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
教师姓名：Dongxiaoying
2 页、第 1 页）
课程内容: BACILLUS DYSENTERY
职称：Associate chief physician
授课日期：25/4/2013 8 时— 10 时
授课对象： Foreign Students
授课方式： Lecture
教材版本：nternal medicine
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, definition, mode of transmission, clinical manifestations, means of
prevention
familiar with: pathogen classification, the main pathological changes, diagnosis, laboratory
features, treatment
Know: pathogenesis, epidemiology, differential diagnosis, complications treatment
self – study: history, prognosis
授课主要内容及学时分配：
Definition: 3 minutes
Etiology: 7 minutes
Incidence and outbreak Features: 2 minutes
Epidemiology: 3 minutes
Pathogenesis and pathology: 5 minutes
Clinical manifestations: 10 minutes
Diagnosis: 5 minutes
Treatment: 10 minutes
Prognosis and prevention: 5 minutes
重点、难点及对学生要求（包括掌握、熟悉、了解、自学）
Dysentery pathogens name, the definition, mode of transmission, clinical manifestations, means
of prevention, pathogen classification, the main pathological changes, diagnosis, laboratory
features, the main treatment is lectures focus.
Tenesmus clinical characteristics of bacillary dysentery to be key description
Add the identify of tenesmus
The identification and treatment of viral and bacterial diarrhea is easy to cause confusion.
Appropriate to add some extra content to enhance students' understanding.
外语词汇：
BACILLUS DYSENTERY
辅助教学情况：
slides, pictures
复习思考题：
 What’s the pathogenic microorganism ?
 What’s the mode of spread?
 How to prevent the spread?
 What’s the clinical manifestations?
参考资料：
 Practice Guidelines for the Management of Infectious Diarrhea , IDSA guidelines.
 WHO/UNICEF joint statement clinical management of acute diarrhoea, The United
Nations Children’s Fund/World Health Organization, 2004
 Alfred S. Evans and Richard A. Kaslow ; Viral Infections of Humans –Epidemiology and
Control, Fourth Edition
 Mandell, Douglas, and Bennett’s ; Principles and Practice of Infectious Diseases, Fifth
Edition
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天 津 医 科 大 学 授 课 教 案
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Definition: 3’
1. Master the definition：Shigellosis is an acute bacterial infection caused by the
genus Shigella resulting in colitis affecting predominantly the rectosigmoid colon.
The disease is characterized by diarrhea, dysentery, fever, abdominal pain, and
tenesmus. Shigellosis is usually limited to a few days.
2 emphasize.： Pathogen: the genus Shigella
Position: rectosigmoid colon
Symptoms: Dysentery syndrome
Etiology: 7 minutes
1. Bacterial species and classification：Shigellae are no motile gram-negative
bacilli belonging to the group Escherichia in the family Enterobacteriaceae.
2. familiar with four subtypes：Four species of shigellae are recognized on the
basis of antigenic and biochemical properties, S. dysenteriae (group A), S. fiexneri
(group B), S. boydii (group C), and S. Sonnei (group D).
2：through the the table below, compare subtype characteristics
Table 1
Group Ornithine
β
decarboxylase -D-galactosidase
A
—
—
B
—
—
C
—
—
D
+
+
serotype
1、2、3、4、5、6、7、8、9、10
1a 、1d、 1c、 2a、 3a 、3c、 4a、
4b、 4c、 5a、 5b、 6、 x、 y
1、2、3、4、5、6、7、8、9、10、11、
12、13、14、15
3：through the the following picture, tell about the strain characteristics
4. add extra content, raise awareness of Shigella：
 106-108 bacteria per gram in stool
 survive in soiled linen for up to seven weeks
 in fresh water for 5-11d
 in salt water for 12-30 hours
 in dust at room temperature for 6 weeks
 in sour milk for 4 weeks
 in kitchen refuse for 1-4 days
 Survival is prolonged at temperatures below 25ºC
 Freezing will not eliminate the organism, although it may reduce the number that survive.

susceptibility Features: 2 minutes
to understand outbreak history of dysentery:
Epidemiology: 3 minutes
key points：
1. source of infection: acute or chronic patients and bacteria-carriers。
2. Infection pathway: fecal-oral route.
3. Predisposition: widespread.
Pathogenesis and pathology: 5 minutes
1.to understand pathogenesis and process:
Since the microorganisms are relatively resistant to acid, shigellae pass the
gastric barrier more readily than other enteric pathogens. The organism may
be cultivated from stools for days or longer. The bacilli regularly initiate
disease in 25% of healthy adults. This contrasts strikingly with the much larger
numbers of typhoid or cholera bacilli required to produce disease in normal
individuals.
2 . Master main pathological.： The primary pathological manifestation is the diffuse
exudative fibrinous inflammation. The ulceration in Shigellosis is maplike and
superficial.
Clinical manifestations: 10 minutes
1. Require to master main content clinical manifestations：

Prodrome: nonspecific

Fever:

Diarrhea and tenesmus

Abdominal pain: in the left lower quadrant mainly

Neurological manifestations: in severe patients only

Complications:
dehydration, Shigella septicemia , and hemolytic-uremic
syndrome .

Post dysenteric syndromes: arthritis and Reiter’s triad

2. stress tenesmus unique performance and increase extra content (differential diagnosis):
Dictation
Diagnosis: 5 minutes
1 .Master stool examination features in typical cases:：microscopic examination of
the stool often reveals numerous leukocytes and erythrocytes.
2. Familiar with other laboratory tests
Blood examination:
Sigmoidoscopic examination:
Evidence in bacteriology：
3. to understand differential diagnosis
Amebic dysentery：
Ulcerative colitis:
Treatment: 10 minutes
familiar with main point contents of treatment:
1. General therapy:
It includes relaxation, aspiration of oxygen, reducing the temperature, taking liquid
diet, disinfections and insulation.
2. Fluid replacement: intravenous fluid replacement is required until initial fluid
and electrolyte losses are corrected. With proper hydration, shigellosis is generally a
self-limiting disease.
3. Antibiotic treatment: emphasis on children's antibiotics contraindications,
memory following two points
Do not give ciprofloxacin to children less than 17 years of age because there is a
theoretical risk of cartilage damage.）
Attention：Agents that decrease intestinal motility should not be used. Such
preparations as diphenoxylate (a kind of antidiarrheal drug) and paregoric may
exacerbate symptoms, presumably by retarding intestinal clearance of the
microorganisms. There is no convincing evidence that pectin- or bismuth-containing
preparations are helpful.
Prognosis and prevention: 5 minutes
1. Require to master the following preventive approach
Controlling the source of infection:
Cutting the infection pathway:
Preventing the predisposition:
2． Brief introduction to other preventive measures
References
 Practice Guidelines for the Management of Infectious Diarrhea , IDSA guidelines.
 WHO/UNICEF joint statement clinical management of acute diarrhoea, The United
Nations Children’s Fund/World Health Organization, 2004
 Alfred S. Evans and Richard A. Kaslow ; Viral Infections of Humans –Epidemiology and
Control, Fourth Edition
 Mandell, Douglas, and Bennett’s ; Principles and Practice of Infectious Diseases, Fifth
Edition
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