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《肠梗阻病例讨论》.pptx

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DepartmentofgeneralsurgeryBiJing-Taofrankbjt@126.comA60-year-oldfemaleisadmittedtotheemergencyroomwitha48-hourhistoryoflowerabdominalpain,nausea,vomitingandconstipation.Thepatientdescribesthepainascrampyinearlyandnotesthatherabdomenhasbecomedistendedoverthelast12hours.Herlastbowelmovementwasthreedayspriortopresentation.女性，60岁，“腹痛、呕吐、腹胀和肛门停止排便排气2天,加重12小时”急诊入院QuestionDoctorneedtoanswer:Whatshouldbedonenext?Herpastmedicalhistoryisremarkableinthatsheunderwentanappendectomyforacuteappenditistenyearsago.Sheisotherwisehealthyandtakesnomedications.ClinicalManifestationsAbdominalpainNauseaandvomitingContispationandobstipationDistentionPhysicalExaminationInspectionPercussionAuscultationRectalexamination:Ahemoglobinof16,hematocrit48,whitebloodcellcount12,200with74polys.Serumelectrolytesshowthelevelofserumsodiumandpotassiumis130mol/land3.0mol/l.ArterialbloodgasanalysisrevealsthattheresultofPHis7.30.AnabdominalX-RAYrevealsmultipledilatedloopsofsmallbowelwithnumerousair-fluidlevels.ThereisnogasorstoolvisibleinthecolonRadiologicalExaminationsSupineCTscanB-UltraSoundSummurySymptomsofthepatientsSignsofthepatientsLaboratoryStudyRadiographyexamDiagnosismustmakeclearthefollowingquestions:1.Whetherintestinalobstructionexists:Throughsymptomsandsigns,thediagnosiscanbemadewithoutdifficulty.2.Whethertheobstructionismechanicalordynamic:mechanicalobstruction:typicalsymptomsandsigns.paralyticobstruction:episodicandcrampingabdominalpainisabsent;distentionisprominent3.Whethertheobstructionissimpleorstrangulationobstruction:Indicationsforstrangulation:1).Abruptonsetwithcontinuousacuteabdominalpain,2).Shock3).Manifestationofperitonitis:leukocytosis,sepsis,reboundandguarding4).Asymmetricaldistention,localbulge,ormasswithtenderness.5).Hematicvomitus,6).Conservativetreatmentinvainandnoimprovementinsymptomsandsigns.7).Isolated,bulged,anddistendedintestinallooponabdominalplainfilm.4.Whethertheobstructionishighorlow:Vomitinginproximalintestinalobstruction.Distentioninlowobstruction,feculentvomitus5.Whet