妇科急腹症ppt课件

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etiology:
受精卵着床于子宫体 腔以外。或因为输卵 管结构异常，或受精 卵行走异常。
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FACTORS
输卵管结构异常 Pelvic inflammatory disease Tubal surgery Previous ectopic， repeated
Previous termination
妇科急腹症
Gyneacologic Acute Abdomen
以腹部疼痛为主要症状的一组妇科急 症。
腹痛
是这三种疾病的主要症状
急：发病突然，症状重，危及生命
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ectopic pregnancy extrauterine pregnancy
torsion of the ovarian pedicle twisted ovarian cysts
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体检
全身：贫血貌，面色苍白，血压下降， 脉搏弱，快。四肢冰冷；
腹部：拒按，腹膜刺激征，全腹压痛、 反跳痛重，肌紧张轻(tenderness,
rebound tenderness and muscular rigidity)，移动性浊音（＋）
妇科：后穹隆饱满，宫颈着色，举痛， 摇摆痛，子宫略大，软，可有飘浮感， 一侧附件区触及不规则包块，压痛明显。
s t o r y
rebound tenderness. • pass water • fainted on the spot • blood presure was zero
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Diagnosis?
ectopic pregnancy
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Ectopic Pregnancy
Definition:
Ectopic pregnancy is defined as pregnancy outsied the uterine cavity
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内科
外科
急性胃肠炎 阑尾炎
中毒性痢疾 肠梗阻
输尿管结石
胆囊炎
脾破裂
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辅助检查
• Urine pregnancy test-may be negative ， (Serial serum B-hCG testing )hCG(Human Chorionic gonadotropin),
• culdocentesis：抽出血，15分钟不凝固。
Salpingitis→adhesions of the tubal wall,
→retards the passage of the fertilized egg →Ectopic pregnancy。
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输卵管的变化
部位 壶腹部 峡部 间质部
解剖 管腔宽 窄 较窄
肌层 较厚 薄 很厚
停经 8-12周 6周 4个月
• Ultrasound ： 宫腔空虚，输卵管部位出现妊娠囊和 异常回声团，子宫前、后有液性暗区可助诊。
• 子宫内膜：为排除宫内妊娠流产，可刮宫。送病理。 • 血常规，Hb进行性下降。可以血液浓缩。
• 腹腔镜：是Gyneacology Acute Abdomen诊断和治疗 手段，可进可退。
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Ultrasound showing uterus and tubal pregnancy
period delayed • spotting type bleeding • 掉出蜕膜管型
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子宫的变化：
• 子宫稍大 • 内膜蜕膜反应 • 胚胎死亡：蜕膜剥离→出血 • Arias-Stell反应
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sumerize the Symptoms
• Lower abdominal pain and Abnormal uterine bleeding approximately 1-2 weeks after the missed menstrual period “异位妊娠最容易诊断，异位妊娠 最不易诊断”
of pregnancy 输卵管发育不良或功能异常 IUD Intrauterine device usage 肌瘤，卵巢肿物，EM
受精卵行走异常 Advancing age DES exposure IVF and ovulation
induction 经宫腔或腹腔向对侧
输卵管移行 smoke
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acute pelvic inflammatory disease
Endomitriosis
a ruptured ovarian lutia
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story
• Acute abdominal pain • wanted to give bowels • the abdomen rigidity and tenderness、
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the UK : 0.25-1% getting more common.
In Finland, tripled between 1966 and 1985
in the US , a four-fold rise between 1970 and 1983.
In Jamaica, an unusually high rate of ectopic pregnancy (1 in 28 deliveries).
Same image. Uterus outlined in red, uterine lining in green, ectopic pregnancy yellow. Fluid in uterus at blue circle - sometimes called a "pseudosac"
表现 流产 破. 裂 破裂
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abdominal pain of ectopic pregnancy
• tubal rupture: sharp colicky pain • tubal abortion:隐痛、胀痛
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伴随症状
• Straining at stool • faintness and shock • amenorrhea or menstrual
Most common site of occurrence is the fallopian tube
Biblioteka Baidu
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• tubal pregnancy 88.5% ovarian pregnancy 4.5% cervical pregnancy 0.7% pregnancy in rudimentary horn 1.5% pregnancy in interstitial 4.8% abdominal pregnancy