小肠疾病英文.ppt

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1、IntestinalobstructionAnatomyThejejunalmucosaisrelativelythickwithprominentplicaecirculares;themesentericvesselsformonlyoneortwoarcadeswithlongvasarecta.Theileumissmallerincircumferenceandhasthinnerwalls;themesentericvesselsformmultiplevasculararcadeswithshortvasarecta.Bloodsupplytothejeju

2、noileumanddistalduodenumisentirelyfromthesuperiormesentericartery,whichcoursesanteriortothethirdportionoftheduodenum.Theceliacarterysuppliestheproximalduodenum.PhysiologyMotility:Peristalsisconsistsofintestinalcontractionspassingaborallyatarateof1to2cm/seccontractionsinitiatedbythemigrati

3、ngmyoelectriccomplex(MMC)underthecontrolofbothneuralandhumoralpathwaysENDOCRINEFUNCTIONObstructionEtiology:Commoncausesofsmallbowelobstructioninindustrializedcountries:ClinicalManifestationsandDiagnosisCardinalsymptoms:colickyabdominalpainnauseavomitingabdominaldistentionfailuretopassflat

4、usandfecesPhysicalExamdistendedabdomenperistalticwavesminimalornobowelsoundsMildabdominaltendernesswith/withoutapalpablemassExamtoruleoutincarceratedherniasRectalexamRadiologicandLaboratoryExaminationsPlainabdominalradiographs:accuracy≈60%-dilatedloopsofsmallintestinewithoutevidenceofcolo

5、nicdistention-multipleair-fluidlevels,ofteninastepwisepattern-demonstratethecauseoftheobstructionCT:formorecomplexcasesPlainabdominalfilmshowscompletebowelobstructioncausedbyalargeradiopaquegallstone(arrow)obstructingthedistalileum.CTscanoftheabdomenofapatientwithamechanicalbowelobstructi

6、onsecondarytoanabscessintherightlowerquadrant(arrow).Multipledilatedandfluid-filledloopsofsmallbowelarenoted.SimpleVsStrangulatingObstruction“Classic”signsofstrangulation:-tachycardia-fever-Leukocytosis-aconstant,noncrampingabdominalpainDifferentiationofpartialfromcompleteSBOPartialSBO:pa

7、ssflatusorliquidstoolsCompleteSBO:obstipationDifferentiationofProximal/distalSBOpain:epigastric/periumbilicalareavomiting:prominent/lateronsetdistention:no/predominateTreatmentMedicalandsurgicalmanagementTheoverlappingsequence:investigationresuscitationoperationThet