有关于11-小肠疾病.ppt

Small Intestinal Disease中南大学湘雅医院胃肠外科裴海平2010.9.9 Anatomy and Physiology The anatomy of small intestine length: 3～5m portions blood supply：superior mesenteric a nerve：autonomic Four layers : mucosa submucosa muscularis serosa Peyer’patches Villus mucosa The physiology of small intestine secrete alkaline intestinal juice digestion and absorption endocrine and immune Inflammatory Bowel Disease Crohn Disease Etiology unclear Pathology occur in any segment of the peptic tract granulomatous inflammatory lesion ，involve full-thickness bowel layer Clinical manifestation occur in any age 60% cases40y intermittent abdominal complaint or pain digestive symptom:diarrhea others low fever fatigue poor appetite anemia and weight loss complications intestinal obstruction 中毒性巨结肠 perforation hemorrhage carcinogenesis diagnosis history and clinical findings barium meal and barium enema coloscopy differential diagnosis bowel tuberculosis ulcerative colitis appendicitis treatment major therapy: medicine surgical indications: complication because its higher recurrence rate 　　 50% Tuberculosis of intestine etiology and pathology secondary infection position：ileum-cecum ulcerative type and proliferative type clinical findings young low fever, night sweat，fatigue, weightloss,poor appetite chronic abdominal pain diarrhea and constipation complication diagnosis blood routine,ESR,chest film,barium meal and barium enema,coloscopy history and clinical manifestation treatment medical therapy surgical indication complication such as obstruction 、 fistula 、 perforation、bleeding operative ways: resect the partial bowel and anastomosis perforation repairment By-pass Intestinal Perforation of Typhoid Fever etiology and pathology infection by bacillus typhus site: the last portion of the ileum simple perforation:80-90% clinical findings diffuse peritonitis symptoms