小肠疾病英文

• Partial SBO: pass flatus or liquid stools • Complete SBO: obstipation
Differentiation of Proximal / distal SBO
• pain: • vomiting: • distention:
epigastric / periumbilical area prominent / later onset no / predominate
CT scan of the abdomen of a patient with a mechanical bowel obstruction secondary to an abscess in the right lower quadrant (arrow). Multiple dilated and fluid-filled loops of small bowel are noted.
under the control of both neural and humoral pathways
• ENDOCRINE FUNCTION
Obstruction
• Etiology:
Common causes of small bowel obstruction in industrialized countries:
Surgical principles
• The nature of problem determines approach to management of SBO. • The criteria of determining bowel viability: color , motility, arterial pulsation • If questionable , released and placed ,reexamined
Physical Exam
• • • • distended abdomen peristaltic waves minimal or no bowel sounds Mild abdominal tenderness with / without a palpable mass • Exam to rule out incarcerated hernias • Rectal exam
Radiologic and Laboratory Examinations
• Plain abdominal radiographs: accuracy≈60% -dilated loops of small intestine without evidence of
colonic distention -multiple air-fluid levels, often in a stepwise pattern -demonstrate the cause of the obstruction
• CT: for more complex cases
Plain abdominal film shows complete bowel obstruction caused by a large radiopaque gallstone (arrow) obstructing the distal ileum.
Simple Vs Strangulating Obstruction
• “Classic” signs of strangulation: -tachycardia -fever -Leukocytosis -a constant, noncramping abdominal pain
Differentiation of partial from complete SBO
Clinical Manifestations and Diagnosis
• Cardinal symptoms:
colicky abdominal pain nausea vomiting abdominal distention failure to pass flatus and feces
上海交通大学医学院附属瑞金医院普外科
Ana百度文库omy
The jejunal mucosa is relatively thick with prominent plicae circulares; the mesenteric vessels form only one or two arcades with long vasa recta. The ileum is smaller in circumference and has thinner walls; the mesenteric vessels form multiple vascular arcades with short vasa recta.
Treatment
• Medical and surgical management • The overlapping sequence :investigation resuscitation operation • The timing of operation depends on three factors: -duration -opportunity of vital organ function -risk of strangulation
Physiology
• Motility:
Peristalsis consists of intestinal contractions passing aborally at a rate of 1 to 2 cm/sec
contractions initiated by the migrating myoelectric complex (MMC)
Medical Management
• Nasointestinal /nasogastric intubation • Intravenous fluids /blood plasma administration • Broad-spectrum antibiotics administration
Blood supply to the jejunoileum and distal duodenum is entirely from the superior mesenteric artery, which courses anterior to the third portion of the duodenum. The celiac artery supplies the proximal duodenum.