小腸疾病分類及應(yīng)用SmallIntestinalDisease課件

小腸疾病分類和應(yīng)用

Small

IntestinalDisease

小腸疾病分類和應(yīng)用SmallIntestinalDisease小腸疾病分類和應(yīng)用

SmallIntestinalDi1小腸疾病分類和應(yīng)用SmallIntestinalDisease小腸疾病分類和應(yīng)用SmallIntestinalDiseas2AnatomyandPhysiologyTheanatomyofsmallintestinelength:3～5mportions

bloodsupply：superiormesentericanerve：autonomic

SympatheticParasympathetic

duodenum:25cmjejunum:2/5ileum:3/5小腸疾病分類和應(yīng)用SmallIntestinalDiseaseAnatomyandPhysiologySympat3Fourlayers:mucosasubmucosamuscularisserosaPeyer’patches小腸疾病分類和應(yīng)用SmallIntestinalDiseaseFourlayers:小腸疾病分類和應(yīng)用SmallInt4VillusmucosaThephysiologyofsmallintestinesecretealkalineintestinaljuicedigestionandabsorptionendocrineandimmune

小腸疾病分類和應(yīng)用SmallIntestinalDiseaseVillusmucosa小腸疾5InflammatoryBowelDisease

CrohnDiseaseEtiologyunclearPathologyoccurinanysegmentofthepeptictractgranulomatousinflammatorylesion，involvefull-thicknessbowellayer小腸疾病分類和應(yīng)用SmallIntestinalDiseaseInflammatoryBowelDisease6Clinicalmanifestationoccurinanyage60%cases<40yintermittentabdominalcomplaintorpaindigestivesymptom:diarrheaotherslowfeverfatiguepoorappetiteanemiaandweightloss小腸疾病分類和應(yīng)用SmallIntestinalDiseaseClinicalmanifestation小腸疾病分類和應(yīng)7complicationsintestinalobstruction中毒性巨結(jié)腸perforationhemorrhagecarcinogenesis小腸疾病分類和應(yīng)用SmallIntestinalDiseasecomplications小腸疾病分類和應(yīng)用SmallInt8diagnosishistoryandclinicalfindingsbariummealandbariumenemacoloscopydifferentialdiagnosisboweltuberculosisulcerativecolitisappendicitis小腸疾病分類和應(yīng)用SmallIntestinalDiseasediagnosis小腸疾病分類和應(yīng)用SmallIntest9treatmentmajortherapy:medicinesurgicalindications:complicationbecauseitshigherrecurrencerate

>50%小腸疾病分類和應(yīng)用SmallIntestinalDiseasetreatment小腸疾病分類和應(yīng)用SmallIntesti10Tuberculosisofintestineetiologyandpathologysecondaryinfectionposition：ileum-cecumulcerativetypeandproliferativetype小腸疾病分類和應(yīng)用SmallIntestinalDiseaseTuberculosisofintestine小腸疾病分11clinicalfindingsyounglowfever,nightsweat，fatigue,weightloss,poorappetitechronicabdominalpaindiarrheaandconstipationcomplication小腸疾病分類和應(yīng)用SmallIntestinalDiseaseclinicalfindings小腸疾病分類和應(yīng)用Smal12diagnosisbloodroutine,ESR,chestfilm,bariummealandbariumenema,coloscopyhistoryandclinicalmanifestation小腸疾病分類和應(yīng)用SmallIntestinalDiseasediagnosis小腸疾病分類和應(yīng)用SmallIntesti13treatmentmedicaltherapysurgicalindicationcomplicationsuchasobstruction

、

fistula

、perforation、bleedingoperativeways:resectthepartialbowelandanastomosisperforationrepairmentBy-pass小腸疾病分類和應(yīng)用SmallIntestinalDiseasetreatment小腸疾病分類和應(yīng)用SmallIntesti14IntestinalPerforationofTyphoidFever

etiologyandpathologyinfectionbybacillustyphussite:thelastportionoftheileumsimpleperforation:80-90%小腸疾病分類和應(yīng)用SmallIntestinalDiseaseIntestinalPerforationofTyph15clinicalfindingsdiffuseperitonitissymptomsacutesevereabdominalpainmuscleguardness,tendernessandreboundtendernessmajortreatmentrepairoftheperforation小腸疾病分類和應(yīng)用SmallIntestinalDiseaseclinicalfindings小腸疾病分類和應(yīng)用Smal16AcuteHemorrhagicEnteritisetiology:unclearmayberelatedtoβtoxinofWelchbaciluspathologythelesionlocalizedinjejunumorileumlocalcongestion,hemorrhage,necrosisandulceration小腸疾病分類和應(yīng)用SmallIntestinalDiseaseAcuteHemorrhagicEnteritis小腸疾17Clinicalfindingsoccurinchildrenandyoungeracuteabdominalpainaccompaniedbynausea,vomiting,diarrhea,hematochezia.distention,tendernesssignsofbowelofstrangulationtoxicshock小腸疾病分類和應(yīng)用SmallIntestinalDiseaseClinicalfindings小腸疾病分類和應(yīng)用Sma18Treatmentmedicaltreatment(mainmethod)keepinternalenvironmentstablefasting,gastrointestinaldecompressionantibioticnutritionalsupport小腸疾病分類和應(yīng)用SmallIntestinalDiseaseTreatment小腸疾病分類和應(yīng)用SmallIntesti19surgicalindicationobviousperitonitisbowelbleedingisdifficulttocontrolintestinalobstructionaggravationaftermedicaltherapyDiagnosisNOTclear小腸疾病分類和應(yīng)用SmallIntestinalDiseasesurgicalindication小腸疾病分類和應(yīng)用Sm20IntestinalObstructiondefinition：apartialorcompleteblockageofthebowelresultsinthefailureoftheintestinalcontentstopassthrough小腸疾病分類和應(yīng)用SmallIntestinalDiseaseIntestinalObstruction小腸疾病分類和應(yīng)21EtiologyandClassification（一）Accordingtotheobstructivecause1、Mechanical：highincidenceintraluminalobstructionExtrinsicboweltractlesionsIntrinsicbowelwalllesion

小腸疾病分類和應(yīng)用SmallIntestinalDiseaseEtiologyandClassification小腸疾221）intraluminalobstruction（1）膽結(jié)石（2）糞石（3）毛發(fā)團（4）異物（5）腸減壓管氣囊（6）寄生蟲（7）腔內(nèi)憩室小腸疾病分類和應(yīng)用SmallIntestinalDisease1）intraluminalobstruction小腸232）lesionsextrinsictothebowel（1）粘連：手術(shù)后；先天性；炎癥后（2）疝：腹壁疝；腹內(nèi)疝（3）先天性：環(huán)狀胰腺；腹膜包裹（4）腫瘤：腸外腫瘤；腸系膜腫瘤（5）炎癥：腹腔內(nèi)膿腫；腹腔異物（6）其他：腸系膜上動脈綜合征；小腸疾病分類和應(yīng)用SmallIntestinalDisease2）lesionsextrinsictothebow243）intrinsicbowelwalllesions（1）腸道閉鎖（2）炎癥狹窄，腸套疊，腸扭轉(zhuǎn)（3）腫瘤等小腸疾病分類和應(yīng)用SmallIntestinalDisease3）intrinsicbowelwalllesions252、Dynamic(Paralyticileus)

1）麻痹性：（1）腹腔手術(shù)后；（2）腹部創(chuàng)傷；（3）急性彌漫性腹膜炎

2）痙攣性：（1）急性腸炎；（2）腸道功能紊亂；（3）慢性鉛中毒；小腸疾病分類和應(yīng)用SmallIntestinalDisease2、Dynamic(Paralyticileus)小腸263、Hematogenesis血運性腸梗阻腸系膜血管栓塞或血栓形成致使腸管發(fā)生血運障礙小腸疾病分類和應(yīng)用SmallIntestinalDisease3、Hematogenesis血運性腸梗阻小腸疾病分類274、IdiopathicIntestinalPseudo-ObstructionChronicillness,recurrenceHeredityImpairedmotorresponsetoboweldistentionDuodenal,colonicslowwavesnormalAbsenceofradiogaphicfindingsofmechanicalobstructionNon-surgicaltreatment小腸疾病分類和應(yīng)用SmallIntestinalDisease4、IdiopathicIntestinalPseud28（二）Accordingtothebloodsupplyofthebowelwall1、simple

只有腸內(nèi)容物通過受阻，無腸管血運障礙。2、strangulation梗阻伴有腸管血運障礙，例如：腸系膜血管栓塞小腸疾病分類和應(yīng)用SmallIntestinalDisease（二）Accordingtothebloodsup29（三）按梗阻部位1高位梗阻：空腸及近段回腸2低位梗阻：結(jié)腸及遠段回腸（四）按梗阻程度1不完全性腸梗阻2完全性腸梗阻（五）按病程緩急1急性腸梗阻2慢性腸梗阻（六）特殊類型：閉袢性腸梗阻

小腸疾病分類和應(yīng)用SmallIntestinalDisease（三）按梗阻部位小腸疾病分類和應(yīng)用SmallIntestin30粘連小腸疾病分類和應(yīng)用SmallIntestinalDisease粘連小腸疾病分類和應(yīng)用SmallIntestinalDise31腸套疊小腸疾病分類和應(yīng)用SmallIntestinalDisease腸套疊小腸疾病分類和應(yīng)用SmallIntestinalDis32嵌頓小腸疾病分類和應(yīng)用SmallIntestinalDisease嵌頓小腸疾病分類和應(yīng)用SmallIntestinalDise33扭轉(zhuǎn)、糞性小腸疾病分類和應(yīng)用SmallIntestinalDisease扭轉(zhuǎn)、糞性小腸疾病分類和應(yīng)用SmallIntestinalD34蛔蟲性小腸疾病分類和應(yīng)用SmallIntestinalDisease蛔蟲性小腸疾病分類和應(yīng)用SmallIntestinalDis35PathologyandPathophysiologypathology（acute）

proximalboweldistention

luminalpressure

venousreturnhindrance

congestin,edema,exudationpressurearteryreturnhindrancenecrosisandperforation小腸疾病分類和應(yīng)用SmallIntestinalDiseasePathologyandPathophysiology小36Chronicintestinalobstructionincomplete

longtimebowelwallhypertrophyintestinalpatternandperistalticwaves小腸疾病分類和應(yīng)用SmallIntestinalDiseaseChronicintestinalobstruction37Pathophysiologythelossofbodyfluid：waterandelectrolytedisorderandmetabolicimbalance(Theintestinaltractsecretesupto8.0L/d)infectionandintoxication：thedamageofintestinalbarrierandbacteriatranslocation,toxinabsorption小腸疾病分類和應(yīng)用SmallIntestinalDiseasePathophysiology小腸疾病分類和應(yīng)用SmallI38shock：dehydration、bloodconcentration、hypovolemia、metabolicdisorder、bacteriainfectionandintoxicationrespiratoryandcirculationdysfunction：abdominalpressureincreasedabdominalcompartmenthypertension小腸疾病分類和應(yīng)用SmallIntestinalDiseaseshock：dehydration、bloodconcen39臨床表現(xiàn)——癥狀痛、嘔、脹、閉小腸疾病分類和應(yīng)用SmallIntestinalDisease臨床表現(xiàn)——癥狀痛、嘔、脹、閉小腸疾病分類和應(yīng)用SmallI40痛小腸疾病分類和應(yīng)用SmallIntestinalDisease痛小腸疾病分類和應(yīng)用SmallIntestinalDisea41嘔小腸疾病分類和應(yīng)用SmallIntestinalDisease嘔小腸疾病分類和應(yīng)用SmallIntestinalDisea42脹小腸疾病分類和應(yīng)用SmallIntestinalDisease脹小腸疾病分類和應(yīng)用SmallIntestinalDisea43ClinicalManifestation

Abdominalpain

VomitingDistentionFailuretopassgasandstool小腸疾病分類和應(yīng)用SmallIntestinalDiseaseClinicalManifestation小腸疾病分類和應(yīng)44單純性機械性腸梗阻反復(fù)發(fā)作的、節(jié)律性的、陣發(fā)性腹部絞痛絞窄性腸梗阻腹痛間歇不斷縮短持續(xù)性腹痛疼痛程度不斷加重麻痹性腸梗阻持續(xù)性脹痛小腸疾病分類和應(yīng)用SmallIntestinalDisease單純性機械性腸梗阻小腸疾病分類和應(yīng)用SmallIntesti45

VomitingEarlyreflectivityParalysisoverflowHighpositionearlyandfrequentlyLowpositionlateandfew小腸疾病分類和應(yīng)用SmallIntestinalDisease小腸疾病分類和應(yīng)用SmallIntestinalDiseas46Distention

高位-------不明顯低位-------顯著，遍及全腹閉袢性(closedloop)腹周膨脹結(jié)腸閉袢腹脹不對稱腸扭轉(zhuǎn)小腸疾病分類和應(yīng)用SmallIntestinalDiseaseDistention腹周膨脹結(jié)腸47Failuretopassgasandstool完全性腸梗阻停止排便排氣高位腸梗阻早期梗阻以下的殘留氣體和糞便仍可排出腸套疊和血運性腸梗阻（絞窄）可排出血性或果醬樣便小腸疾病分類和應(yīng)用SmallIntestinalDiseaseFailuretopassgasandstool小48ExaminationAbdominalsigns：Abdominalbulge,gastrointestinalpatternsandperistalticwaves,tendernessandreboundtenderness,positiveshiftdullness,highpitchedbowelsoundorbowelsilenceinlatestageandbowelparalysisDigitalrectalexamination小腸疾病分類和應(yīng)用SmallIntestinalDiseaseExamination小腸疾病分類和應(yīng)用SmallIntes49

Labtest：theresultswiththechangeoftheprimarydiseaseitself

Earlystage:

normalorslightabnormalLatestage:

disorderofmanyserummarkers小腸疾病分類和應(yīng)用SmallIntestinalDiseaseLabtest：theresultswiththe50X-ray：

Supineanduprightabdominalradiographswithstepladderpatternofair-fluidlevelsandnocolonicgasnote:Thebariumenemaisneediftheintussusceptions,sigmoidrotationorcolontumoraresuspicious.小腸疾病分類和應(yīng)用SmallIntestinalDiseaseX-ray：小腸疾病分類和應(yīng)用SmallIntestinal51

Insmall-bowelobstruction,radiologicevaluationhasseveralgoals.Itiscarriedouttoconfirmthediagnosis,distinguishbetweensimpleandstrangulatingobstruction,differentiatethevariouscausesofobstruction,estimatethedegreeofobstruction,andexcludethepossibilityofcolonicobstructionorparalyticileus

小腸疾病分類和應(yīng)用SmallIntestinalDiseaseInsmall-bowelobstr52小腸疾病分類和應(yīng)用SmallIntestinalDisease小腸疾病分類和應(yīng)用SmallIntestinalDiseas53小腸疾病分類和應(yīng)用SmallIntestinalDisease小腸疾病分類和應(yīng)用SmallIntestinalDiseas54小腸疾病分類和應(yīng)用SmallIntestinalDisease小腸疾病分類和應(yīng)用SmallIntestinalDiseas55小腸疾病分類和應(yīng)用SmallIntestinalDisease小腸疾病分類和應(yīng)用SmallIntestinalDiseas56Diagnosis

isitintestinalobstruction?historyclinicalfindingsX-rayexamination

isitmechanicalordynamic？historyX-rayfindings小腸疾病分類和應(yīng)用SmallIntestinalDiseaseDiagnosis小腸疾病分類和應(yīng)用SmallIntesti57SimpleorStrangulation（VeryImportant）①Acuteandpersistentsevereabdominalpain②Emergentlyandearlyshock③Severeperitonealirritationsign④Asymmetricdistention，palpablemass⑤Bleedingcontentofvomitus,dischargeandabdominalparacentesis⑥X-rayshowsisolatedansainterstinalis⑦Medicaltreatmentfailure小腸疾病分類和應(yīng)用SmallIntestinalDiseaseSimpleorStrangulation（Very58小腸疾病分類和應(yīng)用SmallIntestinalDisease小腸疾病分類和應(yīng)用SmallIntestinalDiseas59小腸疾病分類和應(yīng)用SmallIntestinalDisease小腸疾病分類和應(yīng)用SmallIntestinalDiseas60TheObstructiveSite:LoworHighHigh:vomittingoccurinearlystageandshowslightabdominaldistentionLow:severeabdominaldistentionX-rayfindings小腸疾病分類和應(yīng)用SmallIntestinalDiseaseTheObstructiveSite:LoworH61CompleteorIncompletecomplete:severeandacuteincomplete:chronicandslightTheCauseofObstructionAlwaysverydifficulttoidentificateHistoryisveryimportant小腸疾病分類和應(yīng)用SmallIntestinalDiseaseCompleteorIncomplete小腸疾病分類和應(yīng)62TreatmentPrinciples：CorrectthesystemicpathophysiologicdisorderRelieveobstruction。小腸疾病分類和應(yīng)用SmallIntestinalDiseaseTreatment小腸疾病分類和應(yīng)用SmallIntesti63BasicTreatmentNaso-gastricsuctionCorrectbodyfluiddisorderPreventinfectionandintoxicationGeneraltreatment:sedation,spasmolysis小腸疾病分類和應(yīng)用SmallIntestinalDiseaseBasicTreatment小腸疾病分類和應(yīng)用SmallI64RemovetheObstructionSurgeryIndications：strangulation、causedbytumorandcongenitalbowelmalformation,cannotrelievedbymedicaltherapyAims：utilitythesimplestmethodstoremovetheobstructionandrecoverthecontinuityofthebowelintheshortesttime小腸疾病分類和應(yīng)用SmallIntestinalDiseaseRemovetheObstruction小腸疾病分類和應(yīng)65MethodsRemovethecause：

Suchasadhesionremove,foreignbodytakenout、replacementofintussusceptionandvolvulusIntestinalresectionandanastomosis:

tumor,stenosis,necrosis

小腸疾病分類和應(yīng)用SmallIntestinalDiseaseMethods小腸疾病分類和應(yīng)用SmallIntestina66Howtojudgetheintestinalnecrosisintheoperation?ThebowelwallisblackNoperistalticcapabilityandtensionNopulsationofmesentericterminalarteriole小腸疾病分類和應(yīng)用SmallIntestinalDiseaseHowtojudgetheintestinalne67

Bypassoperation:Thelesionisdifficulttoremove

EnterostomyorIntestinalexteriorizationThepatient’sconditioncannottolerancethecomplicatedoperationortheobstructivelesionisdifficulttotreat

小腸疾病分類和應(yīng)用SmallIntestinalDiseaseBypassoperation:小腸疾病分類和應(yīng)用Sm68手術(shù)方式

A.解除梗阻原因的術(shù)式如粘連松解術(shù)小腸疾病分類和應(yīng)用SmallIntestinalDisease手術(shù)方式小腸疾病分類和應(yīng)用SmallIntestinalDi69如腸切開取異物，腸扭轉(zhuǎn)復(fù)位術(shù)。小腸疾病分類和應(yīng)用SmallIntestinalDisease如腸切開取異物，腸扭轉(zhuǎn)復(fù)位術(shù)。小腸疾病分類和應(yīng)用SmallI70B.腸切除腸吻合術(shù)C.短路手術(shù)小腸疾病分類和應(yīng)用SmallIntestinalDiseaseB.腸切除腸吻合術(shù)C.短路手術(shù)小腸疾病分類和應(yīng)71D.腸造口和腸外置術(shù)小腸疾病分類和應(yīng)用SmallIntestinalDiseaseD.腸造口和腸外置術(shù)小腸疾病分類和應(yīng)用SmallIntest72MedicaltreatmentIndications：simpleadhesiveobstruction,paralysisordynamicileus、obstructionbecauseofascaridorstoolmass,inflammatoryobstructionandearlystageofintussusceptionNotes：Thestateofillnessshouldbemonitorclosedlyduringmedicaltreatment小腸疾病分類和應(yīng)用SmallIntestinalDiseaseMedicaltreatment小腸疾病分類和應(yīng)用Smal73CommontypesAdhesiveObstruction（40%～60%）

Obstructionduetoadhesions小腸疾病分類和應(yīng)用SmallIntestinalDiseaseCommontypes小腸疾病分類和應(yīng)用SmallInte74EtiologyandpathologyCongenitalSecondary

DiagnosisMechanicalobstruction+historyofabdominaloperation,infectionortrauma

*如何區(qū)分廣泛粘連梗阻與局部束帶梗阻？？小腸疾病分類和應(yīng)用SmallIntestinalDiseaseEtiologyandpathology小腸疾病分類和應(yīng)75Prophylaxis:moresignificance減少組織損傷，減輕組織炎癥反應(yīng)

Treatment:simple,incompletemedicaltherapystrangulationsurgicaltherapy

小腸疾病分類和應(yīng)用SmallIntestinalDiseaseProphylaxis:moresignificance76小腸疾病分類和應(yīng)用SmallIntestinalDisease小腸疾病分類和應(yīng)用SmallIntestinalDiseas77小腸疾病分類和應(yīng)用SmallIntestinalDisease小腸疾病分類和應(yīng)用SmallIntestinalDiseas78小腸疾病分類和應(yīng)用SmallIntestinalDisease小腸疾病分類和應(yīng)用SmallIntestinalDiseas79小腸疾病分類和應(yīng)用SmallIntestinalDisease小腸疾病分類和應(yīng)用SmallIntestinalDiseas80IntestinalVolvulus(>3600)

Obstructionduetovolvulus小腸疾病分類和應(yīng)用SmallIntestinalDiseaseIntestinalVolvulus(>3600)小腸疾病81EtiologyAnatomicfactors:ExcessivelongmesenteriumAdhesionPhysicalfactors:EntericbodyDynamicfactors:AbnormalbowelmotivationAlterthebodypositionsuddentlySlight<3600Severe>4800小腸疾病分類和應(yīng)用SmallIntestinalDiseaseEtiology小腸疾病分類和應(yīng)用SmallIntestin82Clinicalfindingsclosedloop：acute/

severeSmallbowel:younger,motionaftermealpainintheperiumbilicusSigmoid:aged,constipationhabitsTreatment:Itisaseveremechanicalobstructionemergentoperation小腸疾病分類和應(yīng)用SmallIntestinalDiseaseClinicalfindings小腸疾病分類和應(yīng)用Smal83Obstructionbyforeignbody（腸蛔蟲、糞塊等）Asimplemechanicalbowelobstruction蛔蟲成團+腸管痙攣Treatment:medicaltherapyandnecessarysurgery小腸疾病分類和應(yīng)用SmallIntestinalDiseaseObstructionbyforeignbody（腸蛔84BowlAscariasisChildren,countrysideMedicaltherapy小腸疾病分類和應(yīng)用SmallIntestinalDiseaseBowlAscariasisChildren,count85IntussusceptionObstructionduetointussusception小腸疾病分類和應(yīng)用SmallIntestinalDiseaseIntussusceptionObstructiondue86Etiologyanatomy:cecumtoofreepathologicalfactors:polyp,tumorabnormalityofintestineTypesintestine-intestineintestine-coloncolon-colon小腸疾病分類和應(yīng)用SmallIntestinalDiseaseEtiology小腸疾病分類和應(yīng)用SmallIntestin87Clinicalfindings80%,<2ychildrenAbdominalpain,currant-jellystool,sausage-shapedmassCoil-springsignAirorBariumenemaReduction小腸疾病分類和應(yīng)用SmallIntestinalDiseaseClinicalfindings小腸疾病分類和應(yīng)用Smal88Treatment:Gasorbariumenema(youngers).Operation:manualreductionbowelresection小腸疾病分類和應(yīng)用SmallIntestinalDiseaseTreatment:小腸疾病分類和應(yīng)用SmallIntest89腸系膜血管缺血性疾病etiologyandpathology1.superiormesentericarteryembolus2.superiormesentericarterialthrombosis3.superiormesentericvenousthrombosis4.others:non-mesentericvascularischemiaischemianecrosis小腸疾病分類和應(yīng)用SmallIntestinalDisease腸系膜血管缺血性疾病小腸疾病分類和應(yīng)用SmallIntest90ClinicalmanifestationhistoryofcoronaryheartdiseaseoratrialfibrillationacuteabdominalcrampseveresymptomandslightabdominalsignintheearlystageDiagnosisabdominalfilm,angiography(DSA)小腸疾病分類和應(yīng)用SmallIntestinalDiseaseClinicalmanifestation小腸疾病分類和應(yīng)91Treatment:Keypoint:EarlydiagnosisandreasonabletherapyVasodilatingagentSurgicaltherapyEmbolectomyVascularbypassIntestinalresectionandanastomosis小腸疾病分類和應(yīng)用SmallIntestinalDiseaseTreatment:小腸疾病分類和應(yīng)用SmallIntest92Case1:

Male,25yearsold,complainsofabdominalpainanddistentionfor2days.PE:P80,abdominalbulge,intestinalpatternsandperistalticwaves,high-pitchedbowelsound.Pasthistory:Heunderwentappendectomy3monthago.Diagnosisandtreatment?小腸疾病分類和應(yīng)用SmallIntestinalDiseaseCase1:小腸疾病分類和應(yīng)用SmallIntestinal93Case2:

male,68yearsold,complainsofabdominalbowelmotionfor3month,abdominaldistentionandstoppassgasandfecesfor2days.PE:P90,Bp130/70mmHg,abdominalbulge,intestinalpatternsandperistalticwaves,high-pitchedbowelsound.

Diagnosisandtreatment?Whichexamintationshouldbeundergonefordiagnosis?小腸疾病分類和應(yīng)用SmallIntestinalDiseaseCase2:小腸疾病分類和應(yīng)用SmallIntestinal94ShortBowelSyndromeDefinition:

ShortBowelSyndrome(SBS)isdefinedasmalabsorptionresultingfromanatomicalorfunctionallossofasignificantlengthofthesmallintestine.小腸疾病分類和應(yīng)用SmallIntestinalDiseaseShortBowelSyndrome小腸疾病分類和應(yīng)用S95PathophysiologyThemajorityofcarbohydrate,protein,fats,vitamins,bilesaltsabsorptiontakesplaceinthesmallbowel.<100cmsevereinfluencebodyfluiddisorderandmalnutrition小腸疾病分類和應(yīng)用SmallIntestinalDiseasePathophysiology小腸疾病分類和應(yīng)用SmallI96ClinicalfindingsFirstsymptom:diarrhea,theseverityrelatestothelengthofresidualbowelWeightloss,fatigue,malnutrition,bodyfluiddisorder小腸疾病分類和應(yīng)用SmallIntestinalDiseaseClinicalfindings小腸疾病分類和應(yīng)用Smal97TreatmentCorrectimbalanceofmetabolismandelectrolyteNutritionalsupport

totalparenteralnutritionpartialparenteralnutrition

enteralnutrtion小腸疾病分類和應(yīng)用SmallIntestinalDiseaseTreatmenttotalparenteraln98Thefirststage(2month)TPNandcorrectthefluiddisorderThesecondstage(1～2y)PPN+ENThethirdstageENorPPN+ENMaybesustainonelife小腸疾病分類和應(yīng)用SmallIntestinalDiseaseThefirststage(2month)小腸疾病分類99

Itneedlong-termregularnutritionmonitoringtopreventproblemsassociatedwithfluid,macro-andmicro-nutrientmalabsorption.Sincetheyareathighriskfordehydrationandbacterialovergrowth,theyneedpromptmedicalattentionanytimetheyhavesymptomsofgastroenteritis.小腸疾病分類和應(yīng)用SmallIntestinalDiseaseItneedlong-termregula100IntestinalTumor小腸腫瘤Lowerincidence（5%inthegastrointestinaltumor）Butmalignancy3/4小腸疾病分類和應(yīng)用SmallIntestinalDiseaseIntestinalTumor小腸疾病分類和應(yīng)用Small101ClinicalFindings:AbdominalpainIntestinalbleedingIntestinalobstructionIntraabdominalmassIntestinalperforationCarcinoidsyndrome小腸疾病分類和應(yīng)用SmallIntestinalDiseaseClinicalFindings:小腸疾病分類和應(yīng)用Sma102DiagnosisClinicalfindings+X-rayBariummealGastroscopyintestinalendoscopyLaparoscopyTreatmentSurgicaloperation小腸疾病分類和應(yīng)用SmallIntestinalDiseaseDiagnosis小腸疾病分類和應(yīng)用SmallIntest103IntestinalFistula

definition:thereisabnormaltractbetweenbowelandotherorgans,orabdominalcavity,abdominalwall.externalfistulainternalfistula小腸疾病分類和應(yīng)用SmallIntestinalDiseaseIntestinalFistuladefinitio104PathophysiologyLossofintestinalfluidwaterandelectrolytedisorderandacid-baseimbalanceLossofproteinmalnutrition,cachexiaDigestivejuiceoverflowskinandtissueerosio,infectionandbleeding小腸疾病分類和應(yīng)用SmallIntestinalDiseasePathophysiology小腸疾病分類和應(yīng)用SmallI105ClinicalManifestationFistulastomaintheabdominalwallandintestinalcontentoverflowBodyfluiddisorderfindingsMalnutritionInfectioussymptoms小腸疾病分類和應(yīng)用SmallIntestinalDiseaseClinicalManifestation小腸疾病分類和應(yīng)106DiagnosisHistory+clinicalfindingsMethylthioniniumChlorideorallyFistulographyBariummeal小腸疾病分類和應(yīng)用SmallIntestinalDiseaseDiagnosis小腸疾病分類和應(yīng)用SmallIntesti107TreatmentNutritionalsupportControltheabdominalinfectionKeepdrainagenonobstructiveAntibioticsSurgeryAdjuvantoperationSuchasdrainage,enterostomy小腸疾病分類和應(yīng)用SmallIntestinalDiseaseTreatment小腸疾病分類和應(yīng)用SmallIntesti108Radicaloperation(3-6mlater)IntestinalfistularesectionandanastomosisSegmentalintestineresectionandanastomosisIntestinalfistularepairmentEnterostomyIntestinalexteriorization小腸疾病分類和應(yīng)用SmallIntestinalDiseaseRadicaloperation(3-6mlater)小109小腸疾病分類和應(yīng)用

Small

IntestinalDisease

小腸疾病分類和應(yīng)用SmallIntestinalDisease小腸疾病分類和應(yīng)用

SmallIntestinalDi110小腸疾病分類和應(yīng)用SmallIntestinalDisease小腸疾病分類和應(yīng)用SmallIntestinalDiseas111AnatomyandPhysiologyTheanatomyofsmallintestinelength:3～5mportions

bloodsupply：superiormesentericanerve：autonomic

SympatheticParasympathetic

duodenum:25cmjejunum:2/5ileum:3/5小腸疾病分類和應(yīng)用SmallIntestinalDiseaseAnatomyandPhysiologySympat112Fourlayers:mucosasubmucosamuscularisserosaPeyer’patches小腸疾病分類和應(yīng)用SmallIntestinalDiseaseFourlayers:小腸疾病分類和應(yīng)用SmallInt113VillusmucosaThephysiologyofsmallintestinesecretealkalineintestinaljuicedigestionandabsorptionendocrineandimmune

小腸疾病分類和應(yīng)用SmallIntestinalDiseaseVillusmucosa小腸疾114InflammatoryBowelDisease

CrohnDiseaseEtiologyunclearPathologyoccurinanysegmentofthepeptictractgranulomatousinflammatorylesion，involvefull-thicknessbowellayer小腸疾病分類和應(yīng)用SmallIntestinalDiseaseInflammatoryBowelDisease115Clinicalmanifestationoccurinanyage60%cases<40yintermittentabdominalcomplaintorpaindigestivesymptom:diarrheaotherslowfeverfatiguepoorappetiteanemiaandweightloss小腸疾病分類和應(yīng)用SmallIntestinalDiseaseClinicalmanifestation小腸疾病分類和應(yīng)116complicationsintestinalobstruction中毒性巨結(jié)腸perforationhemorrhagecarcinogenesis小腸疾病分類和應(yīng)用SmallIntestinalDiseasecomplications小腸疾病分類和應(yīng)用SmallInt117diagnosishistoryandclinicalfindingsbariummealandbariumenemacoloscopydifferentialdiagnosisboweltuberculosisulcerativecolitisappendicitis小腸疾病分類和應(yīng)用SmallIntestinalDiseasediagnosis小腸疾病分類和應(yīng)用SmallIntest118treatmentmajortherapy:medicinesurgicalindications:complicationbecauseitshigherrecurrencerate

>50%小腸疾病分類和應(yīng)用SmallIntestinalDiseasetreatment小腸疾病分類和應(yīng)用SmallIntesti119Tuberculosisofintestineetiologyandpathologysecondaryinfectionposition：ileum-cecumulcerativetypeandproliferativetype小腸疾病分類和應(yīng)用SmallIntestinalDiseaseTuberculosisofintestine小腸疾病分120clinicalfindingsyounglowfever,nightsweat，fatigue,weightloss,poorappetitechronicabdominalpaindiarrheaandconstipationcomplication小腸疾病分類和應(yīng)用SmallIntestinalDiseaseclinicalfindings小腸疾病分類和應(yīng)用Smal121diagnosisbloodroutine,ESR,chestfilm,bariummealandbariumenema,coloscopyhistoryandclinicalmanifestation小腸疾病分類和應(yīng)用SmallIntestinalDiseasediagnosis小腸疾病分類和應(yīng)用SmallIntesti122treatmentmedicaltherapysurgicalindicationcomplicationsuchasobstruction

、

fistula

、perforation、bleedingoperativeways:resectthepartialbowelandanastomosisperforationrepairmentBy-pass小腸疾病分類和應(yīng)用SmallIntestinalDiseasetreatment小腸疾病分類和應(yīng)用SmallIntesti123IntestinalPerforationofTyphoidFever

etiologyandpathologyinfectionbybacillustyphussite:thelastportionoftheileumsimpleperforation:80-90%小腸疾病分類和應(yīng)用SmallIntestinalDiseaseIntestinalPerforationofTyph124clinicalfindingsdiffuseperitonitissymptomsacutesevereabdominalpainmuscleguardness,tendernessandreboundtendernessmajortreatmentrepairoftheperforation小腸疾病分類和應(yīng)用SmallIntestinalDiseaseclinicalfindings小腸疾病分類和應(yīng)用Smal125AcuteHemorrhagicEnteritisetiology:unclearmayberelatedtoβtoxinofWelchbaciluspathologythelesionlocalizedinjejunumorileumlocalcongestion,hemorrhage,necrosisandulceration小腸疾病分類和應(yīng)用SmallIntestinalDiseaseAcuteHemorrhagicEnteritis小腸疾126Clinicalfindingsoccurinchildrenandyoungeracuteabdominalpainaccompaniedbynausea,vomiting,diarrhea,hematochezia.distention,tendernesssignsofbowelofstrangulationtoxicshock小腸疾病分類和應(yīng)用SmallIntestinalDiseaseClinicalfindings小腸疾病分類和應(yīng)用Sma127Treatmentmedicaltreatment(mainmethod)keepinternalenvironmentstablefasting,gastrointestinaldecompressionantibioticnutritionalsupport小腸疾病分類和應(yīng)用SmallIntestinalDiseaseTreatment小腸疾病分類和應(yīng)用SmallIntesti128surgicalindicationobviousperitonitisbowelbleedingisdifficulttocontrolintestinalobstructionaggravationaftermedicaltherapyDiagnosisNOTclear小腸疾病分類和應(yīng)用SmallIntestinalDiseasesurgicalindication小腸疾病分類和應(yīng)用Sm129IntestinalObstructiondefinition：apartialorcompleteblockageofthebowelresultsinthefailureoftheintestinalcontentstopassthrough小腸疾病分類和應(yīng)用SmallIntestinalDiseaseIntestinalObstruction小腸疾病分類和應(yīng)130EtiologyandClassification（一）Accordingtotheobstructivecause