急腹症英文版培训ppt课件

急腹症英文版急腹症英文版1前言Abdominal pain is a complaint seen commonly in the outpatient setting.The differential diagnosis of a patient presenting with acute abdominal pains.pathophysiology of the painthe clinical presentationCourseinitial management急腹症英文版2前言Abdominal pain is a complainA focused historyphysical examination adjunctive testing strategy急腹症英文版3A focused history急腹症英文版3pathophysiology of the painThe abdominal viscera are innervated with nocioceptive afferents within the mesentery,on peritoneal surfaces,and within the mucosa and muscularis of hollow organs.急腹症英文版4pathophysiology of the painTheThe pain genesisMechanicalstretchChemical substance P serotonin prostaglandins hydrogen ions急腹症英文版5The pain genesisMechanicalChemStimuli Dullcrampypoorly localized pain sensations急腹症英文版6Stimuli Dull急腹症英文版6Three broad patternsvisceralParietalreferred急腹症英文版7Three broad patternsvisceral急腹Visceraltypically involves stretch and distension of the abdominal organs.although torsion,and contraction also contribute.The pain stimulus is carried on slow-conducting C-fibers.急腹症英文版8Visceraltypically involves strdull ache.Pain location corresponds to those dermatomes that match the innervation of the injured organ.急腹症英文版9dull ache.急腹症英文版9ParietalSharpwell localized A-fibers,with a rapid conduction velocity急腹症英文版10ParietalSharp急腹症英文版10Referredpain occurs when visceral afferents carrying stimuli from a diseased organ enter the spinal cord at the same level as somatic afferents from a remote anatomic location.急腹症英文版11Referredpain occurs when visceFurthermore,disease processes from organs outside of the abdominal cavity can present with abdominal pain.急腹症英文版12Furthermore,disease processesHistoryassessment of the conditionmedical problemsmedicationsfamily history,substance abuse history,recent travel historyoccupational history.急腹症英文版13Historyassessment of the condiNature of the painits qualityLocationrapidity of onsetChronicityradiation,Intensityexacerbating factorsalleviating factorsAssociated symptoms急腹症英文版14Nature of the painits quality急Physical examinationgeneral observation(review of the vital signs)abdominal inspectionauscultationpalpation急腹症英文版15Physical examinationgeneral ob急腹症英文版16急腹症英文版16Diagnosis of abdominal pain based on location and distributionRight upper quadrant Peptic ulcer diseaseBiliary diseaseBiliarycolicCholedocholithiasisCholecystitisCholangitisLiver diseaseHepatitisNeoplasmAbscessCongestive hepatopathyLung diseasePneumoniaSubphrenic abscessPulmonary embolismPneumothoraxAbdominal wallHerpes zosterMuscular StainKidney diseasePyelonephritisPerinephric abscessNephrolithiasisColonic causesColitisRight sided diverticulitis急腹症英文版17Diagnosis of abdominal pain bMiddle upper abdomenPeptic ulcer diseasePancreatitic diseasePancreatitisPancreatic neoplasmBiliary diseaseBiliary colicCholedocholithiasisCholecystitisCholangitisEsophageal diseaseReflux esophagitisInfectious esophagitisPill esophagitisCardiac diseaseMyocardial ischemiainfarctionPericarditisAAA rupture/aorticdissectionMesenteric ischemia急腹症英文版18Middle upper abdomenPeptic ulcLeft upper quadrantPeptic ulcer diseaseSplenic diseaseSplenic ruptureSplenic infarctPancreatic diseasePancreatitisPancreatic neoplasmLung diseasePneumoniaSubphrenic abscessPulmonary embolismPneumothoraxKidney diseasePyelonephritisPerinephric abscessNephrolithiasis急腹症英文版19Left upper quadrantPeptic ulcePeriumbilicalAppendicitis(early)Small bowel obstructionGastroenteritisMesenteric ischemiaAAA ruptureAortic dissection急腹症英文版20Periumbilical急腹症英文版20Right lower quadrantAppendicitisInflammatory bowel diseaseOB-GYN causesOvarian tumorOvarian torsionEctopic pregnancyPelvic inflammatory disease(PID)Kidney diseasePyelonephritisPerinephric abscessNephrolithiasisIntestinal diseaseRight sided diverticulitisIleocolitisGastroenteritisHernia急腹症英文版21Right lower quadrantAppendicitSuprapubicInflammatory bowel diseaseOB-GYN causesOvarian tumorOvarian torsionEctopic pregnancyPIDDysmenorrheaColonic diseaseProctocolitisDiverticulitisUrinary tract diseaseCystitisNephrolithiasisProstatitis急腹症英文版22SuprapubicInflammatory bowel dLeft lower quadrantInflammatory bowel diseaseOB-GYN causesOvarian tumorOvarian torsionEctopic pregnancyPIDKidney diseasePyelonephritisPerinephric abscessNephrolithiasisIntestinal diseaseSigmoid diverticulitisIleocolitisGastroenteritisHernia急腹症英文版23Left lower quadrantInflammatorDiffuseGastroenteritisBowel obstructionPeritonitisMesenteric ischemiaInflammatory bowel diseaseDiabetic ketoacidosisPorphyriaUremiaHypercalcemiaSickle cell crisisVasculitisHeavy metal intoxicationOpiate wihdrawalFamilial mediterranean feverHereditary angioedema急腹症英文版24DiffuseGastroenteritisHypercal急腹症英文版培训ppt课件25significant abnormality of the vital signs,mental status changes,involuntary guarding,rebound abdominal tenderness,complete absence of bowel sounds,and pain out of proportion to abdominal tenderness急腹症英文版26significant abnormality of thewithout signs or symptoms of an acute abdominal catastrophe,an acute expedited outpatient evaluation should be performed.急腹症英文版27without signs or symptoms of alaboratory and imaging studiesplain abdominal radiographs have been the initial imaging test of choice.rapidly at a relatively low cost急腹症英文版28laboratory and imaging studiesup to 60%of cases of suspected small bowel obstruction.with a perforated viscus,sensitivity of plain films is reported to be as high as 100%.as small as 1 to 2 cc of air has been reported using this method急腹症英文版29up to 60%of cases of suspecteCT is sensitive for the diagnosisrapid helical scanning methods,advances in intravenous and oral contrast agents,three-dimensional reformatting急腹症英文版30CT is sensitive for the diagnoComputed tomography has proven to be more sensitive and specific for nearly all etiologies of acute abdominal pain急腹症英文版31Computed tomography has proven 急腹症英文版32 急腹症英文版32急腹症英文版33急腹症英文版33there is a spectrum of systemic medical disorders,such as adrenal insufficiency,diabetic ketoacidosis,porphyria that can present with abdominal pain.急腹症英文版34there is a spectrum of systemi外科急腹症的治疗原则外科急腹症的治疗原则非手术治疗非手术治疗 适应证适应证适应证适应证就诊时腹膜炎已局限且病人全身情况良好；就诊时腹膜炎已局限且病人全身情况良好；就诊时腹膜炎已局限且病人全身情况良好；就诊时腹膜炎已局限且病人全身情况良好；就诊时不明确且又无紧急手术指证；就诊时不明确且又无紧急手术指证；就诊时不明确且又无紧急手术指证；就诊时不明确且又无紧急手术指证；出血性疾病经输血治疗，血压回升，病情稳出血性疾病经输血治疗，血压回升，病情稳出血性疾病经输血治疗，血压回升，病情稳出血性疾病经输血治疗，血压回升，病情稳定无再出血表现；定无再出血表现；定无再出血表现；定无再出血表现；诊断明确，非手术治疗疗效明显；诊断明确，非手术治疗疗效明显；诊断明确，非手术治疗疗效明显；诊断明确，非手术治疗疗效明显；病情危重，全身情况极差或合并重要器官功病情危重，全身情况极差或合并重要器官功病情危重，全身情况极差或合并重要器官功病情危重，全身情况极差或合并重要器官功能不全，不能耐受手术者。能不全，不能耐受手术者。能不全，不能耐受手术者。能不全，不能耐受手术者。急腹症英文版35外科急腹症的治疗原则非手术治疗 适应证急腹症英文版35外科急腹症的治疗原则外科急腹症的治疗原则非手术治疗的非手术治疗的一般方法一般方法禁止饮食禁止饮食禁止饮食禁止饮食通畅有效的胃肠减压通畅有效的胃肠减压通畅有效的胃肠减压通畅有效的胃肠减压密切观察生命体征的变化密切观察生命体征的变化密切观察生命体征的变化密切观察生命体征的变化应用必要的抗生素，预防和治疗感染应用必要的抗生素，预防和治疗感染应用必要的抗生素，预防和治疗感染应用必要的抗生素，预防和治疗感染反复观察腹部体征的变化反复观察腹部体征的变化反复观察腹部体征的变化反复观察腹部体征的变化及时有效的输血、输液扩充有效血容量，防止休及时有效的输血、输液扩充有效血容量，防止休及时有效的输血、输液扩充有效血容量，防止休及时有效的输血、输液扩充有效血容量，防止休克克克克止痛药物的应用止痛药物的应用止痛药物的应用止痛药物的应用急腹症英文版36外科急腹症的治疗原则非手术治疗的一般方法急腹症英文版36外科急腹症的治疗原则外科急腹症的治疗原则手术治疗手术治疗 适应证适应证适应证适应证急性剧烈的腹痛，非手术治疗无效或加重急性剧烈的腹痛，非手术治疗无效或加重急性剧烈的腹痛，非手术治疗无效或加重急性剧烈的腹痛，非手术治疗无效或加重腹内活动性出血性疾病腹内活动性出血性疾病腹内活动性出血性疾病腹内活动性出血性疾病有明显腹膜炎刺激症状有明显腹膜炎刺激症状有明显腹膜炎刺激症状有明显腹膜炎刺激症状空腹脏器穿孔，腹膜炎较广泛空腹脏器穿孔，腹膜炎较广泛空腹脏器穿孔，腹膜炎较广泛空腹脏器穿孔，腹膜炎较广泛腹腔化脓性感染，需要及时减压引流腹腔化脓性感染，需要及时减压引流腹腔化脓性感染，需要及时减压引流腹腔化脓性感染，需要及时减压引流腹部闭合性损伤，确有内脏损伤或可疑者腹部闭合性损伤，确有内脏损伤或可疑者腹部闭合性损伤，确有内脏损伤或可疑者腹部闭合性损伤，确有内脏损伤或可疑者急腹症英文版37外科急腹症的治疗原则手术治疗 适应证急腹症英文版37外科急腹症的治疗原则外科急腹症的治疗原则手术治疗手术治疗 原则原则原则原则简单简单简单简单有效有效有效有效急腹症英文版38外科急腹症的治疗原则手术治疗 原则急腹症英文版38Thank you!急腹症英文版39Thank you!急腹症英文版39