急腹症英文PPT课件.ppt

急腹症AcuteAbdominalPain 第一附属医院急诊科 1 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 2 前言 Abdominalpainisacomplaintseencommonlyintheoutpatientsetting Thedifferentialdiagnosisofapatientpresentingwithacuteabdominalpains pathophysiologyofthepain theclinicalpresentation Course initialmanagement 3 Afocusedhistoryphysicalexaminationadjunctivetestingstrategy 4 pathophysiologyofthepain Theabdominalvisceraareinnervatedwithnocioceptiveafferentswithinthemesentery onperitonealsurfaces andwithinthemucosaandmuscularisofholloworgans 5 Thepaingenesis Mechanicalstretch ChemicalsubstancePserotoninprostaglandinshydrogenions 6 Stimuli Dullcrampypoorlylocalizedpainsensations 7 Threebroadpatterns visceralParietalreferred 8 Visceral typicallyinvolvesstretchanddistensionoftheabdominalorgans althoughtorsion andcontractionalsocontribute Thepainstimulusiscarriedonslow conductingC fibers 9 dullache Painlocationcorrespondstothosedermatomesthatmatchtheinnervationoftheinjuredorgan 10 Parietal SharpwelllocalizedA fibers witharapidconductionvelocity 11 Referred painoccurswhenvisceralafferentscarryingstimulifromadiseasedorganenterthespinalcordatthesamelevelassomaticafferentsfromaremoteanatomiclocation 12 Furthermore diseaseprocessesfromorgansoutsideoftheabdominalcavitycanpresentwithabdominalpain 13 History assessmentoftheconditionmedicalproblemsmedicationsfamilyhistory substanceabusehistory recenttravelhistoryoccupationalhistory 14 Natureofthepain itsqualityLocationrapidityofonsetChronicityradiation IntensityexacerbatingfactorsalleviatingfactorsAssociatedsymptoms 15 Physicalexamination generalobservation reviewofthevitalsigns abdominalinspectionauscultationpalpation 16 17 Diagnosisofabdominalpainbasedonlocationanddistribution RightupperquadrantPepticulcerdiseaseBiliarydiseaseBiliarycolicCholedocholithiasisCholecystitisCholangitisLiverdiseaseHepatitisNeoplasmAbscessCongestivehepatopathy LungdiseasePneumoniaSubphrenicabscessPulmonaryembolismPneumothoraxAbdominalwallHerpeszosterMuscularStainKidneydiseasePyelonephritisPerinephricabscessNephrolithiasisColoniccausesColitisRightsideddiverticulitis 18 Middleupperabdomen PepticulcerdiseasePancreatiticdiseasePancreatitisPancreaticneoplasmBiliarydiseaseBiliarycolicCholedocholithiasisCholecystitisCholangitis EsophagealdiseaseRefluxesophagitisInfectiousesophagitisPillesophagitisCardiacdiseaseMyocardialischemiainfarctionPericarditisAAArupture aorticdissectionMesentericischemia 19 Leftupperquadrant PepticulcerdiseaseSplenicdiseaseSplenicruptureSplenicinfarctPancreaticdiseasePancreatitisPancreaticneoplasm LungdiseasePneumoniaSubphrenicabscessPulmonaryembolismPneumothoraxKidneydiseasePyelonephritisPerinephricabscessNephrolithiasis 20 Periumbilical Appendicitis early SmallbowelobstructionGastroenteritisMesentericischemiaAAAruptureAorticdissection 21 Rightlowerquadrant AppendicitisInflammatoryboweldiseaseOB GYNcausesOvariantumorOvariantorsionEctopicpregnancyPelvicinflammatorydisease PID KidneydiseasePyelonephritisPerinephricabscessNephrolithiasisIntestinaldiseaseRightsideddiverticulitisIleocolitisGastroenteritisHernia 22 Suprapubic InflammatoryboweldiseaseOB GYNcausesOvariantumorOvariantorsionEctopicpregnancyPIDDysmenorrhea ColonicdiseaseProctocolitisDiverticulitisUrinarytractdiseaseCystitisNephrolithiasisProstatitis 23 Leftlowerquadrant InflammatoryboweldiseaseOB GYNcausesOvariantumorOvariantorsionEctopicpregnancyPIDKidneydiseasePyelonephritisPerinephricabscessNephrolithiasis IntestinaldiseaseSigmoiddiverticulitisIleocolitisGastroenteritisHernia 24 Diffuse GastroenteritisBowelobstructionPeritonitisMesentericischemiaInflammatoryboweldiseaseDiabeticketoacidosisPorphyriaUremia HypercalcemiaSicklecellcrisisVasculitisHeavymetalintoxicationOpiatewihdrawalFamilialmediterraneanfeverHereditaryangioedema 25 basedonhistoryandphysicalalone Physicianswereabletocorrectlydifferentiatebetweenorganicandnonorganiccausesofabdominalpainnearly80 26 significantabnormalityofthevitalsigns mentalstatuschanges involuntaryguarding reboundabdominaltenderness completeabsenceofbowelsounds andpainoutofproportiontoabdominaltenderness 27 withoutsignsorsymptomsofanacuteabdominalcatastrophe anacuteexpeditedoutpatientevaluationshouldbeperformed 28 laboratoryandimagingstudies plainabdominalradiographshavebeentheinitialimagingtestofchoice rapidlyatarelativelylowcost 29 upto60 ofcasesofsuspectedsmallbowelobstruction withaperforatedviscus sensitivityofplainfilmsisreportedtobeashighas100 assmallas1to2ccofairhasbeenreportedusingthismethod 30 CTissensitiveforthediagnosis rapidhelicalscanningmethods advancesinintravenousandoralcontrastagents three dimensionalreformatting 31 Computedtomographyhasproventobemoresensitiveandspecificfornearlyalletiologiesofacuteabdominalpain 32 33 34 thereisaspectrumofsystemicmedicaldisorders suchasadrenalinsufficiency diabeticketoacidosis porphyriathatcanpresentwithabdominalpain 35 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 非手术治疗疗效明显 病情危重 全身