《急腹症病例分析》课件.pptx

ThediagnosisandtreatmentofacuteabdomenDaihaoSpineandTraumadepartmentofGuanghuahospitalShanghai

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AcuteabdomenCharacteristicofacuteabdomenAcuteRapidCriticalChangeARCC

WHENYOUFACE

ANEMERGENCYPATIENT……….Acuteabdominalpain

54yrsMaleAcuteupperabdominalpain3hours(30minsaftermeal),thepaintransferredtotheRightlowerabdomen2hoursago,andnow,fullabdominalpain.T:38.1℃P：113/minR：31/minBp：87/60mmHgWhatisyourjudge?Howtojudge?judgebywhat?Whatisyourfinaldecision?Youraction?

CLINICALDIAGNOSIS〔1〕指出病变的性质〔2〕认定病变的器官性质：1、急性炎症(Acuteinflammation)2、急性穿孔(Acuteperforation)3、急性出血(Acutehemorrhage)4、腔道急性梗阻(Acuteobstructionofbore)5、脏器急性绞窄(Acutestrangulationofviscera)6、血管急性栓塞〔Acuteembolismofbloodvessel〕

Firstaid1“MONITOR〞3“TUBES〞1“FORBIDEN〞

WhatkindsofImformation

doyouneed?Howtogetit?InvestigationHistorydemandphysicalexaminationAssistexaminationGetthecluesstepbystep

Historydemand----Episodecondition诱因、起病的缓急、病症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

Historydemand----Characterofabdomenpain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

Historydemand----Degreeofabdomenpain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

Historydemand----Locusofabdomenpain

Historydemand----TransferorradiatingpaininspecialsiteR

Historydemand----Gastrointestinaltractsymptom反射性呕吐(Reflectivityvomiting)高位肠梗阻(Highintestinalobstruction)一般呕吐之后频繁呕吐低位梗阻(Lowintestinalobstruction)呕吐出现较晚，不如高位梗阻频繁但可吐粪样物根据呕吐性质及味道判断部位喷射性呕吐〔Projectilevomiting〕？

Historydemand----Stoolstate便秘：腹内炎症(abdominalinflammation)频数粘液便：盆腔脓肿(pelvicabscess)无排便排气：完全性梗阻(completeobstruction)粘液血便：肠套叠(intussusception)颜色？

Historydemand----Othercondition

追问病史餐后半小时突发中上腹绞痛，