肠梗阻课件.ppt
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1、肠 梗 阻 Intestinal obstraction,Whenever gastrointestinal luminal content is pathologically prevented from passing distally,Conception,任何原因引起的肠内容物不能正常运行,顺利通过肠道时,称为肠梗阻(intestinal obstruction)。,1. According to its Basic causes 2. Vascular supply to intestinal wall 3. Obstruction level or site 4. The exte
2、nt of obstruction 5. Progression of obstruction,Classification,.According to its Basic causes 机械性肠梗阻( mechanical obstruction) 动力性肠梗阻(dynamic obstruction) 血运性肠梗阻(obstruction of vascular supply origin),Classification,Classification,mechanical obstruction(very common),A. 肠腔堵塞,B.肠管受压,粘连带压迫,ascarid,herni
3、a,mechanical obstruction,C. 肠壁病变,inflammatory,neoplastic,Classification,Dynamic obstruction,Causes : Nerval reflex or toxin stimulation,Classification 麻痹性肠梗阻 (Paralytic ileus ): acute diffuse peritonitis, abdominal operation, retroperitoneal hematoma and infection 痉挛性肠梗阻( Spastic obstruction ),Class
4、ification,Obstruction of vascular supply origin,thrombosis or embolism, then intestinal paralysis,Classification,1. 按梗阻发生的原因 2. 按肠壁有无血运障碍 单纯性肠梗阻 (Simple obstruction) 绞窄性肠梗阻 (Strangulation obstruction),Intussception,Volvulus,Classification,1. According to its Basic causes 2. Vascular supply to intest
5、inal wall 3. 按梗阻发生的部位 高位肠梗阻(high obstruction ) 低位肠梗阻(low obstruction),Classification,1. According to its Basic causes 2. Vascular supply to intestinal wall 3. Obstruction level or site 4. 按梗阻发生的程度 完全性肠梗阻(complete obstruction) 不完全性肠梗阻(Incomplete obstruction),Classification,1. According to its Basic c
6、auses 2. Vascular supply to intestinal wall 3. Obstruction level or site 4. The extent of obstruction 5. 按梗阻发生的速度 急性肠梗阻(Acute obstruction) 慢性肠梗阻(chronic obstruction),Classification,Pathophysiology,Simple mechanical obstruction 梗阻以上肠蠕动增多(contracts vigorously) 梗阻以上肠管膨胀(distention) 梗阻以下肠管瘪陷 膨胀和瘪陷交界处为梗阻
7、所在,肠管局部变化,Pathophysiology,Acute complete obstruction 肠腔压力静脉回流受阻肠壁水肿、增厚、呈暗红色动脉血运受阻肠管变成紫黑色坏死、穿孔。,Pathophysiology,肠管局部变化,Chronic incomplete obstruction 梗阻以上肠腔扩张、肠壁代偿性肥厚 腹壁视诊常可见扩大的肠型和肠蠕动坡。,Pathophysiology,肠管局部变化,全身性病理生理改变 主要由于体液丧失、肠膨胀、毒素的吸收和感染所致,Pathophysiology,体液丧失(lose of body fluid) 引起水、电解质紊乱与酸碱失衡 全身
8、性感染和毒血症 腹膜炎和中毒(peritonitis and poisoning) shock respiration and circulation disorder),Pathophysiology,全身性病理改变,Clinical Manifestations,痛,吐,胀,闭,张某,男性,48岁 阵发性腹痛、恶心、呕吐 出大量草绿色液体,1天后出现腹胀、3天来无排便 。 2年前曾行阑尾切除术,Clinical Manifestations,Clinical Manifestations,Pain (痛),Vomitting (吐),Distension (胀),Constipation
9、(闭),痛,吐,胀,闭,特点,胀痛,Clinical Manifestations,Paralytic ileus,mechanical obstruction,obstruction of vascular supply origin,痛,吐,胀,闭,特点,出现早且频繁 出现晚、次数少且量多 次数多且量多 次数少且量少 暗红或血性液体,high / Strangulation,Low obstruction,Completely,incompletely,Strangulation,Clinical Manifestations,痛,吐,胀,闭,腹部膨隆,肠腔扩张,Clinical Mani
10、festations,How to observe distention? 腹部膨隆 腹壁紧张、皮肤发亮 呼吸困难、不能平卧 X线检查 血气,痛,吐,胀,闭,Clinical Observations,机理,痛,吐,胀,闭,肠管失去蠕动功能 肠蠕动不能正常推进,Clinical Manifestations,痛,吐,胀,闭,特点,完全停止排便、排气 多次少量排便、排气 早期有少量排便、排气 粘液样血便,Completely,incompletely,high,Strangulation,Clinical Manifestations,Clinical Manifestations,R、HR 、
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