文档介绍：肠梗阻
上海交通大学医学院附属瑞金医院
普外科马迪
PBL教学
Intestinal Obstruction
肠梗阻是急诊最常见的外科急腹
症之一,也是外科医生最不愿碰到的,
最头痛的外科急腹症之一。
诊断有时比较困难
临床病情发展较快
需要密切临床观察
严密把握手术时机
Case one(scene1)
Male , age: 65, “Paraxymal abdominal
pain 48h with nausea and vomiting one day”,
you are the doctor on duty.
Q1. According to the plaint, which kind of information you should collect during ask the history?
Main point of the history
1:Abdominal pain
The position、level、kind of pain, with or without radiation ,the
relationship between bowel sound and pain, paroxymal or
continuing.
2:Nausea and vomiting
The kind、volumn、color and smell of vomitus, the relationship
between vomiting and pain.
3:Abdominal distention
Time,level and position
4:Failure to pass flatus and feces
The kind、quantity of feces and the relationship between it and pain,
if the pain relieve after pass flatus and feces.
5:Past history
Case one(scene1)
Q2:To make a definite diagnosis,which kind of information we should pay attention to in the next Physical Examination and Auxiliary Examination?
Main point of the physical examination
General Examination: T: HR:96bpm R:22bpm BP:130/70mmhg No dehydration, no anemia, no jaundice
Abdominal Examination:
Inspection:Distended abdomen, no peristaltic waves can be observed,previous scar in the upper abdomen. Palpation: Mild abdominal tenderness, no rebound,no guarding,no mass, no incarcerated hernia in the groin. Percussion:Tympany.
Auscultation:Hyperactive bowel sounds , 6-8bpm.
Rectal Examination:Negative
Local pathophysiology of intestinal obstruction
肠蠕动增加
长时间强蠕动
肠麻痹
、积气积液
吞咽下的气体,以氮气为主,不易向血液内弥散
长时间梗阻,肠腔内液体不再回流入血,而仍有液体自血液流入肠腔
、通透性增加
梗阻近段肠腔压力升高,静脉回流受阻。
细胞缺氧,能量代谢障碍,肠壁通透性增加。
Q3: What is your diagnosis?
Case one(scene1)
Definition & Classification
Definition:
Intestinal contents can not pass essfully,which
cause many pathophysiology and clinical symptoms.
Classification:
按照梗阻发生基本原因可分为三类:
1. Mechanical Obstruction
2. Dynamic Obstruction
3. Vascular Ob