小肠疾病英文课件

1、Intestinal obstructionIntestinal obstructionAnatomyThe jejunal mucosa is relatively thick with prominent plicae circulares; the mesenteric vessels form only one or two arcades with long vasa recta. The ileum is smaller in circumference and has thinner walls; the mesenteric vessels form multiple vasc

2、ular arcades with short vasa recta.AnatomyThe jejunal mucosa is r Blood supply to the jejunoileum and distal duodenum is entirely from the superior mesenteric artery, which courses anterior to the third portion of the duodenum. The celiac artery supplies the proximal duodenum. Blood supply to the je

3、jPhysiologyPhysiologyMotility: Peristalsis consists of intestinal contractions passing aborally at a rate of 1 to 2 cm/seccontractions initiated by the migrating myoelectric complex (MMC) under the control of both neural and humoral pathwaysMotility: Peristalsis consistsENDOCRINE FUNCTIONENDOCRINE F

4、UNCTIONObstructionEtiology: Common causes of small bowel obstruction in industrialized countries:ObstructionEtiology:Clinical Manifestations and DiagnosisCardinal symptoms: colicky abdominal pain nausea vomiting abdominal distention failure to pass flatus and fecesClinical Manifestations and DiPhysi

5、cal Examdistended abdomenperistaltic wavesminimal or no bowel soundsMild abdominal tenderness with / without a palpable massExam to rule out incarcerated herniasRectal examPhysical Examdistended abdomenRadiologic and Laboratory ExaminationsPlain abdominal radiographs: accuracy60% -dilated loops of s

6、mall intestine without evidence of colonic distention -multiple air-fluid levels, often in a stepwise pattern -demonstrate the cause of the obstructionCT: for more complex casesRadiologic and Laboratory Exam小肠疾病英文课件Plain abdominal film shows complete bowel obstruction caused by a large radiopaque ga

7、llstone (arrow) obstructing the distal ileum.Plain abdominal film shows comCT scan of the abdomen of a patient with a mechanical bowel obstruction secondary to an abscess in the right lower quadrant (arrow). Multiple dilated and fluid-filledloops of small bowel are noted.CT scan of the abdomen of a

8、paSimple Vs Strangulating Obstruction“Classic” signs of strangulation:-tachycardia-fever-Leukocytosis-a constant, noncramping abdominal painSimple Vs Strangulating ObstruDifferentiation of partial from complete SBOPartial SBO: pass flatus or liquid stoolsComplete SBO: obstipation Differentiation of

9、partial froDifferentiation of Proximal / distal SBOpain: epigastric / periumbilical area vomiting: prominent / later onsetdistention: no / predominateDifferentiation of Proximal /TreatmentMedical and surgical managementThe overlapping sequence :investigation resuscitation operationThe timing of oper

10、ation depends on three factors: -duration -opportunity of vital organ function -risk of strangulationTreatmentMedical and surgical Medical ManagementNasointestinal /nasogastric intubation Intravenous fluids /blood plasma administrationBroad-spectrum antibiotics administrationMedical ManagementNasointestinSurgical principlesThe nature of problem determines approach to management of SBO.The