外科学-总论英文课件：Multiple Organ Dysfunction Syndrome.ppt

* * * * Operation Failure of non-operative therapy Perforation Acute Hepatic Failure Definition Characterized by the diffuse lesion and reduction of the hepatic ability of synthesis, transportation,storage and detoxification. Etiology Virus hepatitis Chemical poisonesis Severe trauma Shock Sepsis Clinical Manifestation Conscious disturbance Jaundice Hepatic odor Hemorrhage Other organ failure Treatment Anti-infection Hyperammonemia correction Nutrition amelioration liver transplantation Questions What is the therapeutic principle for MODS? Which electrolyte disorders may occur in ARF? What is the most important treatment for ARDS? * * * * * Clinical Manifestationoliguria stage Uremia Hemorrhagic tendency Infection Clinical Manifestion Diursis stage Urine volume increase 3000ml/d 14d Discovery stage Several months History and physical examination Etiology prerenal pathogen postrenal pathogen Diagnosis Diagnosis Laboratory Urine test Urinary catheter to record urine volume Urine density(1.010-1.014) Urine microscopic examination RBC and renal tubule epithelia(renal cortex and renal medulla necrosis) large Brown casts(renal failure casts) eosinophil↑ (interstitial nephritis) red cell cast(glomerulonephritis) normal(prerenal or postrenal failure earlier period) Diagnosis renal function examination Urine urea nitrogen↓ ( 180mmol/24) Urine Na↑ ( 175mmol/24h) Fractional excretion of filtrated sodium1 FENa（%）=（UNa/PNa）×（PCr/UCr ）×100 Osmotic pressure of urine *ARF------ 400 mOsm/L *prerenal ARF or glomerulonephritis------ 400 mOsm/L BUN (more than 3.8－9.4mmol/L per day) , Cr ↑ Urine/Plasma Cr------20 Renal failure index, RFI＝ Una×（ PCr/UCr ） *1------ARF *1------prerenal Differentiation Diagnosis Differentiation Diagnosis B type ultrasound(renal or ureter enlargement) Abdominal x-rays(calcification, calculus or Obstruction) Treatment Oliguria or anuria stage (7-10days, average 5-6 and max more than 1 month) confine