消化系统课件：Intestinal obstruction

1、 Outline o Background o Concept o Classification o Denomination o Pathophysiology o Diagnosis o Treatment o Examples Background Case fatality rate Year Simple Strangulated 1932 40% 52% 1953 6% 28% 1986 3% 8% Concept Intestinal obstruction An interference in the normal movement of the bowel contents

2、through the intestinal tract. Outline o Background o Concept o Classification o Denomination o Pathophysiology o Diagnosis o Treatment o Examples Classification o Mechanical obstruction o Adynamic obstruction n Paralytic n Spastic o Vascular obstruction o Other classifications Mechanical obstruction

3、 o Hernias and adhesions 70% o Tumors 15% o Others 15% nIntussusception 25109/ml nAcid-base and electrolyte imbalance nOccult blood (+) Radiology examination o Plain film nAir fluid levels 6hrs o Barium enema o Differentiate small and large intestine nSmall: center, mucosal folds nLarge: around, hau

4、stra X-ray of small intestinal obstruction o Bowel dilated above the obstruction o Air fluid levels (stepwise pattern) o Peristalsis o Ascites o Gasless in colon Radiology examination Radiology examination Diagnosis Diagnosis o Obstruction or not? o Mechanic or paralytic? o Simple or strangulated? o

5、 High or low? o Complete or partial? o Cause? Strangulated obstruction o 持续腹痛，阵发加重 o 急性腹痛，持续剧烈，阵发加重 o 早期出现休克，体温上升，白细胞计数 o 腹胀不对称，局部可及肿块，伴腹膜刺激征 o 发现血性液：呕吐物、排出物或腹腔穿刺液 o 积极保守治疗无效 o X线检查见孤立、胀大的肠袢 o 血磷、AMY、ALT、LDH提示肠缺血 Outline o Background o Concept o Classification o Denomination o Pathophysiology o Diag

6、nosis o Treatment o Examples Treatment o Conservational or Preoperative Treatment o Operation n Indication n Principles n Procedure n Bowel viability judgment Conservational o GI decompression o Anti-dehydration o Equilibrate electrolyte imbalances o Infection and intoxication control o Expectant tr

7、eatment o Enteroclysis Operation o Indication n Conservational measures are ineffective (24 hrs) n Tumor, congenital malformation, strangulated, volvulus o Principles n Simplest n Fastest n Most effective n Full GI tract exploration Operation o Procedures nLysis of adhesions nIntestinal bypass nColo

8、stomy nBowel resection with end-to-end anastomosis o Bowel viability judgment nColor nPeristalsis nArtery pulse Operation Short-bowel syndrome o 100cm o Ileum plays a more important role than jejunum n Slower empty n Absorb Vitamin B12 and bile salt n Adaptability Outline o Background o Concept o Cl

9、assification o Denomination o Pathophysiology o Diagnosis o Treatment o Examples Examples o Adhesive obstruction o Volvulus o Intussusception o Incarcerated hernia o Ascaris impactions o Mesenteric venous thrombosis o Case Adhesive obstruction o History nOperation nInflammatory nTrauma o Treatment n

10、Conservational: simple, partial nOperation: strangulated Adhesive obstruction Adhesive obstruction Volvulus oSmall intestine nYoung nAfter meal nMovement oSigmoid colon nElder nConstipation oRadiology oTreatment nSmall intestine: operation nColon: conservational, but operation often needed Volvulus

11、Volvulus Intussusception o Manifestation n Abdominal pain n Bloody stool (jam-like) n Abdominal mass o Radiology o Treatment n Reduce with air instillation n Operation Intussusception Intussusception Intussusception Intussusception Intussusception Incarcerated hernia o No strangulation manual reduction o Operation: herniorrhaphy Ascaris impactions Mesenteric venous thrombosis History inquiry o 腹痛发生时间？ o 以前是否有类似发作？ o 是否有慢性病基础？手术史？ o 阵发痛（单纯、机械性）还是