甲状腺疾病(英文版)PPT课件

.,1,ThyroidDisorders,.,2,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,.,3,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,.,4,Thyroidectomy甲状腺切除术Thyroidcrisis甲状腺危象Atracheostomyset气管切开包Tetamy手足抽搐,ThyroidGland,Itisapartoftheendocrine(内分泌)system,playsamajorroleinregulatingthebodysmetabolism.,.,6,Section1,Anatomy/physiologyofthyroid,.,7,PlaceBloodsupplyNervessupplyFunctions,Anatomy/physiologyofthyroid,.,8,Locatedinthelowerneckanteriortothetrachea.Twolaterallobesconnectedbyanisthmus（峡部）Butterfly-shapedorgan5cmlong,3cmwide，30gTheparathyroidglands（甲状旁腺）lyingonthedorsalside（背面）ofthethyroidgland.,.,9,Rich,fromthesuperiorandinferiorthyroidartery.Artery:Thearterialbranchesprovidebloodsupplytootherstructuresinthearea.Theinteriorthyroidarteryprovidesbranchestothepharynx,tracheaandesophagus.Vein:1)Thesuperiorthyroidvein2)Themiddlethyroidvein3)Theinferiorthyroidvein,.,10,Thenervessupplyingthethyroidoriginatefromvagus(迷走神经）,innervatetheepithelialcells（上皮细胞）ofthefollicles（滤泡）ofthethyroidgland.Onemustbeawareofthebilateralexistenceofarecurrentlaryngealnerve（喉返神经）duringdissection.,.,11,Produces,synthesizes,stores,andsecretesTwoHormonesCalledThyroxine(T4)Thyronine(T3)RegulatesMetabolismsoYourCellsFunctionProperlyAffectsEveryCellintheBody,necessaryfornormalgrowthanddevelopment,.,12,Commondisorder:AdeficiencyofiodineOtherdisorder:AutoimmunethyroiddiseaseClassification:Hyperthyroidism(甲亢）,hypothyroidism（甲减）,tumours,cancerorgoitre（甲状腺肿）.,.,13,WhentheThyroidDoesntWork,HyperthyroidismTooMuchThyroidHormoneMetabolismSpeedsUp,HypothyroidismTooLittleThyroidHormoneMetabolismSlowsDown,.,14,Hyperthyroidism(甲状腺功能亢进）,.,15,Definition,Hyperthyroidismisanimbalanceofmetabolismcausedbyoverproductionofthyroidhormone.,.,16,Cause:Increasedsecretionofthyroidhormone.Females:males=4:1,ittendstoaffectmalesmoreseverely.Incidence:2040yearsoldgroup.,.,17,ClinicalManifestation,GoiterExophthalmos(突眼征）IncreasedmetabolicrateIncreasedfunctionofsympatheticnerve(交感神经）Cardiovascularalteration,.,18,Thethyroidcanbepalpatedforasymmetry(不对称）andsize.Itmayenlarge3-4timestoitsnormalsize.Itiscalledgoitre.,Hyperthyroidism,.,20,.,21,Asaresultofincreasedthyroidhormoneproduction,theclienthasanincreasedmetabolicrate.Weightlossdespiteincreasedappetite,fatigue,poortolerancetoheat,andprofuseperspiration,menstrualirregularities.,.,22,Nervous,restlessness,irritability,difficultyconcentrating,emotionalliability,moodswings,personalitychanges.Finetremorsofthefingersandtongue,shakyhandwriting,clumsiness,troubleinclimbingstairs,ordyspneapossiblyatrest.,.,23,Theskiniswarmandmoist,characteristicsalmoncolour(鲜肉色）.Thehairisfineandsoftwithprematuregreyandincreasedhairloss.Thenailsappearfragilewithdistalnailseparationfromthenailbed.,.,24,Tachycardia:160bpmanddownto80bpmduringsleep.Pulsepressureiswidened.Therecanbemuscularweaknessandatrophy(萎缩）,paralysis（瘫痪）.,.,25,DiagnosticTests,TSH（促甲状腺激素）T3,T4Radioactiveiodineuptake（131）ThyroidscanMensurationofbasicmetabolismrate(BMR),.,26,TSH(ThyroidStimulatingHormone)normalTSHreflectaeuthyroid(甲状腺机能正常的）state.Hyperthyroidism:TSHisloworabsent.Inmildformsofhyperthyroidism:slightlyabnormal.,ThyroidscanScanarehelpfulindetermininglocation,size,shape,andanatomicfunctionofthethyroidgland.,.,28,MensurationofBasicMetabolismRate(BMR),Conditions:Earlyinthemorning,emptystomach,atthetimeofrestBasicMetabolismRate=(Pulserate+Pulsepressure)-111,.,29,Grade,Normal:10%Slightlyabnormal:+20%+30%Moderatelyabnormal:+30%+60%Seriouslyabnormal:+60%,.,30,Treatment,Antithyroiddrugs,radioactiveiodine,orthyroidectomy(甲状腺切除术）.Individualizedanddependsontheageandgeneralstateofhealth，thesizeofthegoiterandtheabilitytoobtainfollow-upcare.,.,31,Partialorcompletethyroidectomymaybecarriedoutasprimarytreatment.Thetypeandextentofthesurgerydependonthediagnosis,goalofsurgery,andprognosis.,.,32,SurgicalIndications,AverylargegoiteroramultinodulargoiterwithrelativelylowradioactiveiodineuptakeMalignantthyroidnodulePsychologicallyormentallyincompetentpatients,.,33,Surgery,Aportionofthethyroidglandisremoved,butatotalthyroidectomymaybeperformed(expensive,risks).Indicationsforsubtotalthyroidectomy:themainadvantagesarerapidcontrolofthediseaseandalowerincidenceofhypothyroidismthancanbeachievedwithradioiodinetreatment.,.,34,Surgery,Ifapartialthyroidectomyisdone,theremainingthyroidtissueshouldprovideadequateamountsofthyroidhormones.Ifacompletethyroidectomyisdone,theclientwillrequirethyroidhormonereplacementforalifetime.,.,35,Theneckisextendedandasymmetrical,gentlycurvedincisionismade1to2cmabovetheclavicle（锁骨）.,Closureofthewoundisaccomplishedbythestrapmusclesinthemidline.Asmallsuctioncatheterisusuallyinsertedthroughastabwound.,.,36,Complicationsaftersurgery,Dyspnea,asphyxiaInjuryoflaryngealnerveSpasmsThyroidcrisis（甲状腺危象）,.,37,HaemorrhageHaematoma(血肿）formationTrachealcollapse（气管塌陷）TrachealmucousaccumulationLaryngealorlocaltissueedema,Cause,.,38,Complicationsaftersurgery,Respiratorydistressandhaemorrhage.Difficultyinrespirationwhichistheoccurswithinafterthesurgery.,mostcriticalcomplication,48hours,.,39,Management,Surgicalevacuationisrequired.ThefirstaidbythebedA.cutoffthesutureB.openedthewoundwideC.removedthehematomaThetracheaiscut,applyoxygenSendtotheoperationroomforfurthertreatment.,.,40,Preventiveinterventions,Atracheostomyset(气管切开包）iskeptatthepatientsbedsideatalltimes,andthesurgeonissummonedatthefirstindicationofrespiratorydistress.,.,41,Injuryoflaryngealnerve,Anyvoicechangesarenotedbecausetheymightindicateinjurytotherecurrentlaryngealnerve（喉返神经）,whichliesjustbehindthethyroidnexttothetrachea.Talkaslittleaspossible.Canbecuredspontaneously,orbyphysicaltherapy.,.,42,Spasm,Theparathyroidglandsmaybeinjuredorremoveddisturbanceofthecalciummetabolismofthebodybloodcalciumlevelfallsspasmsofthehandsandfeetandmusculartwitching“tetany”,laryngospasm,.,43,Management,TemporaryLimittakingofmeat,eggswhicharehighinphosphorus（磷）UseofthesedativetocontrolthepainIntravenousadministrationofcalciumgluconate葡萄糖酸钙,.,44,Thyroidcrisis(storm),Reason:insufficientpreoperativepreparation,areleaseoflargeamountsofthyroidhormone,rareOutcome:canleadtocardiac,hepaticorrenalfailure.Stressfulfactors:surgery,infectionortrauma,pregnancy.,.,45,Timeofoccurring:thefirst12hourspostoperative.Clinicalmanifestation:Tachycardia(130bmp)T39,sometimes41ExaggeratedsymptomsofhyperthyroidismDisturbancesofamajorsystem,.,46,Gastrointestinal(diarrhea,abdominalpain)Neurologic(psychosis,somnolence,coma)Cardiovascular(edema,chestpain,dyspnea,palpitations),.,47,Fatalness:Theclientmaydevelopcongestiveheartfailureanddie.Preventions:Thekeyistodothepreoperativepreparationsufficiently,andperformthesurgeryuntiltheBMRbecomenormal.,.,48,MedicalManagement,Thephysicianmustbeinformedimmediately.TransferthepatienttotheintensivecareforclosermonitoringIodineisadministeredtodecreasetheoutputofthyroidhormone.TakeKIsolution3mlorally,orput10%iodinesodium5mlintoin10%glucose,andgiveivinjectiontothepatient.,.,49,200400mgHydrocortisone氢化可的松isprescribedtotreatshockoradrenalinsufficiency.Theusageofsedative(luminal鲁米纳Q6-8h)Reducebodytemperatureandheartrateandtopreventvascularcollapse(37).Alargeamountofglucoseareneeded.,.,50,Oxygentherapy:HumidifiedoxygenisadministeredtoimprovetissueoxygenationandmeetthehighmetabolicdemandsCardiacproblems:arterialfibrillation,andcongestiveheartfailure,sympatholyticagentsmaybeadministered,suchaspropranolol(心得安),.,51,Preoperativecare,PerfectpreoperativecareBaselineinformationPharmacologictherapyMentalsupportNutritionInstruction,.,52,Pharmacologictherapy,Itisnecessaryforsurgicaltreatment,butitcannotactasatherapueticmedication.Encouragesthepatienttotakethemedicationsasprescribed.Iodinepreparationsmayhavebeenprescribed10to14daysbeforesurgerytodecreasethyroidvascularityanddecreasebleeding.,.,53,2to5dropsofpotassiumiodidesolution(复方碘化钾)orLugolsiodinesolution(卢戈氏液)aregiveninconjunctionwithpropylthiouracil(丙基硫尿嘧啶)todecreasethefriabilityandvascularityofthethyroid,itshouldbeapplieduntilthetimeofoperationandthepatientbecameeuthyroid.,.,54,Requirement:euthyroidPatientsmoodissteady,thesleeptakesafavorableturn,gainweight,pulserate90times/min,BasicMetabolismRate+20%.情绪稳定、睡眠正常、体重增加、心跳正常、代谢恢复,.,55,Nutrition,Severalwell-balancedmealsofsmallamount,evenuptosixmealsaday.Highlyseasonedfoodsandstimulants,suchascoffee,tea,cola,andalcoholarediscouraged.High-calorie,high-proteinfoodsareencouraged.,.,56,Preoperativeteaching,Howtosupporttheneckwiththehandsaftersurgerytopreventstressontheincision.Eyecareandprotectionmaybecomenecessary,correctinstillationofeyedropsorointmentprescribedtosoothetheeyesandprotecttheexposedcornea.,.,57,Postoperativecare,PositionObservationOxygenNutritionMedicationHealthinstruction,.,58,Observation,Cardiac