《急腹症医学》PPT课件

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1、急腹症AcuteAbdominalPain昆明医学院第一附属医院急诊科郑宏宇概念外科急腹症是一组以急性腹痛为主要表现，绝大多数需要紧急外科手术处理的急性炎症、出血、梗阻、穿孔及血运障碍性疾病的总称。前言Abdominalpainisacomplaintseencommonlyintheoutpatientsetting.Thedifferentialdiagnosisofapatientpresentingwithacuteabdominalpains.pathophysiologyofthepainthec

2、linicalpresentationCourseinitialmanagementAfocusedhistoryphysicalexaminationadjunctivetestingstrategypathophysiologyofthepainTheabdominalvisceraareinnervatedwithnocioceptiveafferentswithinthemesentery,onperitonealsurfaces,andwithinthemucosaandmuscularisofho

3、lloworgans.ThepaingenesisMechanicalstretchChemicalsubstancePserotoninprostaglandinshydrogenionsStimuliDullcrampypoorlylocalizedpainsensationsThreebroadpatternsvisceralParietalreferredVisceraltypicallyinvolvesstretchanddistensionoftheabdominalorgans.although

4、torsion,andcontractionalsocontribute.Thepainstimulusiscarriedonslow-conductingC-fibers.dullache.Painlocationcorrespondstothosedermatomesthatmatchtheinnervationoftheinjuredorgan.ParietalSharpwelllocalizedA-〥fibers,witharapidconductionvelocityReferredpainoccu

5、rswhenvisceralafferentscarryingstimulifromadiseasedorganenterthespinalcordatthesamelevelassomaticafferentsfromaremoteanatomiclocation.Furthermore,diseaseprocessesfromorgansoutsideoftheabdominalcavitycanpresentwithabdominalpain.Historyassessmentoftheconditi

6、onmedicalproblemsmedicationsfamilyhistory,substanceabusehistory,recenttravelhistoryoccupationalhistory.NatureofthepainitsqualityLocationrapidityofonsetChronicityradiation,IntensityexacerbatingfactorsalleviatingfactorsAssociatedsymptomsPhysicalexaminationgen

7、eralobservation(reviewofthevitalsigns)abdominalinspectionauscultationpalpationDiagnosisofabdominalpainbasedonlocationanddistributionRightupperquadrantPepticulcerdiseaseBiliarydiseaseBiliarycolicCholedocholithiasisCholecystitisCholangitisLiverdiseaseHepatit

8、isNeoplasmAbscessCongestivehepatopathyLungdiseasePneumoniaSubphrenicabscessPulmonaryembolismPneumothoraxAbdominalwallHerpeszosterMuscularStainKidneydiseasePyelonephritisPerinephricabscessNephrolithiasi