肠疾病肠梗阻阑尾炎.ppt

肠疾病肠梗阻阑尾炎.ppt

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IntestineDiseasesSunLiboChina-JapanUnionHospitalReviewofAnatomyandPhysiologyI.SmallIntestineMacroscopicanatomyTreitzileocecalvalve.2/5jejunum,3/5ileumMesentery:

fat,bloodvessels,lymphatics,andnerves.superiormesenteryarteryandveinMicroscopicanatomy4layers:

mucosa,submucosa,muscularis,andserosa.Physiologyofthesmallintestine1.Digestiondigestsandabsorbsnutrientsfromingestedfood.2.SecretionAlkalinemucusandsomegastroenteralhormones3.MotilityThemovementiscomposedofsegmentalcontractionandperistalsis（short,weak,propulsive）II.LargeIntestineMacroscopicanatomy1.5mlong,endofileumrectum.Rightcolon:

cecum,ascendingcolon,hepaticflexure,andproximaltransversecolonLeftcolon:

thedistaltransversecolon,splenicflexure,descendingcolon,andsigmoidcolon.Bloodsupply:

Superiormesenteryarterytherightcolon.Inferiormesenteryarterytheleftcolon.Microscopicanatomy4layers:

mucosa,submucosa,muscularis,andserosa.Physiologyoflargeintestine1.Digestionelectrolytesandwaterfromtheilealfluid2.SecretionAlkalinemucusandsomegastroenteralhormones3.MotilityRetrogradeperistalsis（dominatesintherightcolon）Segmentalcontraction（inthetransverseanddescendingcolon）Massmovement（astrongringcontractionoverlongdistanceinthetransverseanddescendingcolon）MajorContentsInflammatoryboweldiseasesIBDIntestineObstructionVascularlesionsofmesenteryShortbowelsyndromePolypsTumorCongenitaldiseasesInflammatoryboweldiseasesIBD1）intestinetuberculosis2）typhoidperforation3）amoebicperforation4）nonspecificinflammatorydiseases（CrohnsDiseases,ulcerativecolitis）Surgicalinterventionperforation,obstruction,orhemorrhage（bleeding）Vascularlesionsofmesentery（vascularocclusionorischemia）MesentricarterialembolismorthrombosiscardiacdiseasesMesentericvenousthrombosisHepaticcirrhosisandhaemaldiseasesCharacter-symptomsevere,signlightDiagnosis-angiographyTreatment-operationShortbowelsyndromeEtiologyintestineresectionnotlongenough（100cm）digestiveandabsorptiondisfunctionTreatment1）nutritionsupport（TPN）12yearhalfcompensationrecover2）intestinetransplantationimmunerejectionproblemPolypsandpolyposisDifference100ornotPlace:

anywhere,butcommonincolonPresentation1）changeofdefecation2）rectalbleeding3）ileus（obstruction）TreatmentEndoscopicelectrocauterysnareOpenoperationCongenitaldiseasesClassification:

atresia,stenosis,andmalrotationEtiology:

abnormalgrowthDiagnosis:

1）newborn2）intestinalobstruction3）uppergastrointestinalseriesorbariumenemaevidenceTreatmentoperationObstructionofIntestine（Bowelileus）EtiologyandclassificationI.MechanicalObstructioninside,outsidethelumen,orintestinewalllesions.II.Adynamic（paralytic）ileusoperationoracuteperitonitis.bloodsupply?

simpleorstrangulatedileus.Changeinphysiology1.Lossofbodyfluid:

Metabolicacidosis-lower（distal）obstructionMetabolicalkalosis-high（proximal）obstruction2.InfectionandtoxicsymptomsEndogenousinfectionbybacteriainsidethelumen3.ShockSeverelossofliquidorinfection.4.RespirationandcirculationbarrierCausedbythedistensionofintestine.ClinicalfindingsSymptoms1.Abdominalpain.variable,crampingperi-umbilicalpain2.Vomitingespeciallyinproximal（high）3.Abdominaldistension.middleordistalbowelobstruction,andparalytic（adynamic）obstruction4.Difficultyofdefecationandgasexpelling.variesaccordingtoitiscompleteornotSigns1.GenerallyDehydration,andshockatthelatestage2.LocallyInspection:

Peristalsisindilatedloopsmaybevisibleinthinpatients.Palpation:

mildtendernessAuscultation:

Peristalticrushes,gurgles,andhighpitchedtinklesareaudible.Incarceratedhernia?

AdjuvantexaminationLaboratoryfindingsearlynormallatehemoconcentration,leukocytosiselectrolyteabnormalities.Serumamylaseisoftenelevated.X-rayfindingsPlainfilmsladderlikepatternofdilatedsmallbowelloopswithairfluidlevels.Contrastmediaorallyorbyanasogastrictube.proximalBariumenemadistaldiagnosisandquestionsDiagnosis:

basedaboveclinicalfindingsandadjuvantexaminationQuestions:

（1）isornot?

（2）Mechanicalorparalytic（adynamic）?

（3）Simpleorstrangulated?

（4）highorlower?

（5）completeornot?

（6）thereasonofobstruction?

Indicationofstrangulation1）severecolicpain2）shock3）peritonitis4）visibleorpalpabledilatedintestineloops5）bowelbleeding6）medicaltreatmentisnotsuccessful7）X-rayshowsdistendedbowelloopsthatisnotchangewithtime.Treatment1.Conservativetherapy1）Nasogastricsuction.2）Fluidandelectrolyteresuscitation.3）Antibioticsusedbeforeoperation.4）TraditionalChinesemedicinetherapy.2.Operation.1）removingthecauseofobstruction2）intestineresection3）bypassoperation.4）intestinestomaIntestineTumorI.SmallIntestineTumorsIntroduction1）Themorbidityisrare,occupiednearly2%ofthetumorsingastrointestinaltract.2）Most（3/4）aremalignancies.3）Thediagnosisbeforeoperationisdifficult,sothetreatmentisoftendelayed.Clinicalfindings-nottypical1.abdominalpain:

discomfort,dullpain,orcolicpain2.hemorrhage（bleeding）fromdigestivetract.3.intestineobstruction4.abdominalmass5.intestineperforation6.carcinoidsyndrome:

presentation:

cutaneousflushing,diarrhea,asthma,andcardicvalvulardiseaseReason:

activesubstancessecretedbycarcinoids,suchashistamine,bradykinin,a