简体英文版腹膜炎PPT课件.ppt

急性化脓性腹膜炎(AcuteSuppurativePeritonitis),本章目的要求,掌握急性腹膜炎的临床表现、诊断和鉴别诊断。熟悉化脓性腹膜炎的病因、分类和病理生理。熟悉急性腹膜炎的治疗方法的选择。了解腹腔脓肿的临床表现、诊断和治疗。,一、解剖生理概要（Anatomicalphysiology）腹膜Peritoneum壁腹膜脏腹膜腹腔PeritonealCavity大腹腔小腹腔,神经支配（NerveSupply）壁腹膜ParietalPeritoneum躯体神经对刺激敏感，疼痛定位准确锐痛腹膜炎体征压痛Tenderness反跳痛ReboundTenderness腹肌紧张Involuntarymusclespasm/Rigidity脏腹膜VisceralPeritoneum自主神经对牵引、张力、炎症刺激敏感，定位差钝痛消化道症状：恶心Nausea呕吐Vomiting,腹膜结构和功能结构（Structure）：一层扁平的间皮细胞Mesothelium面积约1.8m2双向的半透性膜。功能（Function）：分泌功能Secretion吸收功能Absorption防御功能Defense修复功能Repair,二、病因（Etiology）原发性腹膜炎PrimaryPeritonitis1)血行播散Bloodstream溶血性链球菌肺炎双球菌2)上行感染Ascendinginfection生殖、泌尿系感染3)直接扩散Directinvasion4)透壁性感染Transmuralinfection肝硬化、肾病时，肠道细菌易位,继发性腹膜炎SecondaryPeritonitis1、脏器穿孔破裂:化学性腹膜炎细菌性腹膜炎2、炎症扩散inflammation3、损伤Injury4、坏死Necrosis5、手术污染Contamination6、吻合口漏AnastomosisLeakage,三、病理生理Pathophysiology,四、临床表现（ClinicalManifestations）症状Symptoms腹痛AbdominalPain恶心Nausea、呕吐Vomiting全身症状systemicsymptoms发热、脉速、气促、大汗、口干，甚至休克,腹部体征（Abdominalsigns）视诊（Inspection）腹部隆起，腹式呼吸减弱或消失触诊（Palpation）腹膜炎体征Peritonealsigns压痛Tenderness反跳痛ReboundTenderness腹肌紧张Involuntarymusclespasm/Rigidity,叩诊Percussion鼓音Tympany移动性浊音ShiftingDullness听诊Auscultation肠鸣音BowelSounds减弱Diminished消失Disappear直肠、阴道检查Rectal&VaginalExaminations盆腔感染PelvicInfection盆腔脓肿PelvicAbscess,五、辅助检查AccessoryExamination1.血常规：WBC中性粒细胞比例2.腹部立位平片：膈下游离气体3.腹腔穿刺：抽出异常液体4.B超：腹腔积液，肠管扩张5.CT：实性脏器，腹腔积液,六、诊断Diagnosis1.病史History2.体格检查PhysicalExamination腹膜炎体征压痛Tenderness反跳痛ReboundTenderness肌紧张Rigidity3.辅助检查（AccessoryExamination）目的在于鉴别原发病和腹膜炎的类型,治疗（Treatment）非手术治疗（NonoperativeTreatment）1、体位Posture半卧位semisupineposition2、禁食、胃肠减压fasting,gastrointestinaldecompression3、纠正水电解质紊乱FluidandElectrolyteImbalance4、抗生素治疗AntibioticTherapy5、营养支持NutritionalSupport,手术治疗（OperativeTreatment）1.去除病因剖腹探查2.清理腹腔（CleaningtheAbdominalCavity）(1)清洁腹腔Cleaning(2)腹腔灌洗lavage3.充分引流Drainage4.术后处理PostoperativeManagement,半卧位semi-supineposition,Peritonealabscess,腹腔脓肿,膈下脓肿subphrenic,盆腔脓肿PelvicAbscess,肠间脓肿InterloopAbscess,膈下脓肿临床表现全身症状：不明原因持续发热toxicsymptomsfever&abdominalpainreoccurseveraldaysafterrecoveryofacuteperitonitisinfectionofintra-abdominalviscusabdominaloperation局部症状：不典型，可有疼痛（腹痛、胸痛、肩痛）呃逆hiccup/hiccough诊断B超引导诊断性穿刺CT,治疗Treatment1、经皮穿刺插管引流术PercutaneousAbscessDrainage,PAD2、切开引流术OpenTransabdominalincisionanddrainage,预防preventionrelativelylowspaceinsupineposition半卧位semi-supineposition,盆腔脓肿PelvicAbscess临床表现全身症状直肠刺激症状里急后重尿路刺激症状诊断Diagnosis直肠或阴道检查B超&CT治疗Treatment盆腔引流PelvicDrainage,肠间脓肿InterloopAbscess单发脓肿多发脓肿症状体征不典型Fever,pain,abdominaldistentionileus&sometimesapalpablemass诊断DiagnosisB超&CT治疗：surgicalintervention,预防prevention半卧位semi-supineposition,AbstractofaMedicalHistoryAmalepatientof30wasadmitted,complainingofintermittentabdominalpainfor10yearswhichwasmoremarkedinthepast6hours.Tenyearsago,hebegantohaveepisodesofpainovertheepigastriumpersistedfordaysorevenweeksateachtime&oftenassociatedwithdietaryindiscretion.Sometimeshehadnocturnalabdominalpain,severeenoughtowakeuphimfromsleepattimes,butbothfood&alkalinemedicinesmayrelievethepain.Suchepisodesoccurredalmostonceayear.6hoursago,hesuddenlysufferedfromsevereupperabdominalpainwhichspreadtothewholeabdomen,accompaniedwithnausea&vomiting.,P.E:T38.5,P105/min,R21/min,BP120/80mmHgNormallydeveloped&mentallyclearbutacutelyill-looking.Nojaundiceonskinorsclerae.Superficiallymphnodesnotpalpable.Necksoftandsupple.Tracheainmidline.Thyroidnotenlarged.Heart&lungsnotabnormal.Abdomenflat&board-likerigidwithmarkedtenderness&reboundtendernessespeciallyinepigastrium,togetherwithdecreasedliverdullness.Spleennotpalpable.Bowelsoundsdecreased.Nopathologicalreflexesfound.X-ray&Laboratoryfindingsreveal:1.X-ray:freeairunderdiaphragm2.Bloodpicture:Hb98g/l,WBC15.6109/LN0.89,L0.11Discussthediagnosis,criteria&thrapeuticplan?,Answers1.Diagnosis:Perforationofpepticulcercomplicatedwithacutegeneralizedperitonitis,2.Diagnosticevidenceintermittentabdominalpain,relievedbyfood&alkalinemedicines.rhythmic&nocturnalabruptsevereupperabdominalpain,spreadtothewholeabdomen,withnausea&vomiting.,P.E:T38.5,P105/min,acutelyill-looking,Abdomenboard-likerigidwithmarkedtenderness&reboundtendernessespeciallyinepigastrium,liverdullness&bow