医学课件妇科急腹症

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1、妇科急腹症GyneacologicAcuteAbdomen以腹部疼痛为主要症状的一组妇科急症。腹痛是这三种疾病的主要症状急：发病突然，症状重，危及生命ectopicpregnancyextrauterinepregnancytorsionoftheovarianpedicletwistedovariancystsacutepelvicinflammatorydiseasearupturedovarianlutiaEndomitriosisstoryAcuteabdominalpainwantedtogivebowelstheabdomenrigidityandtenderne

2、ss、reboundtenderness.passwaterfaintedonthespotbloodpresurewaszeroDiagnosis?ectopicpregnancyEctopicPregnancyDefinition:EctopicpregnancyisdefinedaspregnancyoutsiedtheuterinecavityMostcommonsiteofoccurrenceisthefallopiantubetubalpregnancy88.5%ovarianpregnancy4.5%cervicalpregnancy0.7%pregnancyi

3、nrudimentaryhorn1.5%pregnancyininterstitial4.8%abdominalpregnancy47863125theUK:0.25-1%gettingmorecommon.InFinland,tripledbetween1966and1985intheUS,afour-foldrisebetween1970and1983.InJamaica,anunusuallyhighrateofectopicpregnancy(1in28deliveries).etiology:受精卵着床于子宫体腔以外。或因为输卵管结构异常，或受精卵行走异常。FAC

4、TORS输卵管结构异常受精卵行走异常PelvicinflammatorydiseaseAdvancingageTubalsurgeryDESexposurePreviousectopic，repeatedIVFandovulationinductionPrevioustermination经宫腔或腹腔向对侧ofpregnancy输卵管移行输卵管发育不良或功能异常smokeIUDIntrauterinedeviceusage肌瘤，卵巢肿物，EMSalpingitis→adhesionsofthetubalwall,→retardsthepassageoftheferti

5、lizedegg→Ectopicpregnancy。输卵管的变化部位壶腹部峡部间质部解剖管腔宽窄较窄肌层较厚薄很厚停经8-12周6周4个月表现流产破裂破裂abdominalpainofectopicpregnancytubalrupture:sharpcolickypaintubalabortion:隐痛、胀痛伴随症状Strainingatstoolfaintnessandshockamenorrheaormenstrualperioddelayedspottingtypebleeding掉出蜕膜管型子宫的变化：子宫稍大内膜蜕膜反应胚胎死亡：蜕膜剥离→出血Arias-Stel

6、l反应sumerizetheSymptomsLowerabdominalpainandAbnormaluterinebleedingapproximately1-2weeksafterthemissedmenstrualperiod“异位妊娠最容易诊断，异位妊娠最不易诊断”体检全身：贫血貌，面色苍白，血压下降，脉搏弱，快。四肢冰冷；腹部：拒按，腹膜刺激征，全腹压痛、反跳痛重，肌紧张轻(tenderness,reboundtendernessandmuscularrigidity)，移动性浊音（＋）妇科：后穹隆饱满，宫颈着色，举痛，摇摆痛，子宫略大，软，可有飘浮感，一侧附件区触

7、及不规则包块，压痛明显。内科外科急性胃肠炎阑尾炎中毒性痢疾肠梗阻输尿管结石胆囊炎脾破裂辅助检查Urinepregnancytest-maybenegative，(SerialserumB-hCGtesting)hCG(HumanChorionicgonadotropin),culdocentesis：抽出血，15分钟不凝固。Ultrasound：宫腔空虚，输卵管部位出现妊娠囊和异常回声团，子宫前、后有液性暗区可助诊。子宫内膜：为排除宫内妊娠流产，可刮宫。送病理。血常规，Hb进行性下降。可以血液浓缩。