肠梗阻的诊断

肠梗阻 Intestinalobstruction The2ndaffiliatedhospitalofKunmingMedicalCollegeTangHaoran definitionpathologyandPathophysiologicalclassificationclinicalmanifestationsaccessoryexaminationtherapy Definition Foranyreasonarisingfromthenormalintestinalcontentsshouldnotrunsuccessfullythroughtheintestinaltract calledintestinalobstruction pathologyandPathophysiological classification 一 按梗阻发生的原因分类机械性mechanical动力性dynamicproperty血运性revascularization 二 按肠壁血运有无障碍分类单纯性simple绞窄性strangulated 三 按梗阻部位分类高位小肠highorder低位小肠loworder结肠梗阻colonicobstruction 四 按梗阻程度分类完全性complete不完全性incomplete 机械性肠梗阻常见病因 A blockofintestinal ascarid 机械性肠梗阻常见病因 B intestinalisrepressedbyincarceratedhernia bandinabdomen 机械性肠梗阻常见病因 C pathologicalchangesofintestinal inflammatory cancer 动力性肠梗阻 麻痹性肠梗阻paralyticileus痉挛性肠道梗阻spasticbowelobstruction 血运性肠梗阻 thrombusinveinorartery Colonicobstruction closedloopintestinalobstruction Intestinalobstruction Clinicalmanifestations vomit swollen pain obstruct commonexperience pain Mechanical paroxysmandtwistedRevascularization continuedandviolentStrangulated spread continuedandviolent vomit Upper formerandoften contentsarefluidinstomachorintestinal bileLower latebutmorecontentsinonetime justlikefaecesColonicobstruction lateandless likefaecesParalytic lateandlightStrangulated continuedandviolent likestaledblood swollen Upper notobvious shapelikestomachLower obviousandinallabdomenParalytic early obviousandalsoinallabdomenclosedloopintestinalobstruction notsymmetry obstruct upper remainsfaecesandgasinearlyperiodStrangulated faeceswithslimeandblood 体征 physicalsign 视诊 可见到肠型和蠕动液 腹胀情况触诊 有无腹膜剌激征 有无包块叩诊 鼓音 移动性浊者情况听诊 肠鸣音情况机械性麻痹性直肠指诊 全身情况 accessoryexamination 血常规血生化尿常规粪便及呕吐物检查 小肠梗阻 X线站立位时见小肠 阶梯样 液平ladder平卧位时见积气肠管进入盆腔 accessoryexamination ParalyticX线平片 见小肠 snack 结肠均胀气明显 StrangulatedX线平片 见孤立性肠襻 结肠梗阻 CT平扫见结肠肠腔扩张及结肠内气液平 gas liquidborder 肠套叠乙状结肠扭转 空气灌肠可见肠套叠处呈 杯口 cup 状改变 钡剂灌肠X线检查见扭转部位钡剂受阻 钡影尖端呈 鸟嘴 形 诊断思路 summary 1 是否肠梗阻