甲状腺疾病(英文版)PPT课件.ppt

ThyroidDisorders 1 WordList Thyroiddisorders甲状腺病症Isthmus峡部Thyroxine甲状腺素Triiodothyronine三碘甲状腺氨酸Parathyroidglands甲状旁腺Calcitonin降钙素 2 Recurrentlaryngealnerve喉返神经Hyperthyroidism甲亢Hypothyroidism甲减Goitre甲状腺肿Exophthalmos突眼症Tremor震颤TSH促甲状腺激素 3 Thyroidectomy甲状腺切除术Thyroidcrisis甲状腺危象Atracheostomyset气管切开包Tetamy手足抽搐 4 ThyroidGland Itisapartoftheendocrine 内分泌 system playsamajorroleinregulatingthebody smetabolism 5 Section1 Anatomy physiologyofthyroid 6 PlaceBloodsupplyNervessupplyFunctions Anatomy physiologyofthyroid 7 Locatedinthelowerneckanteriortothetrachea Twolaterallobesconnectedbyanisthmus 峡部 Butterfly shapedorgan5cmlong 3cmwide 30gTheparathyroidglands 甲状旁腺 lyingonthedorsalside 背面 ofthethyroidgland 8 Rich fromthesuperiorandinferiorthyroidartery Artery Thearterialbranchesprovidebloodsupplytootherstructuresinthearea Theinteriorthyroidarteryprovidesbranchestothepharynx tracheaandesophagus Vein 1 Thesuperiorthyroidvein2 Themiddlethyroidvein3 Theinferiorthyroidvein 9 Thenervessupplyingthethyroidoriginatefromvagus 迷走神经 innervatetheepithelialcells 上皮细胞 ofthefollicles 滤泡 ofthethyroidgland Onemustbeawareofthebilateralexistenceofarecurrentlaryngealnerve 喉返神经 duringdissection 10 Produces synthesizes stores andsecretesTwoHormonesCalledThyroxine T4 Thyronine T3 RegulatesMetabolismsoYourCellsFunctionProperlyAffectsEveryCellintheBody necessaryfornormalgrowthanddevelopment 11 Commondisorder AdeficiencyofiodineOtherdisorder AutoimmunethyroiddiseaseClassification Hyperthyroidism 甲亢 hypothyroidism 甲减 tumours cancerorgoitre 甲状腺肿 12 WhentheThyroidDoesn tWork HyperthyroidismTooMuchThyroidHormoneMetabolismSpeedsUp HypothyroidismTooLittleThyroidHormoneMetabolismSlowsDown 13 Hyperthyroidism 甲状腺功能亢进 14 Definition Hyperthyroidismisanimbalanceofmetabolismcausedbyoverproductionofthyroidhormone 15 Cause Increasedsecretionofthyroidhormone Females males 4 1 ittendstoaffectmalesmoreseverely Incidence 20 40yearsoldgroup 16 ClinicalManifestation GoiterExophthalmos 突眼征 IncreasedmetabolicrateIncreasedfunctionofsympatheticnerve 交感神经 Cardiovascularalteration 17 Thethyroidcanbepalpatedforasymmetry 不对称 andsize Itmayenlarge3 4timestoitsnormalsize Itiscalledgoitre 18 Hyperthyroidism 19 20 Asaresultofincreasedthyroidhormoneproduction theclienthasanincreasedmetabolicrate Weightlossdespiteincreasedappetite fatigue poortolerancetoheat andprofuseperspiration menstrualirregularities 21 Nervous restlessness irritability difficultyconcentrating emotionalliability moodswings personalitychanges Finetremorsofthefingersandtongue shakyhandwriting clumsiness troubleinclimbingstairs ordyspneapossiblyatrest 22 Theskiniswarmandmoist characteristicsalmoncolour 鲜肉色 Thehairisfineandsoftwithprematuregreyandincreasedhairloss Thenailsappearfragilewithdistalnailseparationfromthenailbed 23 Tachycardia 160bpmanddownto80bpmduringsleep Pulsepressureiswidened Therecanbemuscularweaknessandatrophy 萎缩 paralysis 瘫痪 24 DiagnosticTests TSH 促甲状腺激素 T3 T4Radioactiveiodineuptake 131 ThyroidscanMensurationofbasicmetabolismrate BMR 25 TSH Thyroid StimulatingHormone normalTSHreflectaeuthyroid 甲状腺机能正常的 state Hyperthyroidism TSHisloworabsent Inmildformsofhyperthyroidism slightlyabnormal 26 ThyroidscanScanarehelpfulindetermininglocation size shape andanatomicfunctionofthethyroidgland 27 MensurationofBasicMetabolismRate BMR Conditions Earlyinthemorning emptystomach atthetimeofrestBasicMetabolismRate Pulserate Pulsepressure 111 28 Grade Normal 10 Slightlyabnormal 20 30 Moderatelyabnormal 30 60 Seriouslyabnormal 60 29 Treatment Antithyroiddrugs radioactiveiodine orthyroidectomy 甲状腺切除术 Individualizedanddependsontheageandgeneralstateofhealth thesizeofthegoiterandtheabilitytoobtainfollow upcare 30 Partialorcompletethyroidectomymaybecarriedoutasprimarytreatment Thetypeandextentofthesurgerydependonthediagnosis goalofsurgery andprognosis 31 SurgicalIndications AverylargegoiteroramultinodulargoiterwithrelativelylowradioactiveiodineuptakeMalignantthyroidnodulePsychologicallyormentallyincompetentpatients 32 Surgery Aportionofthethyroidglandisremoved butatotalthyroidectomymaybeperformed expensive risks Indicationsforsubtotalthyroidectomy themainadvantagesarerapidcontrolofthediseaseandalowerincidenceofhypothyroidismthancanbeachievedwithradioiodinetreatment 33 Surgery Ifapartialthyroidectomyisdone theremainingthyroidtissueshouldprovideadequateamountsofthyroidhormones Ifacompletethyroidectomyisdone theclientwillrequirethyroidhormonereplacementforalifetime 34 Theneckisextendedandasymmetrical gentlycurvedincisionismade1to2cmabovetheclavicle 锁骨 Closureofthewoundisaccomplishedbythestrapmusclesinthemidline Asmallsuctioncatheterisusuallyinsertedthroughastabwound 35 Complicationsaftersurgery Dyspnea asphyxiaInjuryoflaryngealnerveSpasmsThyroidcrisis 甲状腺危象 36 HaemorrhageHaematoma 血肿 formationTrachealcollapse 气管塌陷 TrachealmucousaccumulationLaryngealorlocaltissueedema Cause 37 Complicationsaftersurgery Respiratorydistressandhaemorrhage Difficultyinrespirationwhichistheoccurswithinafterthesurgery mostcriticalcomplication 48hours 38 Management Surgicalevacuationisrequired ThefirstaidbythebedA cutoffthesutureB openedthewoundwideC removedthehematomaThetracheaiscut applyoxygenSendtotheoperationroomforfurthertreatment 39 Preventiveinterventions Atracheostomyset 气管切开包 iskeptatthepatient sbedsideatalltimes andthesurgeonissummonedatthefirstindicationofrespiratorydistress 40 Injuryoflaryngealnerve Anyvoicechangesarenotedbecausetheymightindicateinjurytotherecurrentlaryngealnerve 喉返神经 whichliesjustbehindthethyroidnexttothetrachea Talkaslittleaspossible Canbecuredspontaneously orbyphysicaltherapy 41 Spasm Theparathyroidglandsmaybeinjuredorremoveddisturbanceofthecalciummetabolismofthebodybloodcalciumlevelfallsspasmsofthehandsandfeetandmusculartwitching tetany laryngospasm 42 Management TemporaryLimittakingofmeat eggswhicharehighinphosphorus 磷 UseofthesedativetocontrolthepainIntravenousadministrationofcalciumgluconate葡萄糖酸钙 43 Thyroidcrisis storm Reason insufficientpreoperativepreparation areleaseoflargeamountsofthyroidhormone rareOutcome canleadtocardiac hepaticorrenalfailure Stressfulfactors surgery infectionortrauma pregnancy 44 Timeofoccurring thefirst12hourspostoperative Clinicalmanifestation Tachycardia 130bmp T 39 sometimes 41 ExaggeratedsymptomsofhyperthyroidismDisturbancesofamajorsystem 45 Gastrointestinal diarrhea abdominalpain Neurologic psychosis somnolence coma Cardiovascular edema chestpain dyspnea palpitations 46 Fatalness Theclientmaydevelopcongestiveheartfailureanddie Preventions Thekeyistodothepreoperativepreparationsufficiently andperformthesurgeryuntiltheBMRbecomenormal 47 MedicalManagement Thephysicianmustbeinformedimmediately TransferthepatienttotheintensivecareforclosermonitoringIodineisadministeredtodecreasetheoutputofthyroidhormone TakeKIsolution3mlorally orput10 iodinesodium5mlintoin10 glucose andgiveivinjectiontothepatient 48 200 400mgHydrocortisone氢化可的松isprescribedtotreatshockoradrenalinsufficiency Theusageofsedative luminal鲁米纳Q6 8h Reducebodytemperatureandheartrateandtopreventvascularcollapse 37 Alargeamountofglucoseareneeded 49 Oxygentherapy HumidifiedoxygenisadministeredtoimprovetissueoxygenationandmeetthehighmetabolicdemandsCardiacproblems arterialfibrillation andcongestiveheartfailure sympatholyticagentsmaybeadministered suchaspropranolol 心得安 50 Preoperativecare PerfectpreoperativecareBaselineinformationPharmacologictherapyMentalsupportNutritionInstruction 51 Pharmacologictherapy Itisnecessaryforsurgicaltreatment butitcannotactasatherapueticmedication Encouragesthepatienttotakethemedicationsasprescribed Iodinepreparationsmayhavebeenprescribed10to14daysbeforesurgerytodecreasethyroidvascularityanddecreasebleeding 52 2to5dropsofpotassiumiodidesolution 复方碘化钾 orLugol siodinesolution 卢戈氏液 aregiveninconjunctionwithpropylthiouracil 丙基硫尿嘧啶 todecreasethefriabilityandvascularityofthethyroid itshouldbeapplieduntilthetimeofoperationandthepatientbecameeuthyroid 53 Requirement euthyroidPatient smoodissteady thesleeptakesafavorableturn gainweight pulserate 90times min BasicMetabolismRate 20 情绪稳定 睡眠正常 体重增加 心跳正常 代谢恢复 54 Nutrition Severalwell balancedmealsofsmallamount evenuptosixmealsaday Highlyseasonedfoodsandstimulants suchascoffee tea cola andalcoholarediscouraged High calorie high proteinfoodsareencouraged 55 Preoperativeteaching Howtosupporttheneckwiththehandsaftersurgerytopreventstressontheincision Eyecareandprotectionmaybecomenecessary correctinstillationofeyedropsorointmentprescribedtosoothetheeyesandprotecttheexposedcornea 56 Postoperativecare PositionObservationOxygenNutritionMedicationHealthinstruction 57 Observation Cardiacandrespiratoryf