急腹症英文版ppt课件.ppt

乙方有义务提供相应的执业资格证、执业印章等配合甲方工程招投标、承担的工程项目报建及建设施工过程中各类手续办理。 Intestinal Obstuction Hua-dan Xue 2008-11-30 Ileus (intestinal obstruction) Mechanical intestinal obstruction Simple obstruction：occlusion/constriction of bowel lumen Strangulated obstruction：impaired blood supply of obstructed segment Ileus (adynamic/non-obstructive) Paralytic spasm Derangement impairing proper distal propulsion of intestinal contents Cautions to barium exam due to the possibility of obstruction aggravating Classification - location Gastric outlet obstruction: Only one/two air-fluid levels Homogeneous mass displacing transverse colon Duodenal obstruction: Double-bubble sign; Frequently normal due to absence of gas from vomiting Classification - location Jejunal and ileal obstruction: Candy cane: 3 loops+3cm gas-fluid levels+3~5 hours onset Disparity in size between obstructed and normal loops Little/no gas + stool in colon with complete mechanical obstruction after 12-24 hours Stepladder appearance; string-of-bead; Cave: fluid-distended loops may lead one to overlook obstruction!!! Mechanical obstruction Classification - location Colonic obstruction Dilated colon only Dilated small bowel (incompetent ileo-cecal valve) Gas-fluid levels distal to hepatic flexure (fluid is normal in cecum and ascending colon) Cecum most dilated portion (10cm will be critical) Classification – location Localized ileus Causes: often associated with adjacent acute inflammatory process (acute pancreatitis, acute appendicitis, etc.) Sentinel loop: loops near the local peritonitis Closed-loop obstruction Closed-loop obstruction Closed-loop obstruction Fixation of bowel loop: Coffee bean sign: gas filled loop Pseudo-tumor: fluid-filled loop U-shaped dilated bowel loop Increasing intra-luminal fluid Beak sign: point of obstruction Whirl sign: twisting of bowel Closed-loop obstruction Large volvulus Beak sign Classification - etiology 机械性肠梗阻 单纯性肠梗阻：肠管通畅性障碍 绞窄性肠梗阻：肠管通畅性障碍伴有血运障碍 动力性肠梗阻 麻痹性肠梗阻： 痉挛性肠梗阻： 血运性肠梗阻：肠系膜