简体英文版腹膜炎ppt课件.ppt

1 急性化脓性腹膜炎 AcuteSuppurativePeritonitis 2 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 3 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 4 5 6 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 7 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 8 二 病因 Etiology 原发性腹膜炎PrimaryPeritonitis 1 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Directinvasion 4 透壁性感染Transmuralinfection肝硬化 肾病时 肠道细菌易位 9 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 10 三 病理生理Pathophysiology 11 12 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 13 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 14 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 15 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 16 17 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 18 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 19 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 20 Peritonealabscess 腹腔脓肿 膈下脓肿subphrenic 盆腔脓肿PelvicAbscess 肠间脓肿InterloopAbscess 21 膈下脓肿临床表现全身症状 不明原因持续发热toxicsymptomsfever abdominalpainreoccurseveraldaysafterrecoveryof acuteperitonitis infectionofintra abdominalviscus abdominaloperation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 22 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 23 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 24 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 25 AbstractofaMedicalHistoryAmalepatientof30wasadmitted complainingofintermittentabdominalpainfor10yearswhichwasmoremarkedinthepast6hours Tenyearsago hebegantohaveepisodesofpainovertheepigastriumpersistedfordaysorevenweeksateachtime oftenassociatedwithdietaryindiscretion Sometimeshehadnocturnalabdominalpain severeenoughtowakeuphimfromsleepattimes butbothfood alkalinemedicinesmayrelievethepain Suchepisodesoccurredalmostonceayear 6hoursago hesuddenlysufferedfromsevereupperabdominalpainwhichspreadtothewholeabdomen accompaniedwithnausea vomiting 26 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 6 109 LN0 89 L0 11Discussthediagnosis criteria thrapeuticplan 27 Answers1 Diagnosis Perforationofpepticulcercomplicatedwithacutegeneralizedperitonitis 28 2 Diagnosticevidence intermittentabdominalpain relievedbyfood alkalinemedicines rhythmic nocturnalabruptsevereupperabdominalpain spreadtothewholeabdomen withnausea vomiting 29 P E T38 5 P105 min acutelyill looking Abdomenboard likerigidwithmarkedtenderness reboundtendernessespeciallyinepigastrium liverdullness bowelsounds Accessoryexaminations 1