Download 天 津 医 科 大 学 授 课 教 案

天 津 医 科 大 学 授 课 教 案
（共
课程名称： internal medicine
课程内容: CHOLERA
教师姓名：Dongxiaoying
授课日期：24/4/2013
2 页、第 1 页）
职称：Associate chief physician
10 时--12 时
授课对象： Foreign Students
教材版本：internal medicine
授课方式： Lecture
学时数： 2
听课人数：80
本单元或章节的教学目的与要求：
Master: pathogens name, mode of transmission, clinical manifestations, the precautionary
principle, contents of the WHO oral rehydration, treatment
familiar with: pathogens classification, the main pathological changes, diagnosis, laboratory
examination features,
to understand: pathogenesis, epidemiology, differential diagnosis
self – study: history, prognosis
授课主要内容及学时分配：
Overview: 2 minutes
Etiology and epidemiology: 5 minutes
Pathology: 10 minutes
Clinical manifestations: 10 minutes
Laboratory tests five minutes
Diagnosis: 3 minutes
Treatment: 10 minutes
Prognosis and prevention: 3 minutes
Summary: 2 minutes
重点、难点及对学生要求（包括掌握、熟悉、了解、自学）
About the spread of cholera, clinical manifestations, means of prevention, laboratory
features, the main treatment is lectures focus.
Key description about dehydrated clinical features and severity of
the cholera,
emphasizing the importance of the rehydration and methods
Enhance the memory of
spread mode and the treatment, emphasizing the importance
of prevention。
Adding the appropriate extra content, enhance students' impression.
外语词汇：
CHOLERA： 霍乱
辅助教学情况：
slides, pictures
复习思考题：
 In pathogenesis of cholera, which is more important, the invasiveness or exotoxin?

What’s the pathogenic microorganism ?
 What’s the mode of spread?
 How to prevent the spread?
 What’s the clinical manifestations?
 What’s the composition of WHO ORS?
参考资料：
1. Cecil textbook of Medicine, 20th edition.
2. http://www.cdc.gov/
3. http://www.who.gov
4. http://gsbs.utmb.edu/microbook/ch024
5. Donald Armstrong, Jonathan Cohen. Infectious Disease, 1999
6. Richard A. Finkelstein: Cholera, Vibrio cholerae O1 and O139, and Other Pathogenic
Vibrios.
主任签字：
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月
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天 津 医 科 大 学 授 课 教 案
（共 2 页、第 2 页）
一、Overview：2’
1. Questions.
2
pathogenic bacteria：
Vibrio cholerae.
3
history of outbreak：Cholera could be outbreaks or take place sporadically .
4.
route of transmission: Transmission to humans is by water or food.
二、Etiology, epidemiology：10’
1 , appearance, characteristics
Vibrio cholerae is a short, slightly curved, rapidly motile by means of a single polar
flagellum, and gram-negative. It’s distributed in all parts of the world, especially favoring
brackish or salt-fresh water interfaces. It is classified as Enterobacteriaceae which has H-antigen
and O-antigen.
2 .Serogroups Ol : characteristic，names of two biotypes of ( Classical and ElTor ),
3. characteristic of Serogroups Ol39 Bangal ：
4. master：exotoxins is responsible for the characteristic diarrhea of the disease, they are
currently responsible for major epidemics.
5. history of prevalence
6. master: infection sources, route of transmission, Susceptible population
7. introduce the popular geographical and seasonal reasons, and bind the discussion.
三、pathomechanism：10’
1.
Virucidal action of gastric acid.
Vibrios are sensitive to acid, and most die in the stomach**. So the persons with more
gastric acid pruduction will have less risk.
2. Master: (cholera enterotoxin), is the main pathogenesis of cholera.
3. focuses on the reason of cause of dehydration, add to extracurricular picture to
understand the effects of the virus, emphasizing All signs and symptoms of cholera
derive from the fluid losses，
四、clinical manifestation：10’
1
Required to master the three major clinical manifestations:
massive watery diarrhea.
Severe vomiting
dehydration
2
to understand performance and complications
hypovolemic shock , renal failure，Muscle cramps， sepsis and pneumonia
emphasizing：The outcome of the disease depends on the extent of water and electrolyte
loss and the adequacy of body fluids repletion therapy. If not received adequate hydration,
fever secondary to will appear commonly
Signs: Loss of skin turgor, scaphoid abdomen, and weak pulse
3 . Add to the form, detailing the different clinical manifestations of dehydration for all levels,
stress the dehydrated patients hazards.
三、laboratory examination: 5’
1. Master the hanging drop test results
Hanging-drop test: Using dark-field microscope, shuttle-like or meteor-like movement.
2
understand of other laboratory tests：
Immobilization test:
Culture of stool
Serological examination:
3
Stress that require aggressive rehydration treatment before laboratory results
Fluid replacement should be started without delay as soon as diarrhea begins , not
depending on an etiologic diagnosis.
四、diagnosis：3’
1. Familiar with the diagnostic process
2. increase contents of the differential diagnosis
Shigellosis：mucus, pus and blood in stool.
Food poisoning: Caused by salmonella, E.coli, staphylococcus aureus, et al.
Viral gastroenteritis: Usually caused by rotavirus, infant, autumn and winter.
五、treatment：10’
1
Require to master the three principles of treatment
Strict insulation to cut off transmission
Fluid and electrolytes replacement in time ( most important, oral or intravenous)
Antibiotic is assistant
2
Stress the importance of the oral rehydration, and describes of the production methods
of the family solution:
Early and complete，started as soon as diarrhea begins，in all situations ，fewer risks, and
much less costly.
The safest and most effective of these is a thick but drinkable suspension prepared from rice
or other ground starchy foods
3
Require to master the meaning and content of ORS
WHO Oral rehydration salts ( ORS )：
2.5 g;
glucose, 20.0 g.
NaCl, 3.5 g;
KCl, 1.5 g;
NaHCO3,
This mixture is dissolved in 1 L of water
4
familiar with intravenous rehydration indications and cautions
5
stress the main principles of treatment rehydration, antibiotics supplemented
Fluid and electrolyte replacement is all-important; patients who are adequately rehydrated
and maintained will virtually always survive, and antibiotic treatment alone is not sufficient.
六、Prognosis and prevention：3’
1
Master principles of p revention：
Recognize and isolate patients early.
Patients suspected to have cholera should be reported to state health authorities by telephone
or fax immediately because of epidemic risks.
Safe water supplies , appropriate disposal of human waste, special beds (cholera cots) and
fecal conduits must be offered to avoid widespread dissemination into surrounding areas.
Handwashing with soap before handling food.
七、summary: 2’
Add : After the earthquake of the Haiti, the cholera outbreak, emphasizing the disease
characteristics
References:
1. Cecil textbook of Medicine, 20th edition.
2. http://www.cdc.gov/
3. http://www.who.gov
4. http://gsbs.utmb.edu/microbook/ch024
5. Donald Armstrong, Jonathan Cohen. Infectious Disease, 1999
6. Richard A. Finkelstein: Cholera, Vibrio cholerae O1 and O139, and Other
Pathogenic Vibrios.
教务处制