ClinicalPathologicalConference教材幻灯片.ppt

 Bilious vomiting intermittent irritable crying Dehydration Hypertension Leukocytosis Hyperchloremia Soft tissue mass over RLQ by Abdomen sonography Decreased urine output and downhill BP in 16 hours one-year-six month-old boy Wilms tumor It may be associated with hemihypertrophy, aniridia, and other congenital anomalies, usually of the genitourinary tract. Sign of Wilms tumor:palpable mass in abdomen (60﹪),hypertension (25﹪), hematuria(15﹪),abdomen mass is the most common presenting symptom and sign ,occasionally there is abdomen pain,especially when hemorrhage occurs in the tumor following trauma. Wilms tumor Some patients may present with abdominal pain and vomiting and, infrequently, hematuria. Occasionally, rapid abdominal enlargement and anemia may occur owing to bleeding into the renal parenchyma or pelvis. Wilms tumorGrainger Allisons Diagnostic Radiology: A Textbook of Medical Imaging, 4th ed., On ultrasound examination the tumour appears as a well-defined, solid mass of mixed echogenicity.Areas of haemorrhage and necrosis can produce focal hypoechoic lesions within the mass. Ultrasound may be used for periodic surveillance of the opposite kidney. Superior mesenteric artery syndrome The classic example is an adolescent who starts vomiting after application of a body cast for orthopedic surgery. Other associated factors include anorexia, prolonged bed rest, weight loss, abdominal surgery, and exaggerated lumbar lordosis. The diagnosis is established radiologically with the demonstration of a cutoff of the duodenum just to the right of the midline. Superior mesenteric artery syndrome An extrinsic compression of the duodenum in children after rapid weight loss and in a supine position. The compression is thought to occur as the mesentery loses its fat and allows the superior mesenteric artery to collapse on the duodenum, compressing it between the superior mesenteric artery anteriorly and the aorta posteriorly. Inflammatory bowe