外科肠梗阻教材教学稿件.pptVIP

Intestinal obstructionDefination A blockade of the flow of intestinal content. Anatomic, functional changes but also systemically physiologic disorders.;Clinical manifestations complicated Most common emergency disease;3.According to obstruction level or site.  Proximal, distal intestinal, or large bowel obstruction, or high and low obstruction 4.According to the extent of obstruction Incomplete and complete obstruction, 5.According to mode of onset and progression of obstruction.  Acute and chronic obstruction;PathophysiologyMotility of the small intestineThe intestine contracts vigorouslyThe patient crampy abdominal pain Finally the intestine dilated.;Absorption and secretion water and electrolytes accumulate. a decrease in absorption, an increase in intestinal secretion.;Infection and toxemiaThe bacteria proliferate, produce toxin.Vascular supply or viability compromised  bacteria,toxin diffuse severe peritonitis and toxemia.;Shock Severe dehydration, decrease of blood volume electrolytic disturbance,  acid-base imbalance,  bacterial infection and toxemia, ;Clinical manifestations Nausea and vomiting Colicky abdominal pain Obstipation Abdominal distention.  Their onset varies not only with the duration of established obstruction but also with its anatomic site.;1.Nausea and vomiting:  may be the only symptoms. 1).The nature of the vomitus.  undigested food particles.  becomes bilious. feculent. 2).The onset and character of vomiting--level. Recurrent vomiting of bile-stained fluid (proximal ) Prolonged nausea precedes vomiting, feculent.(distal) Vomiting a late finding if the ileocecal valve prevents;Physical Examination the signs of dehydration, sunken eyes, dry mucous membranes, loss of skin turgor, and before resuscitation, resting tachycardia.;Inspection: The degree of abdominal distention varies with both the duration and the location of the obstruct