【医学生物PPT】Present_王又德医师.pptVIP

业精于勤荒于嬉 行成于思毁于随 →【医学生物PPT，欢迎收藏分享】豆丁网友 Morning meeting Present：王又德醫師 Supervisor：楊浚銘醫師 Introduction Bowel obstruction, gastroenteritis Severe pain, especially visceral pain Severe systemic illness (myocardial infarction, sepsis, or shock) Pregnancy (hormones) Increased intracranial pressure (central mechanism) Chemotherapy (chemoreceptor trigger zone). History Content Time Associated symptoms (fever, headache, abdominal pain..) Social history (drug or alcohol abuse) Past medical history (any GI disease, surgery) Medication list Complication Hypovolemia Metabolic alkalosis Hypokalemia Mallory-Weiss tears typically follow a forceful bout of retching and vomiting. The lesion itself is a 1- to 4-cm tear through the mucosa and submucosa; Boerhaaves syndrome – -- perforation of all layers of the esophagus -- free passage of esophageal contents into the mediastinum and thorax -- 80% of cases involve the posterolateral aspect of the distal esophagus -- surgical emergency. -- Mortality is 50% if surgery is not performed within 24 hours Aspiration of gastric contents Hiatal hernia Introduction Frequent finding by radiologists and gastroenterologists. Type I: Sliding hernia? 95 % of cases. Widening of the muscular hiatal tunnel and circumferential laxity of the phrenoesophageal membrane ? gastric cardia to herniate upward. The phrenoesophageal membrane remains intact Posterior mediastinum Type I: Sliding hernia Most small hiatal hernias are asymptomatic and, even with larger type I hernias Clinical implication is the propensity to develop gastroesophageal reflux disease (GERD). The likelihood of symptomatic gastroesophageal reflux increases with the size of the hiatal hernia. Other types of hiatal hernia Less common types of hiatal hernia, types II, III, and IV, are varieties of paraesophageal hernias ? up to 5 % of all hiatal hernias Surgical dissection of the hiatus as occurs during antireflux procedures, esophag