医学课件Intestinal .ppt

Intestinal Obstuction Hua-dan Xue 2008-11-30 Ileus (intestinal obstruction) Mechanical intestinal obstruction Simple obstruction：occlusion/constriction of bowel lumen Strangulated obstruction：impaired blood supply of obstructed segment Ileus (adynamic/non-obstructive) Paralytic spasm Derangement impairing proper distal propulsion of intestinal contents Classification - location Gastric outlet obstruction: Only one/two air-fluid levels Homogeneous mass displacing transverse colon Duodenal obstruction: Double-bubble sign; Frequently normal due to absence of gas from vomiting Classification - location Jejunal and ileal obstruction: Candy cane: 3 loops+3cm gas-fluid levels+3~5 hours onset Disparity in size between obstructed and normal loops Little/no gas + stool in colon with complete mechanical obstruction after 12-24 hours Stepladder appearance; string-of-bead; Mechanical obstruction Classification - location Colonic obstruction Dilated colon only Dilated small bowel (incompetent ileo-cecal valve) Gas-fluid levels distal to hepatic flexure (fluid is normal in cecum and ascending colon) Cecum most dilated portion (10cm will be critical) Classification – location Localized ileus Causes: often associated with adjacent acute inflammatory process (acute pancreatitis, acute appendicitis, etc.) Sentinel loop: loops near the local peritonitis Closed-loop obstruction Closed-loop obstruction Closed-loop obstruction Fixation of bowel loop: Coffee bean sign: gas filled loop Pseudo-tumor: fluid-filled loop U-shaped dilated bowel loop Increasing intra-luminal fluid Beak sign: point of obstruction Whirl sign: twisting of bowel Classification - etiology 机械性肠梗阻 单纯性肠梗阻：肠管通畅性障碍 绞窄性肠梗阻：肠管通畅性障碍伴有血运障碍 动力性肠梗阻 麻痹性肠梗阻： 痉挛性肠梗阻： 血运性肠梗阻：肠系膜动脉血栓或栓塞所致 单纯性肠梗阻 阶梯状气液平 大跨度肠袢 鱼肋征 绞窄性肠梗阻Strangulated obstruction Triad: closed-loop obstruction of the involved segment (majority of cases) Mechanical obstruction proximal to the involved segment Venous congestion of the involved loop Abdominal pl