小肠疾病英文.pptVIP

小肠疾病英文 AnatomyThe jejunal mucosa is relatively thick with prominent plicae circulares; the mesenteric vessels form only one or two arcades with long vasa recta. The ileum is smaller in circumference and has thinner walls; the mesenteric vessels form multiple vascular arcades with short vasa recta.第二页，共21页。2 Blood supply to the jejunoileum and distal duodenum is entirely from the superior mesenteric artery, which courses anterior to the third portion of the duodenum. The celiac artery supplies the proximal duodenum.第三页，共21页。3 Physiology第四页，共21页。4 Motility: Peristalsis consists of intestinal contractions passing aborally at a rate of 1 to 2 cm/seccontractions initiated by the migrating myoelectric complex (MMC) under the control of both neural and humoral pathways第五页，共21页。5 ENDOCRINE FUNCTION第六页，共21页。6 ObstructionEtiology: Common causes of small bowel obstruction in industrialized countries:第七页，共21页。7 Clinical Manifestations and DiagnosisCardinal symptoms: colicky abdominal pain nausea vomiting abdominal distention failure to pass flatus and feces第八页，共21页。8 Physical Examdistended abdomenperistaltic wavesminimal or no bowel soundsMild abdominal tenderness with / without a palpable massExam to rule out incarcerated herniasRectal exam第九页，共21页。9 Radiologic and Laboratory ExaminationsPlain abdominal radiographs: accuracy≈60% -dilated loops of small intestine without evidence of colonic distention -multiple air-fluid levels, often in a stepwise pattern -demonstrate the cause of the obstructionCT: for more complex cases第十页，共21页。10 第十一页，共21页。11 Plain abdominal film shows complete bowel obstruction caused by a large radiopaque gallstone (arrow) obstructing the distal ileum.第十二页，共21页。12 CT scan of the abdomen of a patient with a mechanical bowel obstruction secondary to an abscess in the right lower quadrant (arrow). Multiple dilated and fluid-filledloops of small bowel are noted.第十三页，共21页。13 Simple Vs Strangulating Obstruction“Classic” signs of