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1. ???? ??????????? ?????

2. ???? ?????: ??? : ????: ????????: ????: ????: ??: ??:

3. ????? ??????????????? ????????????????? ???????????,???????????????????

4. ??????(1) Rotavirus(????): Astrovirus(????) : Adenovirus(40‚41)(???): Norwalk virus(calidviruses)(?????):

5. ??????(2) Rotavirus: all mammals and birds Astrovirus (????) : children & infant ~ second most important ~ similar to rotavirus, but be milder ~ mild to moderate watery diarrhea ~ less significant dehydration ~ hospital outbreaks are common

6. ??????(3) Adenovirus(40‚41)(???): ~ third most common ~ mostly <= 2 y/o ~ year-round ~ do not cause respiratory symptoms ~ diarrhea of longer duration, 10-14 days

7. ??????(4) Norwalk virus(calidviruses)(?????): ~ older children and adult ~ vomiting and nausea ~ brief duration, 1-3 days of symptom ~ resembles food poisoning from toxins (Staphylococcus aureus or Bacillus cereus) ~ school, cruise ship, and hospital ~ shellfish or water used in food preparation

8. ???? – ??? ??????A?B?C?D?E?F?G? A???????????????? B??C????????? ???????????,??????

9. ???? – ????(1) ?????3??(95%)???????? ?????: 3-24?? 6???????????:??????, ??????????? ?????????: ~ ?????? ~ ??????????? Very few virion are needed to cause disease

10. 1993-1997??????????????

11. ???? – ????(2) ????????????????,?????????? ??????????? ?????????????,???????????? ???:??48?? ????:???? ???????????10?

12. 1993-1997??????????????

13. ???? – ????(3) ?????????? ??????????? ????????????? ?????????? ??????????? ??????????? ???PH? 2 ???????

14. ???????(1) ?????:???? ??????:???? ?????:?? ????(??????):???? ??????????????? ???????:????????? ?????????? ???????:??????????

15. ???????(2)?????? ??????????????? ???????? ??????????? ??????? ??????????????, ??????????????

16. ?????(1) ??(??????) ??(?????????) ??(??????) ?????????????????? ??? ??+??? ??? ???+?? ????????,???????? ??? ???? ???+???

17. ?????(2) ??(?????????)????????? ???????????????? ?????????????? ???????? ????:????(?/???????????????)

18. ?????(3) ?????????????????????????????? ???????????. Why ? ??????????????????????????? ???????????????????? ????????????????,??????

19. ?????(4) ????????4-6????????,?????????(??)??4-6?? ????(PH<6):?????????????????? ?????????:????????-form????? -form???????,??????????????

20. ???????(3)????????? ?????????????????? ???????????????? ????????????????????? ???????? ?????????????

21. ???????(4)?????: ????????? ?????????? ???:??????? ???:???????? ?????????????????

22. ??????:????????? destroy villus tip cells in small intestine gastric mucosa is not affected upper villus enterocytes (differentiated cell) in small intestine ~ ???? (hydrolysis of disaccharides) ~ ???? (transport of water & electrolyte via glucose & amino acid cotransporters) ????????(1)

23. ????????(2) ??????: ~ ????? ??????? ~ ??????????? ??????????????????,????????,??????

24. ???? – ???? (1) ???: 1~3? (< 48hr ) ??:?/?????????????????????,??????? ?????1-2?,??????? 5-7? ???????:??3??-3?? ??????? ??????????????? ????: ??????? ????? ????

25. ???? – ???? (2) ??????????????? ??????? ?????????,??????? ?????????????????? ??:~ ?????? ~ ???????????? ~ ???????? ~ ????,???????? ~ ?????????

26. ???? ????: ?????????,?? ?????,?????? ~ Isotonic dehydration with acidosis ~ stools are free of blood and leukocytes ~ WBC may be moderately elevated secondary to stress ??????????(??????): ?????????? ????: ?????????  

27. ???? – ?? (1) ????????: ??????? ??????????? ????:~ ???????? ~ ?????????????, ?????????? ~ ???????? ?????????:?????????? ?????

28. ???? – ?? (2) ???:6~8??????????, ?????? ??12??: ~ clear liquid or dilute formula: without benefit ~????????,????????? ?????: ????????? ?????: ????????

29. ???? – ?? (3) ????:(?????????) ~??????? (????) ~??????????? ~???????? no role for drug treatment ~??????:?????????? ~???:no benefit

30. ???? – ?? (3) ???????(????????????)????:???????,????????? ????(????????) BRAT(bananas, rice, apple sauce, toast) :not been shown to be superior

31. ?? (4) -???????? 1 ??:??????????? ????????,????????????? ??????30~60mEq/L (??90mEq/L) ??????2~2.5% (??5%) ????????5%??????? ???????????(?70%),??????????????

32. ?? (4) -????????2 ???????????????,??????????? ??????3%,???????,??????????????? ???????,?????,???????????? ??????????

33. ????(1) ??????6~28mEq/L 10%??? ????????????? ??????????????;???????????? ??????,??????????

34. ????(2) ??????,?????????? ???????????????????,?????????? ?????:???4~6????(???? ???),??????? ????????????? ??????,?????? ????:????????? ????:?????????,????

35. ????-??? ????:????????????????????? ??????,???????,??????????? ??????????,??????????,????????????,????????

36. ?? ??:?????(?????????) ???????????????,???????????? ~ limited protection against any subsequent infection (38%) and diarrhea (77%) ~ protection against severe diarrhea (87%)

37. ?? ??????:????????????,?????????????? ??????:??????????,????????? ??????:?????????????,????????? ??????:????????

38. ???? ?????:?????? ????:??????????? ????????: ~ persistent high fever ~ WBC in the stool ~ persistent severe or bilious vomiting (especially in the absence of diarrhea)

39. ???? ?????:?????????? ????????? ????? ???: ????? ?????????/???? ???????? ???: ?????????/????

40. Thanks for your attention