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1 老年人便秘之面面觀臺中榮民總醫院胃腸肝膽科張繼森醫師

3 胃腸症狀之三個月盛行率症狀描述陽性人數三個月盛行率 (%) 1. 吃完飯後有好幾小時覺得腹脹, 或是覺得食物在胃中停留過久感覺吃一點就飽, 或無法吃完正常份量的一餐飯後腹部明顯飽脹, 有時必須放鬆衣褲, 才感覺舒服是否曾因腸胃不適, 而有噁心想吐的感覺飯後是否曾發生嘔吐曾發生胃部疼痛的情形胃部有夜間疼痛, 或空腹時疼痛的情形感覺胸骨後有心臟灼熱, 或胸口有灼熱的感覺喉嚨或嘴巴裡有胃逆流上來的酸味或苦味物質經常重複打嗝肚臍下部感覺疼痛曾發生大便很稀 ( 腹瀉 ) 的情形曾發生排便困難 ( 便秘 ) 的情形曾發生排出血便或是黑便的情形曾發生因為忍不住便意而衝到廁所的情形排便時, 會有糞便排不乾淨的情形有效樣本數 =1025

胃部有夜間疼痛, 或空腹時疼痛的情形 118 11.5 8. 感覺胸骨後有心臟灼熱, 或胸口有灼熱的感覺 61 6.0 9. 喉嚨或嘴巴裡有胃逆流上來的酸味或苦味物質 173 16.9 10. 經常重複打嗝 150 14.6 11.

4 Quantifying the target group T constipated people, i.e. people who assessed themselves as constipated 16% 3% 3% Laxative users 3% 7% 1% 6% symptomatic people* not constipated or not symptomatic or not using laxatives 61% Base n = 1,020 * persons suffering from at least one symptom of the 3 defined ones at least once a month

5 Prevalence of constipation - in the last 12 months - the rest of the world - - self definition - 34% 46% indigestion constipation diarhoea Irritable Bowel Syndrome 30% 31% 29% 47% 25% 25% 20% 15% 13% 6% USA SK T none of these 50% none of these 40% none of these 37% Q1b _ Base: USA = 2,028 SK = 1,000 T = 1,020

Syndrome 30% 31% 29% 47% 25% 25% 20% 15% 13% 6% USA SK T none of these 50%

6 Prevalence of constipation (self defined) - in the last 12 months - D UK 10% 6% USA 15% SK 25% - gender: females = 14% males = 5% - gender: females = 8% males = 4% 6% - gender: females = 20% males = 10% - gender: females = 12% males = 38% - age: less than 60 = 6% 60 and over = 19% - age: less than 60 = 6% 60 and over = 7% - age: less than 60 = 14% 60 and over = 19% - age: less than 60 = 25% 60 and over = 15% F 19% E 17% I 23% T 29% - gender: females = 26% males = 11% - gender: females = 24% males = 10% - gender: females = 30% males = 15% - gender: females = 37% males = 21% - age: less than 60 = 17% 60 and over = 25% - age: less than 60 = 16% 60 and over = 21% - age: less than 60 = 21% 60 and over = 30% - age: less than 60 = 28% 60 and over = 31% Q1b _ Base: USA = 2,028 UK = 2,000 D = 2,468 F = 2,023 E = 2,006 I = 2,001 SK = 1,000 T = 1,020

and over = 15% F 19% E 17% I 23% T 29% - gender: females = 26% males = 11% - gender: females = 24% males = 10% - gender: females = 30% males = 15% - gender: females = 37% males = 21% - age: less than

7 The colon is 120 to 200 cm in length and is highly distensible.

9 Approximately 8500 ml of fluid are added to the gastrointestinal tract daily, 1500 ml coming from the diet and 7000 ml coming from endogenous secretions from the stomach, small intestine, pancreas, and biliary tree. Of this amount, roughly 7000 ml is absorbed in the small intestine, leaving 1500 ml of fluid for the cecum to handle. In the cecum, proximal colon, and distal colon, a further 1400 ml is absorbed, leaving approximately 100 ml of fluid to be expelled with the solid fecal material in the stool. Sellin JH, 1994

Of this amount, roughly 7000 ml is absorbed in the small intestine, leaving 1500 ml of fluid for the cecum to handle.

11 Narducci F, Bassotti G, Gaburri M, et al, 1987 The motility of the colon from the transverse, descending, and rectosigmoid colons over a 24-hour period from healthy individuals. Motor activity shows similar diurnal and nocturnal changes in all three regions of the colon.

a 24-hour period from healthy individuals.

12 No cephalic phase, mechano- and chemoreceptors, fat>protein>cho

18 Loss of Interstitial Cells of Cajal and Inhibitory Innervation in Insulin-Dependent Diabetes C-kit-immunopositive structures are shown in white. A decrease in c-kit-positive immunoreactivity was seen in all regions of the jejunum in the diabetic patient compared with the control. He CL, 2001

19 The scintigraphic pattern of colonic transit in a normal individual is shown after cecal perfusion of a radiolabelled marker. In the earliest images, tracer activity concentrates in the right colon, but by 6 hours the radioligand has migrated to the transverse colon. Over the course of 1 to 2 days, the tracer is propelled into the ascending colon and rectosigmoid colon to be expelled in the feces. Krevsky B, et al, 1986

In the earliest images, tracer activity concentrates in the right colon, but by 6 hours the radioligand

20 In this technique, radiopaque markers are taken per os, and abdominal radiographs are taken at specific intervals to locate the markers in the right colon (R), left colon (L), and rectosigmoid colon (RS). Transit times through these regions are calculated using a derived mathematical equation:

right colon (R), left colon (L), and rectosigmoid colon (RS).

21 Metcalf AM, Phillips SF, Zinsmeister AF, et al, 1987 In both men and women, the markers reside in the rectosigmoid region for the longest period of time, indicative of a storage function for this region. There is also prolonged residence of the markers in the ascending colon. This portion of the colon has been hypothesized to possess storage capabilities as well, based on the directionality of contractile patterns in this region. The mean colonic transit is slightly longer in women than in men.

22 Colonic Transit Time by ROM

23 Slow-Transit Constipation

24 便秘病人處理流程

30 95 歲的日本老翁原口浩三在 2005 年 6 月 20 日以秒創下 95 至 99 歲級百米世界紀錄他也曾在 2000 年創下 90 至 94 歲級的百米世界紀錄, 成績為秒當旁人問到他是否計劃挑戰一百歲級的百米世界紀錄時, 他說 : 如果我能活到那麼久, 我會試試看

Microsoft Word - ICF的編碼指引-new sjl.doc

Microsoft Word - ICF的編碼指引-new sjl.doc 壹組織和結構 ICF 的編碼指引 1. 分類系統之內容 (Parts of the Classification) (1) ICF 分類系統分為以下兩個部份 : 第一部份由身體功能和身體構造以及活動與參與組成第二部分由環境因素以及個人因素組成 (ICF 分類系統不