common, including the need for vigilance in detecting Escherichia coli O157:H7 infection. In this review, we discuss diagnostic approaches (emphasizing the importance of rapid, accurate, and thorough microbiologic investigation) and measures that can be taken to support patients while awaiting information that determines the cause of their disease. These topics are discussed in the context of the medical care that is available to children and adults with bloody diarrhea in most institutions in developed nations.
急性血性腹泻应被视为医疗急症。其病因往往严重或可采取行动，或两者兼而有之，且通常可以查明。然而，在过去几十年里，急性血性腹泻作为一种独立的临床表现很少受到学术关注。尽管急性血性腹泻的可能病因范围很广，但感染因素最为重要，在对此类患者进行评估时应始终优先考虑。病史、检查和实验室检测应着重于尽量缩短诊断时间（进而实施适当治疗）。策略性地选择检测和影像学检查、避免无关的诊断措施，以及在等待明确诊断期间提供支持性治疗，是妥善处理急性血性腹泻患者的关键。成人和儿童的诊断考虑因素略有不同，但有许多共同之处，包括需要警惕检测大肠杆菌O157:H7感染。在本综述中，我们讨论了诊断方法（强调快速、准确和全面的微生物学调查的重要性）以及在等待确定病因信息期间可采取的支持患者的措施。这些主题是在发达国家大多数机构为患有血性腹泻的儿童和成人提供的医疗服务背景下进行讨论的。
