《急腹症病例分析》ppt课件.pptxVIP

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

Firstaid1“MONITOR”3“TUBES”1“FORBIDEN”

WhatkindsofImformation

doyouneed?Howtogetit?HistorydemandAssistexaminationGetthecluesstepbystepInvestigationphysicalexamination

Historydemand---Episodecondition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

0102030405Historydemand01---Characterofabdomenpain02阵发性的绞痛：管道阻塞后痉挛收缩的结果04持续性钝痛或隐痛：炎症或出血刺激腹膜的表现03持续腹痛阵发加剧：炎症和梗阻并存，互为因果05

Historydemand01---Degreeofabdomenpain02急性炎症：较轻，可以忍受03管道梗阻：绞痛通常都较剧烈04穿孔：出血性胰腺炎：疼痛剧烈伴休克05

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？12

Historydemand---Othercondition1溃疡穿孔：过去有长期溃疡病史突发上腹部剧痛3粘连性肠梗阻：有腹部手术、外伤、炎症史2胆囊炎：右上腹反复发作疼痛史4寒战、高热：化脓性病变