急腹症培训课件.ppt

Kidney Stone Mineral deposits form in kidney, move to ureter Often associated with history of recent UTI Severe flank pain radiates to groin, scrotum Nausea, vomiting, hematuria Extreme restlessness ? Abdominal Aortic Aneurysm Localized weakness of blood vessel wall with dilation (like bubble on tire) Pulsating mass in abdomen Can cause lower back pain Rupture shock, exsanguination ? Pancreatitis Inflammation of pancreas Triggered by ingestion of EtOH; large amounts of fatty foods Nausea, vomiting; abdominal tenderness; pain radiating from upper abdomen straight through to back Signs, symptoms of hypovolemic shock Cholecystitis Inflammation of gall bladder Commonly associated with gall stones More common in 30 to 50 year old females Nausea, vomiting; RUQ pain, tenderness; fever Attacks triggered by ingestion of fatty foods Bowel Obstruction Blockage of inside of intestine Interrupts normal flow of contents Causes include adhesions, hernias, fecal impactions, tumors Crampy abdominal pain; nausea, vomiting (often of fecal matter); abdominal distension Esophageal Varices Dilated veins in lower part of esophagus Common in EtOH abusers, patients with liver disease Produce massive upper GI bleeds Management Airway High concentration O2 Anticipate vomiting Anticipate hypovolemia Nothing by mouth No analgesics, sedatives Management In adults 30, consider possibility of referred cardiac pain. In females, consider possible gyn problem, especially tubal ectopic pregnancy 常见急腹症的诊断 (1) 急性阑尾炎病史：a. 突发上腹或脐周围疼痛，既而转移至右下腹，即“转移性右下腹痛”， 占70~80%；b. 胃肠道症状：可有恶心、呕吐、腹泻，c. 全身症状：发热、乏力、精神差。 体检：a. 右下腹压痛，典型的是麦氏点压痛或伴有  肌紧张、反跳痛； b. 结肠充气试验、腰大肌试验、闭孔内肌  试验：有助于诊断，但主要是用来术前 阑尾定位。辅助检查：a. 实验室：血RT WBC↑N↑；b. 器械检查：可行阑尾B超或稀钡灌肠。 （2）急性胆囊炎病史：a . 右上腹剧痛或绞痛，持续性或阵发性加重，常放射至右肩部（牵涉痛）； b. 胃肠道症状：可有恶心、呕吐； c. 全身症状：畏寒、发热、但无黄疸。 体检：a. 右上腹压痛，Murphy sign(+)，或伴有肌紧张，压痛、反跳痛；b. 有时可触及肿大胆囊；辅助检查：a. 实验室：血RT WBC↑N↑；b. B超：胆囊大，壁厚或有积脓，有助于确诊。  （3）急性胰腺炎病史：a. 上腹部持续性疼痛，或伴向腰背部放射，多有胆道病