各种急腹症的X线表现PPT课件

.,1,急腹症acuteabdomen,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,2,急腹症急性的腹部疾病包括：肠梗阻，急性腹部脏器炎症，腹部外伤，泌尿系结石，肠穿孔，出血等。X线检查是诊断急腹症的重要手段检查方法：立卧位透视及腹平片消化道造影（碘剂及钡剂）,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,3,正常X线表现,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,4,正常腹部平片,腹壁及腹内器官均为软组织结构，缺乏自然对比,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,5,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,6,胃肠道穿孔,病因：胃、十二指肠溃疡（最常见）腹外伤肿瘤炎症,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,7,临床表现：突发的刀割样腹痛面色苍白，出冷汗，甚至休克全腹压痛反跳痛腹肌紧张(板状腹),胃肠道穿孔,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,8,X线诊断：膈下游离气体（新月状）-气腹征注：50ml以上的气体X线才能发现,胃肠道穿孔,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,9,.,10,.,11,.,12,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,13,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,14,鉴别诊断：间位结肠胃泡影,胃肠道穿孔,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,15,.,16,.,17,是否有膈下游离气体就一定有胃肠道穿孔是否没有膈下游离气体就一定没有胃肠道穿孔,？,？,？,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,18,产生气腹的原因有：,腹部手术后几天内输卵管通气术后产气细菌感染的腹膜炎孤立性肠壁浆膜下囊肿破裂女性剧烈呕吐时,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,19,肠梗阻intestinalobstruction,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,20,一、肠梗阻的定义,肠梗阻,肠内容物,不能正常运行,通过障碍,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,21,二、临床表现,症状：腹痛、腹胀呕吐肛门停止排便排气体征,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,22,三、检查方法,立卧位透视及腹平片侧卧位水平投照碘水、稀钡造影（了解梗阻部位和性质）,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,23,四、肠梗阻的X线诊断,X线检查的目的：是否有梗阻梗阻的类型梗阻的部位梗阻的程度,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,24,四、肠梗阻的X线诊断,肠梗阻的基本X线表现：肠管扩张积气肠管内有液平,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,25,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,26,判断有无梗阻：基本X线表现注：最好在发病36h后做X线检查,四、肠梗阻的X线诊断,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,27,判断梗阻的类型按原因分机械性肠梗阻动力性（神经性）肠梗阻血运性（血管性）肠梗阻,四、肠梗阻的X线诊断,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,28,判断梗阻的类型按肠壁血供有无障碍分单纯性绞窄性,四、肠梗阻的X线诊断,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,29,单纯性肠梗阻,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,30,单纯性小肠梗阻,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,31,单纯性小肠梗阻,.,32,绞窄性肠梗阻,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,33,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,34,肠扭转,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,35,肠扭转,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,36,8字形肠形,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,37,同心圆,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,38,花瓣征,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,39,香蕉征,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,40,.,41,.,42,判断梗阻的平面空肠梗阻：液平在左中上腹，粘膜呈弹簧状。回肠梗阻：液平在右中下腹,盆腔,粘膜呈腊肠样。结肠梗阻：液平在两侧腹或中腹，有结肠袋。,四、肠梗阻的X线诊断,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,43,判断梗阻的程度不完全性肠梗阻完全性肠梗阻,四、肠梗阻的X线诊断,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,44,肠套叠intussusception,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,45,多见于2岁以下小儿，病因不明，可能与回盲部淋巴组织增生和肠动力增快有关。肠套叠由三条同心管组成：套入管反折管套鞘,一、肠套叠总论,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,46,肠套叠的分型：小肠型结肠型小肠结肠型（回结型）常见部位：盲肠和升结肠,一、肠套叠总论,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,47,二、临床表现,阵发性哭闹（腹痛）粘液血便腹部软组织包块,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,48,三、X线表现,肠管空虚征,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,49,空气或钡灌肠A.钡剂（气柱）头端受阻B.钡剂（气柱）头端杯口状C.杯口状近端圆形充盈缺损或见软组织块影,.,50,.,51,.,52,空气灌肠复位的指征：A.起病在2448小时内B.一般情况良好C.无腹膜炎和肠坏死征象空气灌肠复位的操作注入空气的压力要缓慢持续压力维持在810KP可用镇静剂,手法按摩或全麻,四、空气灌肠复位,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,53,复位成功的标志A.杯口状充盈缺损消失B.大量气体进入小肠C.腹部柔软，肿块消失D.小儿症状消失，安静入睡复位致肠穿孔的表现：A.腹部异常透亮B.立位膈下游离气体,四、空气灌肠复位,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,54,.,55,.,56,.,57,.,58,乙状结肠扭转,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,59,乙状结肠扭转-是乙状结肠袢沿其长轴旋转而形成梗阻扭转的原因：乙状结肠的肠系膜过长乙状结肠的肠袢过长乙状结肠的肠袢固定两端的距离近临床症状：腹部绞痛，腹胀，呕吐，便秘中上腹有压痛的膨胀性肿物,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,60,X线表现：1.立位透视或摄片：A.乙状结肠明显胀气，呈马蹄状，内有液平。B.周围结肠有轻、中度充气，无液平C.小肠内无气或有少量气体。2.钡灌肠：直肠与乙状结肠交界处阻塞，上端呈鸟嘴状。,府谷县中医院放射科FuguCountyChineseMedicineHospital,.,61,府谷县中