急腹症英文版课件

Intestinal Obstuction,Hua-dan Xue 2008-11-30,Ileus (intestinal obstruction),Mechanical intestinal obstruction Simple obstruction：occlusion/constriction of bowel lumen Strangulated obstruction：impaired blood supply of obstructed segment Ileus (adynamic/non-obstructive) Paralytic & spasm Derangement impairing proper distal propulsion of intestinal contents,Cautions to barium exam due to the possibility of obstruction aggravating,Classification - location,Gastric outlet obstruction: Only one/two air-fluid levels Homogeneous mass displacing transverse colon Duodenal obstruction: Double-bubble sign; Frequently normal due to absence of gas from vomiting,Classification - location,Jejunal and ileal obstruction: Candy cane: 3 loops+3cm gas-fluid levels+35 hours onset Disparity in size between obstructed and normal loops Little/no gas + stool in colon with complete mechanical obstruction after 12-24 hours Stepladder appearance; string-of-bead;,Cave: fluid-distended loops may lead one to overlook obstruction!,Mechanical obstruction,Classification - location,Colonic obstruction Dilated colon only Dilated small bowel (incompetent ileo-cecal valve) Gas-fluid levels distal to hepatic flexure (fluid is normal in cecum and ascending colon) Cecum most dilated portion (10cm will be critical),Classification location,Localized ileus Causes: often associated with adjacent acute inflammatory process (acute pancreatitis, acute appendicitis, etc.) Sentinel loop: loops near the local peritonitis Closed-loop obstruction,Closed-loop obstruction,Closed-loop obstruction Fixation of bowel loop: Coffee bean sign: gas filled loop Pseudo-tumor: fluid-filled loop U-shaped dilated bowel loop Increasing intra-luminal fluid Beak sign: point of obstruction Whirl sign: twisting of bowel,Closed-loop obstruction Large volvulus,Beak sign,Classification - etiology,机械性肠梗阻 单纯性肠梗阻：肠管通畅性障碍 绞窄性肠梗阻：肠管通畅性障碍伴有血运障碍 动力性肠梗阻 麻痹性肠梗阻： 痉挛性肠梗阻： 血运性肠梗阻：肠系膜动脉血栓或栓塞所致,钡剂造影须慎重使用，钡剂吸收水分会加重梗阻,单纯性肠梗阻,阶梯状气液平 大跨度肠袢 鱼肋征,绞窄性肠梗阻 Strangulated obstruction,Triad: closed-loop obstruction of the involved segment (majority of cases) Mechanical obstruction proximal to the involved segment Venous congestion of the involved loop Abdominal plain film : signs for volvulus（肠扭转） or closed-loop obstruction + bowel thickening CT has 63%100% detection rate! Poor/no enhancement of bowel wall Mesenteric haziness due to edema,绞窄性肠梗阻,假肿瘤征： 两端闭锁的绞锁肠段内充满大量液体，仰卧位呈肿块影，而站立位或侧卧位水平位片上则在该肿瘤块影上部见一短小的液面 咖啡豆征：闭襻 小跨度蜷曲肠襻：肠系膜增厚缩短 长液面征：张力低、血性液体 空回肠换位征：小肠扭转,肠扭转,小肠扭转：空回肠换位、花瓣样或香蕉样排列,麻痹性肠梗阻 Ileus,Causes: postoperative intraabdominal inflammation ischemic bowel disease Large + small bowel gastric distension Decreased small bowel distension in serial films Delayed but free passage of contrast material,Strangulated obstruction,Triad: Closed-loop obstruction of the involved segment (majority of cases) Mechanical obstruction proximal to the involved segment Venous congestion of the involved loop Abdominal plain film : Signs for volvulus or closed-loop obstruction + bowel thickening CT has 63%100% detection rate! Poor/no enhancement of bowel wall Mesenteric haziness due to edema,Comparison - Simple obstruction,Stepladder gas-fluid level Large span loop Fish-rib appearance,Comparison - Strangulated obstruction,Pseudo-tumor Coffee bean sign：closed loop Small span loop：shortening of mesentery Long gas-fluid level：low tension Displacement of jejunum and ileum,Volvulus,Small intestine volvulus： displacement of ileum and jejunum, banana-like flower-leaves-like form (representing the twisting bowel),Ileus (paralytic ),Causes: Postoperative Intra-abdominal inflammation Ischemic bowel disease Large + small bowel gastric distension Decreased small bowel distension in serial films Delayed but free passage of contrast material,Finding the reasons,Post-operation Infection Intussusception Thrombosis Tumor (extrinsic and intrinsic bowel) Congenital,Intestinal obstruction,Modalities, Methods and indications 1、Plain abdominal film：acute perforation and obstruction of bowel 2、Barium enema：diagnose and therapy of obstructive disorders, e.g. intussusception, volvulus 3、CT scan：all kinds