急腹症英文.ppt

急腹症AcuteAbdominalPain 第一附属医院急诊科 概念 外科急腹症是一组以急性腹痛为主要表现 绝大多数需要紧急外科手术处理的急性炎症 出血 梗阻 穿孔及血运障碍性疾病的总称 inflammation bleed gastricperforation ischemiaofintestine Thetermacuteabdomenreferstoasudden severeabdominalpainofunclearetiology thatislessthan24hoursinduration Itisinmanycasesamedicalemergency requiringurgentandspecificdiagnosis Severalcausesneedsurgicaltreatment 前言 Abdominalpainisacomplaintseencommonlyintheoutpatientsetting Thedifferentialdiagnosisofapatientpresentingwithacuteabdominalpains pathophysiologyofthepain theclinicalpresentation Course initialmanagement Afocusedhistoryphysicalexaminationadjunctivetestingstrategy pathophysiologyofthepain Theabdominalvisceraareinnervatedwithnocioceptiveafferentswithinthemesentery onperitonealsurfaces andwithinthemucosaandmuscularisofholloworgans Thepaingenesis Mechanicalstretch ChemicalsubstancePserotoninprostaglandinshydrogenions Stimuli Dullcrampypoorlylocalizedpainsensations Threebroadpatterns visceralParietalreferred Visceral typicallyinvolvesstretchanddistensionoftheabdominalorgans althoughtorsion andcontractionalsocontribute Thepainstimulusiscarriedonslow conductingC fibers dullache Painlocationcorrespondstothosedermatomesthatmatchtheinnervationoftheinjuredorgan Parietal SharpwelllocalizedA fibers witharapidconductionvelocity Referred painoccurswhenvisceralafferentscarryingstimulifromadiseasedorganenterthespinalcordatthesamelevelassomaticafferentsfromaremoteanatomiclocation Furthermore diseaseprocessesfromorgansoutsideoftheabdominalcavitycanpresentwithabdominalpain History assessmentoftheconditionmedicalproblemsmedicationsfamilyhistory substanceabusehistory recenttravelhistoryoccupationalhistory Natureofthepain itsqualityLocationrapidityofonsetChronicityradiation IntensityexacerbatingfactorsalleviatingfactorsAssociatedsymptoms Physicalexamination generalobservation reviewofthevitalsigns abdominalinspectionauscultationpalpation Diagnosisofabdominalpainbasedonlocationanddistribution RightupperquadrantPepticulcerdiseaseBiliarydiseaseBiliarycolicCholedocholithiasisCholecystitisCholangitisLiverdiseaseHepatitisNeoplasmAbscessCongestivehepatopathy LungdiseasePneumoniaSubphrenicabscessPulmonaryembolismPneumothoraxAbdominalwallHerpeszosterMuscularStainKidneydiseasePyelonephritisPerinephricabscessNephrolithiasisColoniccausesColitisRightsideddiverticulitis Middleupperabdomen PepticulcerdiseasePancreatiticdiseasePancreatitisPancreaticneoplasmBiliarydiseaseBiliarycolicCholedocholithiasisCholecystitisCholangitis EsophagealdiseaseRefluxesophagitisInfectiousesophagitisPillesophagitisCardiacdiseaseMyocardialischemiainfarctionPericarditisAAArupture aorticdissectionMesentericischemia Leftupperquadrant PepticulcerdiseaseSplenicdiseaseSplenicruptureSplenicinfarctPancreaticdiseasePancreatitisPancreaticneoplasm LungdiseasePneumoniaSubphrenicabscessPulmonaryembolismPneumothoraxKidneydiseasePyelonephritisPerinephricabscessNephrolithiasis Periumbilical Appendicitis early SmallbowelobstructionGastroenteritisMesentericischemiaAAAruptureAorticdissection Rightlowerquadrant AppendicitisInflammatoryboweldiseaseOB GYNcausesOvariantumorOvariantorsionEctopicpregnancyPelvicinflammatorydisease PID KidneydiseasePyelonephritisPerinephricabscessNephrolithiasisIntestinaldiseaseRightsideddiverticulitisIleocolitisGastroenteritisHernia Suprapubic InflammatoryboweldiseaseOB GYNcausesOvariantumorOvariantorsionEctopicpregnancyPIDDysmenorrhea ColonicdiseaseProctocolitisDiverticulitisUrinarytractdiseaseCystitisNephrolithiasisProstatitis Leftlowerquadrant InflammatoryboweldiseaseOB GYNcausesOvariantumorOvariantorsionEctopicpregnancyPIDKidneydiseasePyelonephritisPerinephricabscessNephrolithiasis IntestinaldiseaseSigmoiddiverticulitisIleocolitisGastroenteritisHernia Diffuse GastroenteritisBowelobstructionPeritonitisMesentericischemiaInflammatoryboweldiseaseDiabeticketoacidosisPorphyriaUremia HypercalcemiaSicklecellcrisisVasculitisHeavymetalintoxicationOpiatewihdrawalFamilialmediterraneanfeverHereditaryangioedema basedonhistoryandphysicalalone Physicianswereabletocorrectlydifferentiatebetweenorganicandnonorganiccausesofabdominalpainnearly80 significantabnormalityofthevitalsigns mentalstatuschanges involuntaryguarding reboundabdominaltenderness completeabsenceofbowelsounds andpainoutofproportiontoabdominaltenderness withoutsignsorsymptomsofanacuteabdominalcatastrophe anacuteexpeditedoutpatientevaluationshouldbeperformed laboratoryandimagingstudies plainabdominalradiographshavebeentheinitialimagingtestofchoice rapidlyatarelativelylowcost upto60 ofcasesofsuspectedsmallbowelobstruction withaperforatedviscus sensitivityofplainfilmsisreportedtobeashighas100 assmallas1to2ccofairhasbeenreportedusingthismethod CTissensitiveforthediagnosis rapidhelicalscanningmethods advancesinintravenousandoralcontrastagents three dimensionalreformatting Computedtomographyhasproventobemoresensitiveandspecificfornearlyalletiologiesofacuteabdominalpain thereisaspectrumofsystemicmedicaldisorders suchasadrenalinsufficiency diabeticketoacidosis porphyriathatcanpresentwithabdominalpain 外科急腹症的治疗原则 非手术治疗适应证就诊时腹膜炎已局限且病人全身情况良好 就诊时不明确且又无紧急手术指证 出血性疾病经输血治疗 血压回升 病情稳定无再出血表现 诊断明确 非手术治疗疗效