外科学课件：小肠疾病（英语）

1、 Crohns disease is the most common primary surgical disease of the small bowel, with an annual incidence of 3 to 7 cases per 100,000 of the general population; the incidence is highest in North America and Northern Europe. Crohns disease primarily attacks young adults in the second and third decades

2、 of life. The risk for developing Crohns disease is about two times higher in smokers than in nonsmokers. Although Crohns disease is uncommon in African blacks, blacks in the United States have rates similar to whites. Certain ethnic groups, particularly Jews, have a greater incidence of Crohns dise

3、ase than do age- and gender-matched control subjects. 1. Intraluminal obturator obstruction (e.g. gallstones, ascarid, foreign bodies) 2. Obstruction arising from extraluminal causes such as adhesions, hernias, carcinomas, and abscesses Hernias Adhesions 3. Obstruction intrinsic to the bowel wall (e

4、.g., primary tumors) : Inflammation tumour paralytic ileus dynamic ileus Occluded SMA:Sudden occlusion of small bowel arterial supply A. Supine film shows dilated loops of small bowel in an orderly arrangement, without evidence of colonic gas. B. Upright film shows multiple, short, air-fluid levels

5、arranged in a stepwise pattern. 79 yr old lady with a week of colicky abdominal pain, distension and vomiting. Diagnosis:Caecal volvulus Computed tomography scan of the abdomen of a patient with a mechanical bowel obstruction secondary to an abscess in the right lower quadrant (arrow). Multiple dila

6、ted and fluid-filled loops of small bowel are noted. Barium study demonstrates jejunojejunal intussusception Barium radiograph demonstrates a typical apple-core lesion (arrows) caused by adenocarcinoma of the small bowel, producing a partial obstruction with dilated proximal bowel. 机械性肠梗阻和动力性肠梗阻的区别

7、3. 绞窄性肠梗阻的表现绞窄性肠梗阻的表现： （1）发作急发作急：腹痛发作急骤持续：腹痛发作急骤持续 （2）发展快发展快：病情发展迅速，早期出现休克：病情发展迅速，早期出现休克 （3）腹膜征腹膜征：有明显腹膜刺激征及全身中毒表现：有明显腹膜刺激征及全身中毒表现 （4）起包块起包块：腹胀不对称，可触及包块：腹胀不对称，可触及包块 （5）血性液血性液：呕吐物、胃肠减压液、粪便或腹腔：呕吐物、胃肠减压液、粪便或腹腔 穿刺液为血性穿刺液为血性 （6）无改善无改善：非手术治疗无效：非手术治疗无效 （7）影象征影象征：X线：孤立、胀大肠袢，不因时间线：孤立、胀大肠袢，不因时间 改变位置，假肿瘤阴影，肠间隙

8、增宽改变位置，假肿瘤阴影，肠间隙增宽 Complete constipation No residual colonic gas Vomit frequently Almost all should be operated on within 24h 名词解释名词解释： strangulated intestinal obstruction 问答题：问答题： 1. 机械性肠梗阻与动力性肠梗阻的区别？ 2. 绞窄性肠梗阻的特点有哪些？ 3. 肠梗阻的诊断步骤？ 4. 肠梗阻的手术适应症？ Chapter 4 Short Bowel Syndrome Chapter 4 Short Bowel S

9、yndrome Pathogency： Chapter 4 Short Bowel Syndrome Chapter 4 Short Bowel Syndrome The treatment course may be divided into early and late phases. In its early phase, treatment is primarily directed at the control of diarrhea, replacement of fluid and electrolytes, and prompt institution of TPN. As soon as the patient has recovered from the acute phase, enteral nutrition s