单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,上海交通大学医学院附属瑞金医院普外科,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,Intestinal obstruction,Intestinal obstruction,Anatomy,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.,AnatomyThe jejunal mucosa is r,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.,Blood supply to the jej,Physiology,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),under the control of both neural and humoral pathways,Motility:Peristalsis consists,ENDOCRINE FUNCTION,ENDOCRINE FUNCTION,Obstruction,Etiology:,Common causes of small bowel obstruction in industrialized countries:,ObstructionEtiology:,Clinical Manifestations and Diagnosis,Cardinal symptoms:,colicky abdominal pain,nausea,vomiting,abdominal distention,failure to pass flatus and feces,Clinical Manifestations and Di,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,Physical Examdistended abdomen,Radiologic and Laboratory Examinations,Plain abdominal radiographs:accuracy60%,-,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,Radiologic and Laboratory Exam,小肠疾病英文ppt课件,Plain abdominal film shows complete bowel obstruction caused by a large radiopaque gallstone,(arrow),obstructing,the distal ileum.,Plain abdominal film shows com,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,.,CT scan of the abdomen of a pa,Simple Vs Strangulating Obstruction,“Classic”signs of strangulation:,-tachycardia,-fever,-Leukocytosis,-a constant,noncramping abdominal pain,Simple Vs Strangulating Obstru,Differentiation of partial from complete SBO,Partial SBO:pass flatus or liquid stools,Complete SBO:obstipation,Differentiation of partial fro,Differentiation of Proximal /distal SBO,pain:epigastric/periumbilical area,vomiting:prominent/later onset,distention:no/predominate,Differentiation of Proximal /,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,TreatmentMedical and surgical,Medical Management,Nasointestinal /nasogastric intubation,Intravenous fluids/blood plasma administration,Broad-spectrum antibiotics administration,Medical ManagementNasointestin,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,re-examined,Surgical principlesThe nature,谢谢,谢谢,