肠梗阻病例讨论教学教案.pptxVIP

Department of general surgery Bi Jing-Tao frankbjt@126.com ;Question;Doctor need to answer:;What should be done next?;Her past medical history is remarkable in that she underwent an appendectomy for acute appenditis ten years ago. She is otherwise healthy and takes no medications.;Clinical Manifestations;Abdominal pain ;Nausea and vomiting ;Contispation and obstipation ;Distention ;Physical Examination;Inspection ;;Percussion ;Auscultation;Rectal examination:;A hemoglobin of 16, hematocrit 48, white blood cell count 12,200 with 74 polys. Serum electrolytes show the level of serum sodium and potassium is 130mol/l and 3.0mol/l. Arterial blood gas analysis reveals that the result of PH is 7.30. An abdominal X-RAY reveals multiple dilated loops of small bowel with numerous air-fluid levels. There is no gas or stool visible in the colon ;Radiological Examinations ;Supine;;CT scan;B-UltraSound;Summury;Symptoms of the patients;Signs of the patients;Laboratory Study;Radiography exam;Diagnosismust make clear the following questions:;1.Whether intestinal obstruction exists:  Through symptoms and signs, the diagnosis can be made without difficulty. ;2.Whether the obstruction is mechanical or dynamic:mechanical obstruction: typical symptoms and signs. paralytic obstruction: episodic and cramping abdominal pain is absent;distention is prominent ;3.Whether the obstruction is simple or strangulation obstruction:  Indications for strangulation:1).Abrupt onset with continuous acute abdominal pain,2).Shock3).Manifestation of peritonitis: leukocytosis, sepsis,rebound and guarding; 4).Asymmetrical distention, local bulge, or mass with tenderness.5).Hematic vomitus, 6).Conservative treatment in vain and no improvement in symptoms and signs.7).Isolated, bulged, and distended intestinal loop on abdominal plain film.;4.Whether the obstruction is high or low:  V