上海交大外科学肠梗阻PBL.ppt

肠 梗 阻 上海交通大学医学院附属瑞金医院 普外科 马迪 PBL教学 肠梗阻是急诊最常见的外科急腹 症之一，也是外科医生最不愿碰到的， 最头痛的外科急腹症之一。 诊断有时比较困难 临床病情发展较快 需要密切临床观察 严密把握手术时机 Case one(scene1) Male , age: 65, “Paraxymal abdominal pain 48h with nausea and vomiting one day”, you are the doctor on duty. Main point of the history 1:Abdominal pain The position、level、kind of pain, with or without radiation ,the relationship between bowel sound and pain, paroxymal or continuing. 2:Nausea and vomiting The kind、volumn、color and smell of vomitus, the relationship between vomiting and pain. 3:Abdominal distention Time,level and position 4:Failure to pass flatus and feces The kind、quantity of feces and the relationship between it and pain, if the pain relieve after pass flatus and feces. 5:Past history Case one(scene1) Main point of the physical examination Local pathophysiology of intestinal obstruction Case one(scene1) Q3: What is your diagnosis? Definition Classification Definition: Intestinal contents can not pass successfully,which cause many pathophysiology and clinical symptoms. Classification: 按照梗阻发生基本原因可分为三类： 1. Mechanical Obstruction 2. Dynamic Obstruction 3. Vascular Obstrucion Mechanical obstruction include： Intraluminal obstruction Extraluminal obstruction Obstruction intrinsic to the bowel wall Reasons of the intraluminal obstruction: Foreign bodies Gallstones Ascarid and etc. Reason of the extraluminal obstruction : Adhesions Incarceration hernia Volvulus and etc. Reason of the obstruction intrinsic to the bowel wall: Vascular Obstrucion Caution： In the early stage of vascular obstruction, patients often have obvious chief complaint but without abdominal sign. But in the late stage, besides the obvious chief complaint, patients will have peritoneal irritation sign and bloody stool. 按照有无血运障碍分为： 1: Simple Obstruction 2: Strangulating Obstruction 其他分类： Proximal obstruction--- Dist