小肠疾病英文

1、2021/3/102AnatomyThe jejunal mucosa is relatively thick with prominent plicae circulares; the mesenteric vessels form only one or two arcades with long vasa recta. The ileum is smaller in circumference and has thinner walls; the mesenteric vessels form multiple vascular arcades with short vasa recta

2、.2021/3/103 Blood supply to the jejunoileum and distal duodenum is entirely from the superior mesenteric artery, which courses anterior to the third portion of the duodenum. The celiac artery supplies the proximal duodenum.2021/3/104Physiology2021/3/105 Motility: Peristalsis consists of intestinal c

3、ontractions passing aborally at a rate of 1 to 2 cm/seccontractions initiated by the migrating myoelectric complex (MMC) under the control of both neural and humoral pathways2021/3/106 ENDOCRINE FUNCTION2021/3/107Obstruction Etiology: Common causes of small bowel obstruction in industrialized countr

4、ies:2021/3/108Clinical Manifestations and Diagnosis Cardinal symptoms: colicky abdominal pain nausea vomiting abdominal distention failure to pass flatus and feces2021/3/109Physical Exam distended abdomen peristaltic waves minimal or no bowel sounds Mild abdominal tenderness with / without a palpabl

5、e mass Exam to rule out incarcerated hernias Rectal exam2021/3/1010Radiologic and Laboratory Examinations Plain abdominal radiographs: accuracy60% -dilated loops of small intestine without evidence of colonic distention -multiple air-fluid levels, often in a stepwise pattern -demonstrate the cause o

6、f the obstruction CT: for more complex cases2021/3/10112021/3/1012Plain abdominal film shows complete bowel obstruction caused by a large radiopaque gallstone (arrow) obstructing the distal ileum.2021/3/1013CT scan of the abdomen of a patient with a mechanical bowel obstruction secondary to an absce

7、ss in the right lower quadrant (arrow). Multiple dilated and fluid-filledloops of small bowel are noted.2021/3/1014Simple Vs Strangulating Obstruction “Classic” signs of strangulation: -tachycardia -fever -Leukocytosis -a constant, noncramping abdominal pain2021/3/1015Differentiation of partial from

8、 complete SBO Partial SBO: pass flatus or liquid stools Complete SBO: obstipation 2021/3/1016Differentiation of Proximal / distal SBO pain: epigastric / periumbilical area vomiting: prominent / later onset distention: no / predominate2021/3/1017Treatment Medical and surgical management The overlappi

9、ng sequence :investigation resuscitation operation The timing of operation depends on three factors: -duration -opportunity of vital organ function -risk of strangulation2021/3/1018Medical Management Nasointestinal /nasogastric intubation Intravenous fluids /blood plasma administration Broad-spectrum antibiotics administration2021/3/1019Surgical principles The nature of problem determines approach to management of SB