11-小肠疾病

Inflammatory Bowel Disease
Crohn Disease Etiology
➢unclear Pathology
➢ occur in any segment of the peptic tract ➢granulomatous inflammatory lesion ，
involve full-thickness bowel layer
1） intraluminal obstruction
（1） 胆结石 （2） 粪石 （3） 毛发团 （4） 异物 （5 ）肠减压管气囊 （6） 寄生虫 （7） 腔内憩室
2）lesions extrinsic to the bowel
（1） 粘连：手术后；先天性；炎症后 （2） 疝：腹壁疝；腹内疝 （3） 先天性：环状胰腺；腹膜包裹 （4） 肿瘤：肠外肿瘤； 肠系膜肿瘤 （5） 炎症：腹腔内脓肿；腹腔异物 （6） 其他：肠系膜上动脉综合征；
Intestinal Perforation of Typhoid Fever
etiology and pathology ➢infection by bacillus typhus ➢site: the last portion of the ileum ➢ simple perforation:80-90%
➢shock：dehydration、blood concentration、hypovolemia 、metabolic disorder、bacteria infection and intoxication
➢ respiratory and circulation dysfunction： abdominal pressure increased
Small Intestinal Disease
Anatomy and Physiology
The anatomy of small intestine
➢ length: 3～5m
duodenum:25cm
➢portions jejunum :2/5
ileum:3/5
➢blood supply：superior
Clinical findings
➢occur in children and younger ➢acute abdominal pain accompanied by
nausea, vomiting ,diarrhea , hematochezia. distention , tenderness ➢signs of bowel of strangulation
mesenteric a
Sympathetic
➢ nerve：autonomicParasympathetic
➢ Four layers : mucosa submucosa muscularis serosa
➢ Peyer’patches
Villus
mucosa
The physiology of small intestine ➢ secrete alkaline intestinal juice ➢digestion and absorption ➢ endocrine and immune
1、simple
只有肠内容物通过受阻，无肠管血 运障碍。
2 、strangulation
梗阻伴有肠管血运障碍，例如：肠系 膜血管栓塞
（三）按梗阻部位
1 高位梗阻：空肠及近段回肠 2 低位梗阻：结肠及远段回肠
（四）按梗阻程度
1 不完全性肠梗阻 2 完全性肠梗阻
（五）按病程缓急
1 急性肠梗阻 2 慢性肠梗阻
3）intrinsic bowel wall lesions
（1）肠道闭锁 （2）炎症狭窄，肠套叠，肠扭转 （3）肿瘤等
2、Dynamic (Paralytic ilLeabharlann Baiduus)
1）麻痹性：（1）腹腔手术后； （2）腹部创伤； （3）急性弥漫性腹膜炎
2）痉挛性：（1）急性肠炎； （2）肠道功能紊乱； （3）慢性铅中毒；
Intestinal Obstruction
definition：a partial or complete blockage of the bowel results in the failure of the intestinal contents to pass through
Etiology and Classification
➢ clinical findings diffuse peritonitis symptoms ➢acute severe abdominal pain ➢muscle guardness, tenderness and rebound tenderness
➢ major treatment ➢repair of the perforation
Acute Hemorrhagic Enteritis
etiology:unclear ➢maybe related to βtoxin of Welch bacilus
pathology ➢ the lesion localized in jejunum or ileum ➢local congestion, hemorrhage,necrosis and ulceration
pressure
artery return hindrance
necrosis and perforation
Chronic intestinal obstruction incomplete
long time
bowel wall hypertrophy
intestinal pattern and peristaltic waves
Clinical manifestation
➢occur in any age 60% cases<40y ➢intermittent abdominal complaint or pain ➢digestive symptom:diarrhea ➢others
low fever fatigue poor appetite anemia and weight loss
Pathophysiology ➢ the loss of body fluid：water and electrolyte disorder and metabolic imbalance (The intestinal tract secretes up to 8.0L/d ) ➢ infection and intoxication ：the damage of intestinal barrier and bacteria translocation, toxin absorption
diagnosis ➢blood routine,ESR,chest film,barium meal and barium enema,coloscopy ➢history and clinical manifestation
treatment
➢ medical therapy ➢ surgical indication
➢ complication such as obstruction 、 fistula 、
perforation、bleeding ➢ operative ways:
➢ resect the partial bowel and anastomosis ➢ perforation repairment ➢ By-pass
（一）According to the obstructive cause 1、 Mechanical ：high incidence intraluminal obstruction Extrinsic bowel tract lesions Intrinsic bowel wall lesion
➢ 单纯性机械性肠梗阻
反复发作的、节律性的、阵发性腹部绞痛
➢ 绞窄性肠梗阻
腹痛间歇不断缩短
持续性腹痛
疼痛程度不断加重
➢ 麻痹性肠梗阻
持续性胀痛
➢ Vomiting
Early
reflectivity
Paralysis
➢surgical indication obvious peritonitis bowel bleeding is difficult to control intestinal obstruction aggravation after medical therapy Diagnosis NOT clear
complications ➢intestinal obstruction ➢perforation ➢hemorrhage ➢carcinogenesis
中毒性巨结肠
diagnosis ➢history and clinical findings ➢barium meal and barium enema ➢coloscopy
3、Hematogenesis 血运性肠梗阻
肠系膜血管栓塞或血栓形成致使肠管发 生血运障碍
4、 Idiopathic Intestinal PseudoObstruction
Chronic illness, recurrence Heredity Impaired motor response to bowel
distention Duodenal,colonic slow waves normal Absence of radiogaphic findings of
mechanical obstruction Non-surgical treatment
（二） According to the blood supply of the bowel wall
> 50%
Tuberculosis of intestine
etiology and pathology ➢ secondary infection ➢ position：ileum-cecum ➢ ulcerative type and proliferative type
clinical findings ➢ young ➢low fever, night sweat，fatigue, weightloss,poor appetite ➢chronic abdominal pain ➢diarrhea and constipation ➢complication
toxic shock
Treatment ➢medical treatment (main method) keep internal environment stable fasting, gastrointestinal decompression antibiotic nutritional support
abdominal compartment hypertension
临床表现——症状
痛、呕、胀、闭
痛
呕
胀
Clinical Manifestation ➢ Abdominal pain ➢ Vomiting ➢ Distention ➢ Failure to pass gas and stool
differential diagnosis ➢bowel tuberculosis ➢ulcerative colitis ➢appendicitis
treatment ➢major therapy: medicine ➢surgical indications: complication because its higher recurrence rate
（六）特殊类型：闭袢性肠梗阻
粘连
肠套叠
嵌顿
扭转、粪性
蛔虫性
Pathology and Pathophysiology
pathology （acute） proximal bowel distention
luminal pressure
venous return hindrance
congestin,edema, exudation