急腹症病例分析.pptxVIP

The diagnosis and treatment of acute abdomenSpine and Trauma department of Guanghua hospital ShanghaiAcute abdomen是一类以急性腹痛为突出表现，需要早期诊断和及时处理的腹部疾病Characteristic of acute abdomenChangeRapidAcute Critical ARCCAcute abdominal painWHEN YOU FACE AN EMERGENCY PATIENT……….54 yrs MaleAcute upper abdominal pain 3 hours (30 mins after meal ), the pain transferred to the Right lower abdomen 2 hours ago, and now, full abdominal pain .T: 38.1℃P：113/min R：31/min Bp：87/60mmHgWhat is your judge? How to judge ? judge by what?What is your final decision ?Your action?CLINICAL DIAGNOSIS（1）指出病变的性质（2）认定病变的器官 性质：1、急性炎症(Acute inflammation)2、急性穿孔(Acute perforation)3、急性出血(Acute hemorrhage)4、腔道急性梗阻(Acute obstruction of bore)5、脏器急性绞窄(Acute strangulation of viscera)6、血管急性栓塞（Acute embolism of blood vessel）First aid1“MONITOR”3“TUBES”1“FORBIDEN”What kinds of Imformation do you need ?How to get it ?History demandInvestigationphysical examinationAssist examinationGet the clues step by step History demand----Episode condition诱因、起病的缓急、症状出现的先后主次和演变过程等 餐后腹痛： 胃、十二指肠溃疡穿孔、胆囊炎、胰腺炎伤后腹痛： 内出血/脏器破裂动后腹痛： 肠扭转或尿路结石热后腹痛： 内科病由轻到重，腹痛局限： 炎症病变突发剧痛，迅速扩散： 腔道的穿孔、梗阻和脏器的破裂、扭转、出血 History demand---- Character of abdomen pain持续性钝痛或隐痛：炎症或出血刺激腹膜的表现阵发性的绞痛：管道阻塞后痉挛收缩的结果持续腹痛阵发加剧：炎症和梗阻并存，互为因果 History demand---- Degree of abdomen pain急性炎症：较轻，可以忍受管道梗阻：绞痛通常都较剧烈穿孔：出血性胰腺炎：疼痛剧烈 伴休克 History demand---- Locus of abdomen pain History demand---- Transfer or radiating pain in special siteR History demand---- Gastrointestinal tract symptom反射性呕吐(Reflectivity vomiting)高位肠梗阻(High intestinal obstruction) 一般呕吐之后频繁呕吐低位梗阻(Low intestinal obstruction)呕吐出现较晚，不如高位梗阻频繁但可吐粪样物喷射性呕吐（ Projectile vomiting ）？根据呕吐性质及味道判断部位 History demand---- Stool state 便秘：腹内炎症(abdominal inflammation)频数粘液便：盆腔脓肿(pelvic abscess)无排便排气：完全性梗阻(complete obstruction)粘液血便：肠套叠(intussusception)颜 色 ？ History demand---- Other condition 溃疡穿孔：过去有长期溃疡病史突发上腹部剧痛 胆囊炎：右上腹反复发作疼痛史 粘连性肠梗阻：有腹部手术、外伤、炎症史 寒战、高热：化脓性病变 尿频尿急、排尿困难或血尿：泌尿系病变 追问病史 餐后半小时突发中上腹绞痛，剧痛难忍，进行性加重。10分钟后疼痛转移至右下腹，出现局部持续性