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ID:59456200
大小:5.18 MB
页数:52页
时间:2020-09-16
《外科学课件:Revised Acute peritontitis急性阑尾炎.ppt》由会员上传分享,免费在线阅读,更多相关内容在行业资料-天天文库。
1、急性阑尾炎AcuteappendicitisYouarecalledtoseeapatientintheEmergencyDepartment,whoisa25year-oldfemalewitha1dayhistoryofright-lowerquadrantabdominalpain.HistoryWhatotherpointsofthehistorydoyouwanttoknow?CharacterizationofsymptomsTemporalsequenceAlleviatingExacerba
2、tingfactors:Relevantfamilyhx.AssociatedsignsandsymptomsConsidertheFollowingHistoryPainstartedinthemiddleofthenightandwokethepatientfromsleep.FeltnauseatedandvomitedafterpainNosignificantMED.HX.orSURGHX.NegativeFamilyHXNotedsomeindigestionyesterdayFeelsurge
3、tohavebowelmovement,buthasbeenconstipatedWhatisyourDifferentialDiagnosis?DifferentialDiagnosisBasedonHistoryandPresentationSystemicorinfectiousconditionsInfluenzaGastroenteritisHepatitisDiaphragmaticpleurisySpinaldiseaseTyphoidTuberculosisAcuteporphyriaDia
4、beticketoacidosisDifferentialDiagnosis(cont.)Intra-abdominalconditionsAcuteAppendicitisAcuteCholecystitisDiverticulitis(Meckel’s)InflammatoryBowelDisease(Crohn’s)DuodenalUlcerIntestinalObstructionCarcinomaoftheCecumNonspecificadenitis–PossibleYersiniainfec
5、tionDifferentialDiagnosis(cont.)Intra-pelvicconditionsSalpingitisPelvicInflammatoryDiseaseEctopicPregnancyRupturedCorpusLuteumCystRupturedFollicularCyst(Mittelschmerz)RupturedOvarianCystOvarianTorsionPyelonephritisUreteral/RenalstonePhysicalExaminationWhat
6、wouldyoulookfor?PhysicalExaminationVitalSigns:39oC,HR=75,RR=15,BP=125/75Appearance:PatientislyingquietlyonbedinfetalpositionHEENT:NoicterusVAGINAL:nontender,noDischargeCV:nlS1S2,nomurmursRECTAL:Guaiacneg,uncomfortableduringexamPULM:CTABilat.nopainwithinspi
7、rationNeuromuscular:MinimalhyperesthesiaaboveumbilicusABD:ModeratelytenderinRLQbetweenpubicsymphysisandASIS,involuntaryguarding,NegbowelsoundsWouldyouliketoreviseyourDifferentialDiagnosis?ReviseyourDifferentialDiagnosis?AcuteappendicitsDiverticulitis(Mecke
8、l’s)InflammatoryBowelDisease(Crohn’s)OvarianpathologyAcutecholecystitisIntestinalobstructionNonspecificadenitis–PossibleYersiniainfectionDifferentialDiagnosisLaboratoryWhatwouldyouobtain?LabsorderedCBCElectro
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