小腸疾病分類及應用SmallIntestinalDisease課件

小腸疾病分類和應用

Small

IntestinalDisease

小腸疾病分類和應用SmallIntestinalDisease小腸疾病分類和應用

SmallIntestinalDi1小腸疾病分類和應用SmallIntestinalDisease小腸疾病分類和應用SmallIntestinalDiseas2AnatomyandPhysiologyTheanatomyofsmallintestinelength:3～5mportions

bloodsupply：superiormesentericanerve：autonomic

SympatheticParasympathetic

duodenum:25cmjejunum:2/5ileum:3/5小腸疾病分類和應用SmallIntestinalDiseaseAnatomyandPhysiologySympat3Fourlayers:mucosasubmucosamuscularisserosaPeyer’patches小腸疾病分類和應用SmallIntestinalDiseaseFourlayers:小腸疾病分類和應用SmallInt4VillusmucosaThephysiologyofsmallintestinesecretealkalineintestinaljuicedigestionandabsorptionendocrineandimmune

小腸疾病分類和應用SmallIntestinalDiseaseVillusmucosa小腸疾5InflammatoryBowelDisease

CrohnDiseaseEtiologyunclearPathologyoccurinanysegmentofthepeptictractgranulomatousinflammatorylesion，involvefull-thicknessbowellayer小腸疾病分類和應用SmallIntestinalDiseaseInflammatoryBowelDisease6Clinicalmanifestationoccurinanyage60%cases<40yintermittentabdominalcomplaintorpaindigestivesymptom:diarrheaotherslowfeverfatiguepoorappetiteanemiaandweightloss小腸疾病分類和應用SmallIntestinalDiseaseClinicalmanifestation小腸疾病分類和應7complicationsintestinalobstruction中毒性巨結腸perforationhemorrhagecarcinogenesis小腸疾病分類和應用SmallIntestinalDiseasecomplications小腸疾病分類和應用SmallInt8diagnosishistoryandclinicalfindingsbariummealandbariumenemacoloscopydifferentialdiagnosisboweltuberculosisulcerativecolitisappendicitis小腸疾病分類和應用SmallIntestinalDiseasediagnosis小腸疾病分類和應用SmallIntest9treatmentmajortherapy:medicinesurgicalindications:complicationbecauseitshigherrecurrencerate

>50%小腸疾病分類和應用SmallIntestinalDiseasetreatment小腸疾病分類和應用SmallIntesti10Tuberculosisofintestineetiologyandpathologysecondaryinfectionposition：ileum-cecumulcerativetypeandproliferativetype小腸疾病分類和應用SmallIntestinalDiseaseTuberculosisofintestine小腸疾病分11clinicalfindingsyounglowfever,nightsweat，fatigue,weightloss,poorappetitechronicabdominalpaindiarrheaandconstipationcomplication小腸疾病分類和應用SmallIntestinalDiseaseclinicalfindings小腸疾病分類和應用Smal12diagnosisbloodroutine,ESR,chestfilm,bariummealandbariumenema,coloscopyhistoryandclinicalmanifestation小腸疾病分類和應用SmallIntestinalDiseasediagnosis小腸疾病分類和應用SmallIntesti13treatmentmedicaltherapysurgicalindicationcomplicationsuchasobstruction

、

fistula

、perforation、bleedingoperativeways:resectthepartialbowelandanastomosisperforationrepairmentBy-pass小腸疾病分類和應用SmallIntestinalDiseasetreatment小腸疾病分類和應用SmallIntesti14IntestinalPerforationofTyphoidFever

etiologyandpathologyinfectionbybacillustyphussite:thelastportionoftheileumsimpleperforation:80-90%小腸疾病分類和應用SmallIntestinalDiseaseIntestinalPerforationofTyph15clinicalfindingsdiffuseperitonitissymptomsacutesevereabdominalpainmuscleguardness,tendernessandreboundtendernessmajortreatmentrepairoftheperforation小腸疾病分類和應用SmallIntestinalDiseaseclinicalfindings小腸疾病分類和應用Smal16AcuteHemorrhagicEnteritisetiology:unclearmayberelatedtoβtoxinofWelchbaciluspathologythelesionlocalizedinjejunumorileumlocalcongestion,hemorrhage,necrosisandulceration小腸疾病分類和應用SmallIntestinalDiseaseAcuteHemorrhagicEnteritis小腸疾17Clinicalfindingsoccurinchildrenandyoungeracuteabdominalpainaccompaniedbynausea,vomiting,diarrhea,hematochezia.distention,tendernesssignsofbowelofstrangulationtoxicshock小腸疾病分類和應用SmallIntestinalDiseaseClinicalfindings小腸疾病分類和應用Sma18Treatmentmedicaltreatment(mainmethod)keepinternalenvironmentstablefasting,gastrointestinaldecompressionantibioticnutritionalsupport小腸疾病分類和應用SmallIntestinalDiseaseTreatment小腸疾病分類和應用SmallIntesti19surgicalindicationobviousperitonitisbowelbleedingisdifficulttocontrolintestinalobstructionaggravationaftermedicaltherapyDiagnosisNOTclear小腸疾病分類和應用SmallIntestinalDiseasesurgicalindication小腸疾病分類和應用Sm20IntestinalObstructiondefinition：apartialorcompleteblockageofthebowelresultsinthefailureoftheintestinalcontentstopassthrough小腸疾病分類和應用SmallIntestinalDiseaseIntestinalObstruction小腸疾病分類和應21EtiologyandClassification（一）Accordingtotheobstructivecause1、Mechanical：highincidenceintraluminalobstructionExtrinsicboweltractlesionsIntrinsicbowelwalllesion

小腸疾病分類和應用SmallIntestinalDiseaseEtiologyandClassification小腸疾221）intraluminalobstruction（1）膽結石（2）糞石（3）毛發(fā)團（4）異物（5）腸減壓管氣囊（6）寄生蟲（7）腔內憩室小腸疾病分類和應用SmallIntestinalDisease1）intraluminalobstruction小腸232）lesionsextrinsictothebowel（1）粘連：手術后；先天性；炎癥后（2）疝：腹壁疝；腹內疝（3）先天性：環(huán)狀胰腺；腹膜包裹（4）腫瘤：腸外腫瘤；腸系膜腫瘤（5）炎癥：腹腔內膿腫；腹腔異物（6）其他：腸系膜上動脈綜合征；小腸疾病分類和應用SmallIntestinalDisease2）lesionsextrinsictothebow243）intrinsicbowelwalllesions（1）腸道閉鎖（2）炎癥狹窄，腸套疊，腸扭轉（3）腫瘤等小腸疾病分類和應用SmallIntestinalDisease3）intrinsicbowelwalllesions252、Dynamic(Paralyticileus)

1）麻痹性：（1）腹腔手術后；（2）腹部創(chuàng)傷；（3）急性彌漫性腹膜炎

2）痙攣性：（1）急性腸炎；（2）腸道功能紊亂；（3）慢性鉛中毒；小腸疾病分類和應用SmallIntestinalDisease2、Dynamic(Paralyticileus)小腸263、Hematogenesis血運性腸梗阻腸系膜血管栓塞或血栓形成致使腸管發(fā)生血運障礙小腸疾病分類和應用SmallIntestinalDisease3、Hematogenesis血運性腸梗阻小腸疾病分類274、IdiopathicIntestinalPseudo-ObstructionChronicillness,recurrenceHeredityImpairedmotorresponsetoboweldistentionDuodenal,colonicslowwavesnormalAbsenceofradiogaphicfindingsofmechanicalobstructionNon-surgicaltreatment小腸疾病分類和應用SmallIntestinalDisease4、IdiopathicIntestinalPseud28（二）Accordingtothebloodsupplyofthebowelwall1、simple

只有腸內容物通過受阻，無腸管血運障礙。2、strangulation梗阻伴有腸管血運障礙，例如：腸系膜血管栓塞小腸疾病分類和應用SmallIntestinalDisease（二）Accordingtothebloodsup29（三）按梗阻部位1高位梗阻：空腸及近段回腸2低位梗阻：結腸及遠段回腸（四）按梗阻程度1不完全性腸梗阻2完全性腸梗阻（五）按病程緩急1急性腸梗阻2慢性腸梗阻（六）特殊類型：閉袢性腸梗阻

小腸疾病分類和應用SmallIntestinalDisease（三）按梗阻部位小腸疾病分類和應用SmallIntestin30粘連小腸疾病分類和應用SmallIntestinalDisease粘連小腸疾病分類和應用SmallIntestinalDise31腸套疊小腸疾病分類和應用SmallIntestinalDisease腸套疊小腸疾病分類和應用SmallIntestinalDis32嵌頓小腸疾病分類和應用SmallIntestinalDisease嵌頓小腸疾病分類和應用SmallIntestinalDise33扭轉、糞性小腸疾病分類和應用SmallIntestinalDisease扭轉、糞性小腸疾病分類和應用SmallIntestinalD34蛔蟲性小腸疾病分類和應用SmallIntestinalDisease蛔蟲性小腸疾病分類和應用SmallIntestinalDis35PathologyandPathophysiologypathology（acute）

proximalboweldistention

luminalpressure

venousreturnhindrance

congestin,edema,exudationpressurearteryreturnhindrancenecrosisandperforation小腸疾病分類和應用SmallIntestinalDiseasePathologyandPathophysiology小36Chronicintestinalobstructionincomplete

longtimebowelwallhypertrophyintestinalpatternandperistalticwaves小腸疾病分類和應用SmallIntestinalDiseaseChronicintestinalobstruction37Pathophysiologythelossofbodyfluid：waterandelectrolytedisorderandmetabolicimbalance(Theintestinaltractsecretesupto8.0L/d)infectionandintoxication：thedamageofintestinalbarrierandbacteriatranslocation,toxinabsorption小腸疾病分類和應用SmallIntestinalDiseasePathophysiology小腸疾病分類和應用SmallI38shock：dehydration、bloodconcentration、hypovolemia、metabolicdisorder、bacteriainfectionandintoxicationrespiratoryandcirculationdysfunction：abdominalpressureincreasedabdominalcompartmenthypertension小腸疾病分類和應用SmallIntestinalDiseaseshock：dehydration、bloodconcen39臨床表現(xiàn)——癥狀痛、嘔、脹、閉小腸疾病分類和應用SmallIntestinalDisease臨床表現(xiàn)——癥狀痛、嘔、脹、閉小腸疾病分類和應用SmallI40痛小腸疾病分類和應用SmallIntestinalDisease痛小腸疾病分類和應用SmallIntestinalDisea41嘔小腸疾病分類和應用SmallIntestinalDisease嘔小腸疾病分類和應用SmallIntestinalDisea42脹小腸疾病分類和應用SmallIntestinalDisease脹小腸疾病分類和應用SmallIntestinalDisea43ClinicalManifestation

Abdominalpain

VomitingDistentionFailuretopassgasandstool小腸疾病分類和應用SmallIntestinalDiseaseClinicalManifestation小腸疾病分類和應44單純性機械性腸梗阻反復發(fā)作的、節(jié)律性的、陣發(fā)性腹部絞痛絞窄性腸梗阻腹痛間歇不斷縮短持續(xù)性腹痛疼痛程度不斷加重麻痹性腸梗阻持續(xù)性脹痛小腸疾病分類和應用SmallIntestinalDisease單純性機械性腸梗阻小腸疾病分類和應用SmallIntesti45

VomitingEarlyreflectivityParalysisoverflowHighpositionearlyandfrequentlyLowpositionlateandfew小腸疾病分類和應用SmallIntestinalDisease小腸疾病分類和應用SmallIntestinalDiseas46Distention

高位-------不明顯低位-------顯著，遍及全腹閉袢性(closedloop)腹周膨脹結腸閉袢腹脹不對稱腸扭轉小腸疾病分類和應用SmallIntestinalDiseaseDistention腹周膨脹結腸47Failuretopassgasandstool完全性腸梗阻停止排便排氣高位腸梗阻早期梗阻以下的殘留氣體和糞便仍可排出腸套疊和血運性腸梗阻（絞窄）可排出血性或果醬樣便小腸疾病分類和應用SmallIntestinalDiseaseFailuretopassgasandstool小48ExaminationAbdominalsigns：Abdominalbulge,gastrointestinalpatternsandperistalticwaves,tendernessandreboundtenderness,positiveshiftdullness,highpitchedbowelsoundorbowelsilenceinlatestageandbowelparalysisDigitalrectalexamination小腸疾病分類和應用SmallIntestinalDiseaseExamination小腸疾病分類和應用SmallIntes49

Labtest：theresultswiththechangeoftheprimarydiseaseitself

Earlystage:

normalorslightabnormalLatestage:

disorderofmanyserummarkers小腸疾病分類和應用SmallIntestinalDiseaseLabtest：theresultswiththe50X-ray：

Supineanduprightabdominalradiographswithstepladderpatternofair-fluidlevelsandnocolonicgasnote:Thebariumenemaisneediftheintussusceptions,sigmoidrotationorcolontumoraresuspicious.小腸疾病分類和應用SmallIntestinalDiseaseX-ray：小腸疾病分類和應用SmallIntestinal51

Insmall-bowelobstruction,radiologicevaluationhasseveralgoals.Itiscarriedouttoconfirmthediagnosis,distinguishbetweensimpleandstrangulatingobstruction,differentiatethevariouscausesofobstruction,estimatethedegreeofobstruction,andexcludethepossibilityofcolonicobstructionorparalyticileus

小腸疾病分類和應用SmallIntestinalDiseaseInsmall-bowelobstr52小腸疾病分類和應用SmallIntestinalDisease小腸疾病分類和應用SmallIntestinalDiseas53小腸疾病分類和應用SmallIntestinalDisease小腸疾病分類和應用SmallIntestinalDiseas54小腸疾病分類和應用SmallIntestinalDisease小腸疾病分類和應用SmallIntestinalDiseas55小腸疾病分類和應用SmallIntestinalDisease小腸疾病分類和應用SmallIntestinalDiseas56Diagnosis

isitintestinalobstruction?historyclinicalfindingsX-rayexamination

isitmechanicalordynamic？historyX-rayfindings小腸疾病分類和應用SmallIntestinalDiseaseDiagnosis小腸疾病分類和應用SmallIntesti57SimpleorStrangulation（VeryImportant）①Acuteandpersistentsevereabdominalpain②Emergentlyandearlyshock③Severeperitonealirritationsign④Asymmetricdistention，palpablemass⑤Bleedingcontentofvomitus,dischargeandabdominalparacentesis⑥X-rayshowsisolatedansainterstinalis⑦Medicaltreatmentfailure小腸疾病分類和應用SmallIntestinalDiseaseSimpleorStrangulation（Very58小腸疾病分類和應用SmallIntestinalDisease小腸疾病分類和應用SmallIntestinalDiseas59小腸疾病分類和應用SmallIntestinalDisease小腸疾病分類和應用SmallIntestinalDiseas60TheObstructiveSite:LoworHighHigh:vomittingoccurinearlystageandshowslightabdominaldistentionLow:severeabdominaldistentionX-rayfindings小腸疾病分類和應用SmallIntestinalDiseaseTheObstructiveSite:LoworH61CompleteorIncompletecomplete:severeandacuteincomplete:chronicandslightTheCauseofObstructionAlwaysverydifficulttoidentificateHistoryisveryimportant小腸疾病分類和應用SmallIntestinalDiseaseCompleteorIncomplete小腸疾病分類和應62TreatmentPrinciples：CorrectthesystemicpathophysiologicdisorderRelieveobstruction。小腸疾病分類和應用SmallIntestinalDiseaseTreatment小腸疾病分類和應用SmallIntesti63BasicTreatmentNaso-gastricsuctionCorrectbodyfluiddisorderPreventinfectionandintoxicationGeneraltreatment:sedation,spasmolysis小腸疾病分類和應用SmallIntestinalDiseaseBasicTreatment小腸疾病分類和應用SmallI64RemovetheObstructionSurgeryIndications：strangulation、causedbytumorandcongenitalbowelmalformation,cannotrelievedbymedicaltherapyAims：utilitythesimplestmethodstoremovetheobstructionandrecoverthecontinuityofthebowelintheshortesttime小腸疾病分類和應用SmallIntestinalDiseaseRemovetheObstruction小腸疾病分類和應65MethodsRemovethecause：

Suchasadhesionremove,foreignbodytakenout、replacementofintussusceptionandvolvulusIntestinalresectionandanastomosis:

tumor,stenosis,necrosis

小腸疾病分類和應用SmallIntestinalDiseaseMethods小腸疾病分類和應用SmallIntestina66Howtojudgetheintestinalnecrosisintheoperation?ThebowelwallisblackNoperistalticcapabilityandtensionNopulsationofmesentericterminalarteriole小腸疾病分類和應用SmallIntestinalDiseaseHowtojudgetheintestinalne67

Bypassoperation:Thelesionisdifficulttoremove

EnterostomyorIntestinalexteriorizationThepatient’sconditioncannottolerancethecomplicatedoperationortheobstructivelesionisdifficulttotreat

小腸疾病分類和應用SmallIntestinalDiseaseBypassoperation:小腸疾病分類和應用Sm68手術方式

A.解除梗阻原因的術式如粘連松解術小腸疾病分類和應用SmallIntestinalDisease手術方式小腸疾病分類和應用SmallIntestinalDi69如腸切開取異物，腸扭轉復位術。小腸疾病分類和應用SmallIntestinalDisease如腸切開取異物，腸扭轉復位術。小腸疾病分類和應用SmallI70B.腸切除腸吻合術C.短路手術小腸疾病分類和應用SmallIntestinalDiseaseB.腸切除腸吻合術C.短路手術小腸疾病分類和應71D.腸造口和腸外置術小腸疾病分類和應用SmallIntestinalDiseaseD.腸造口和腸外置術小腸疾病分類和應用SmallIntest72MedicaltreatmentIndications：simpleadhesiveobstruction,paralysisordynamicileus、obstructionbecauseofascaridorstoolmass,inflammatoryobstructionandearlystageofintussusceptionNotes：Thestateofillnessshouldbemonitorclosedlyduringmedicaltreatment小腸疾病分類和應用SmallIntestinalDiseaseMedicaltreatment小腸疾病分類和應用Smal73CommontypesAdhesiveObstruction（40%～60%）

Obstructionduetoadhesions小腸疾病分類和應用SmallIntestinalDiseaseCommontypes小腸疾病分類和應用SmallInte74EtiologyandpathologyCongenitalSecondary

DiagnosisMechanicalobstruction+historyofabdominaloperation,infectionortrauma

*如何區(qū)分廣泛粘連梗阻與局部束帶梗阻？？小腸疾病分類和應用SmallIntestinalDiseaseEtiologyandpathology小腸疾病分類和應75Prophylaxis:moresignificance減少組織損傷，減輕組織炎癥反應

Treatment:simple,incompletemedicaltherapystrangulationsurgicaltherapy

小腸疾病分類和應用SmallIntestinalDiseaseProphylaxis:moresignificance76小腸疾病分類和應用SmallIntestinalDisease小腸疾病分類和應用SmallIntestinalDiseas77小腸疾病分類和應用SmallIntestinalDisease小腸疾病分類和應用SmallIntestinalDiseas78小腸疾病分類和應用SmallIntestinalDisease小腸疾病分類和應用SmallIntestinalDiseas79小腸疾病分類和應用SmallIntestinalDisease小腸疾病分類和應用SmallIntestinalDiseas80IntestinalVolvulus(>3600)

Obstructionduetovolvulus小腸疾病分類和應用SmallIntestinalDiseaseIntestinalVolvulus(>3600)小腸疾病81EtiologyAnatomicfactors:ExcessivelongmesenteriumAdhesionPhysicalfactors:EntericbodyDynamicfactors:AbnormalbowelmotivationAlterthebodypositionsuddentlySlight<3600Severe>4800小腸疾病分類和應用SmallIntestinalDiseaseEtiology小腸疾病分類和應用SmallIntestin82Clinicalfindingsclosedloop：acute/

severeSmallbowel:younger,motionaftermealpainintheperiumbilicusSigmoid:aged,constipationhabitsTreatment:Itisaseveremechanicalobstructionemergentoperation小腸疾病分類和應用SmallIntestinalDiseaseClinicalfindings小腸疾病分類和應用Smal83Obstructionbyforeignbody（腸蛔蟲、糞塊等）Asimplemechanicalbowelobstruction蛔蟲成團+腸管痙攣Treatment:medicaltherapyandnecessarysurgery小腸疾病分類和應用SmallIntestinalDiseaseObstructionbyforeignbody（腸蛔84BowlAscariasisChildren,countrysideMedicaltherapy小腸疾病分類和應用SmallIntestinalDiseaseBowlAscariasisChildren,count85IntussusceptionObstructionduetointussusception小腸疾病分類和應用SmallIntestinalDiseaseIntussusceptionObstructiondue86Etiologyanatomy:cecumtoofreepathologicalfactors:polyp,tumorabnormalityofintestineTypesintestine-intestineintestine-coloncolon-colon小腸疾病分類和應用SmallIntestinalDiseaseEtiology小腸疾病分類和應用SmallIntestin87Clinicalfindings80%,<2ychildrenAbdominalpain,currant-jellystool,sausage-shapedmassCoil-springsignAirorBariumenemaReduction小腸疾病分類和應用SmallIntestinalDiseaseClinicalfindings小腸疾病分類和應用Smal88Treatment:Gasorbariumenema(youngers).Operation:manualreductionbowelresection小腸疾病分類和應用SmallIntestinalDiseaseTreatment:小腸疾病分類和應用SmallIntest89腸系膜血管缺血性疾病etiologyandpathology1.superiormesentericarteryembolus2.superiormesentericarterialthrombosis3.superiormesentericvenousthrombosis4.others:non-mesentericvascularischemiaischemianecrosis小腸疾病分類和應用SmallIntestinalDisease腸系膜血管缺血性疾病小腸疾病分類和應用SmallIntest90ClinicalmanifestationhistoryofcoronaryheartdiseaseoratrialfibrillationacuteabdominalcrampseveresymptomandslightabdominalsignintheearlystageDiagnosisabdominalfilm,angiography(DSA)小腸疾病分類和應用SmallIntestinalDiseaseClinicalmanifestation小腸疾病分類和應91Treatment:Keypoint:EarlydiagnosisandreasonabletherapyVasodilatingagentSurgicaltherapyEmbolectomyVascularbypassIntestinalresectionandanastomosis小腸疾病分類和應用SmallIntestinalDiseaseTreatment:小腸疾病分類和應用SmallIntest92Case1:

Male,25yearsold,complainsofabdominalpainanddistentionfor2days.PE:P80,abdominalbulge,intestinalpatternsandperistalticwaves,high-pitchedbowelsound.Pasthistory:Heunderwentappendectomy3monthago.Diagnosisandtreatment?小腸疾病分類和應用SmallIntestinalDiseaseCase1:小腸疾病分類和應用SmallIntestinal93Case2:

male,68yearsold,complainsofabdominalbowelmotionfor3month,abdominaldistentionandstoppassgasandfecesfor2days.PE:P90,Bp130/70mmHg,abdominalbulge,intestinalpatternsandperistalticwaves,high-pitchedbowelsound.

Diagnosisandtreatment?Whichexamintationshouldbeundergonefordiagnosis?小腸疾病分類和應用SmallIntestinalDiseaseCase2:小腸疾病分類和應用SmallIntestinal94ShortBowelSyndromeDefinition:

ShortBowelSyndrome(SBS)isdefinedasmalabsorptionresultingfromanatomicalorfunctionallossofasignificantlengthofthesmallintestine.小腸疾病分類和應用SmallIntestinalDiseaseShortBowelSyndrome小腸疾病分類和應用S95PathophysiologyThemajorityofcarbohydrate,protein,fats,vitamins,bilesaltsabsorptiontakesplaceinthesmallbowel.<100cmsevereinfluencebodyfluiddisorderandmalnutrition小腸疾病分類和應用SmallIntestinalDiseasePathophysiology小腸疾病分類和應用SmallI96ClinicalfindingsFirstsymptom:diarrhea,theseverityrelatestothelengthofresidualbowelWeightloss,fatigue,malnutrition,bodyfluiddisorder小腸疾病分類和應用SmallIntestinalDiseaseClinicalfindings小腸疾病分類和應用Smal97TreatmentCorrectimbalanceofmetabolismandelectrolyteNutritionalsupport

totalparenteralnutritionpartialparenteralnutrition

enteralnutrtion小腸疾病分類和應用SmallIntestinalDiseaseTreatmenttotalparenteraln98Thefirststage(2month)TPNandcorrectthefluiddisorderThesecondstage(1～2y)PPN+ENThethirdstageENorPPN+ENMaybesustainonelife小腸疾病分類和應用SmallIntestinalDiseaseThefirststage(2month)小腸疾病分類99

Itneedlong-termregularnutritionmonitoringtopreventproblemsassociatedwithfluid,macro-andmicro-nutrientmalabsorption.Sincetheyareathighriskfordehydrationandbacterialovergrowth,theyneedpromptmedicalattentionanytimetheyhavesymptomsofgastroenteritis.小腸疾病分類和應用SmallIntestinalDiseaseItneedlong-termregula100IntestinalTumor小腸腫瘤Lowerincidence（5%inthegastrointestinaltumor）Butmalignancy3/4小腸疾病分類和應用SmallIntestinalDiseaseIntestinalTumor小腸疾病分類和應用Small101ClinicalFindings:AbdominalpainIntestinalbleedingIntestinalobstructionIntraabdominalmassIntestinalperforationCarcinoidsyndrome小腸疾病分類和應用SmallIntestinalDiseaseClinicalFindings:小腸疾病分類和應用Sma102DiagnosisClinicalfindings+X-rayBariummealGastroscopyintestinalendoscopyLaparoscopyTreatmentSurgicaloperation小腸疾病分類和應用SmallIntestinalDiseaseDiagnosis小腸疾病分類和應用SmallIntest103IntestinalFistula

definition:thereisabnormaltractbetweenbowelandotherorgans,orabdominalcavity,abdominalwall.externalfistulainternalfistula小腸疾病分類和應用SmallIntestinalDiseaseIntestinalFistuladefinitio104PathophysiologyLossofintestinalfluidwaterandelectrolytedisorderandacid-baseimbalanceLossofproteinmalnutrition,cachexiaDigestivejuiceoverflowskinandtissueerosio,infectionandbleeding小腸疾病分類和應用SmallIntestinalDiseasePathophysiology小腸疾病分類和應用SmallI105ClinicalManifestationFistulastomaintheabdominalwallandintestinalcontentoverflowBodyfluiddisorderfindingsMalnutritionInfectioussymptoms小腸疾病分類和應用SmallIntestinalDiseaseClinicalManifestation小腸疾病分類和應106DiagnosisHistory+clinicalfindingsMethylthioniniumChlorideorallyFistulographyBariummeal小腸疾病分類和應用SmallIntestinalDiseaseDiagnosis小腸疾病分類和應用SmallIntesti107TreatmentNutritionalsupportControltheabdominalinfectionKeepdrainagenonobstructiveAntibioticsSurgeryAdjuvantoperationSuchasdrainage,enterostomy小腸疾病分類和應用SmallIntestinalDiseaseTreatment小腸疾病分類和應用SmallIntesti108Radicaloperation(3-6mlater)IntestinalfistularesectionandanastomosisSegmentalintestineresectionandanastomosisIntestinalfistularepairmentEnterostomyIntestinalexteriorization小腸疾病分類和應用SmallIntestinalDiseaseRadicaloperation(3-6mlater)小109小腸疾病分類和應用

Small

IntestinalDisease

小腸疾病分類和應用SmallIntestinalDisease小腸疾病分類和應用

SmallIntestinalDi110小腸疾病分類和應用SmallIntestinalDisease小腸疾病分類和應用SmallIntestinalDiseas111AnatomyandPhysiologyTheanatomyofsmallintestinelength:3～5mportions

bloodsupply：superiormesentericanerve：autonomic

SympatheticParasympathetic

duodenum:25cmjejunum:2/5ileum:3/5小腸疾病分類和應用SmallIntestinalDiseaseAnatomyandPhysiologySympat112Fourlayers:mucosasubmucosamuscularisserosaPeyer’patches小腸疾病分類和應用SmallIntestinalDiseaseFourlayers:小腸疾病分類和應用SmallInt113VillusmucosaThephysiologyofsmallintestinesecretealkalineintestinaljuicedigestionandabsorptionendocrineandimmune

小腸疾病分類和應用SmallIntestinalDiseaseVillusmucosa小腸疾114InflammatoryBowelDisease

CrohnDiseaseEtiologyunclearPathologyoccurinanysegmentofthepeptictractgranulomatousinflammatorylesion，involvefull-thicknessbowellayer小腸疾病分類和應用SmallIntestinalDiseaseInflammatoryBowelDisease115Clinicalmanifestationoccurinanyage60%cases<40yintermittentabdominalcomplaintorpaindigestivesymptom:diarrheaotherslowfeverfatiguepoorappetiteanemiaandweightloss小腸疾病分類和應用SmallIntestinalDiseaseClinicalmanifestation小腸疾病分類和應116complicationsintestinalobstruction中毒性巨結腸perforationhemorrhagecarcinogenesis小腸疾病分類和應用SmallIntestinalDiseasecomplications小腸疾病分類和應用SmallInt117diagnosishistoryandclinicalfindingsbariummealandbariumenemacoloscopydifferentialdiagnosisboweltuberculosisulcerativecolitisappendicitis小腸疾病分類和應用SmallIntestinalDiseasediagnosis小腸疾病分類和應用SmallIntest118treatmentmajortherapy:medicinesurgicalindications:complicationbecauseitshigherrecurrencerate

>50%小腸疾病分類和應用SmallIntestinalDiseasetreatment小腸疾病分類和應用SmallIntesti119Tuberculosisofintestineetiologyandpathologysecondaryinfectionposition：ileum-cecumulcerativetypeandproliferativetype小腸疾病分類和應用SmallIntestinalDiseaseTuberculosisofintestine小腸疾病分120clinicalfindingsyounglowfever,nightsweat，fatigue,weightloss,poorappetitechronicabdominalpaindiarrheaandconstipationcomplication小腸疾病分類和應用SmallIntestinalDiseaseclinicalfindings小腸疾病分類和應用Smal121diagnosisbloodroutine,ESR,chestfilm,bariummealandbariumenema,coloscopyhistoryandclinicalmanifestation小腸疾病分類和應用SmallIntestinalDiseasediagnosis小腸疾病分類和應用SmallIntesti122treatmentmedicaltherapysurgicalindicationcomplicationsuchasobstruction

、

fistula

、perforation、bleedingoperativeways:resectthepartialbowelandanastomosisperforationrepairmentBy-pass小腸疾病分類和應用SmallIntestinalDiseasetreatment小腸疾病分類和應用SmallIntesti123IntestinalPerforationofTyphoidFever

etiologyandpathologyinfectionbybacillustyphussite:thelastportionoftheileumsimpleperforation:80-90%小腸疾病分類和應用SmallIntestinalDiseaseIntestinalPerforationofTyph124clinicalfindingsdiffuseperitonitissymptomsacutesevereabdominalpainmuscleguardness,tendernessandreboundtendernessmajortreatmentrepairoftheperforation小腸疾病分類和應用SmallIntestinalDiseaseclinicalfindings小腸疾病分類和應用Smal125AcuteHemorrhagicEnteritisetiology:unclearmayberelatedtoβtoxinofWelchbaciluspathologythelesionlocalizedinjejunumorileumlocalcongestion,hemorrhage,necrosisandulceration小腸疾病分類和應用SmallIntestinalDiseaseAcuteHemorrhagicEnteritis小腸疾126Clinicalfindingsoccurinchildrenandyoungeracuteabdominalpainaccompaniedbynausea,vomiting,diarrhea,hematochezia.distention,tendernesssignsofbowelofstrangulationtoxicshock小腸疾病分類和應用SmallIntestinalDiseaseClinicalfindings小腸疾病分類和應用Sma127Treatmentmedicaltreatment(mainmethod)keepinternalenvironmentstablefasting,gastrointestinaldecompressionantibioticnutritionalsupport小腸疾病分類和應用SmallIntestinalDiseaseTreatment小腸疾病分類和應用SmallIntesti128surgicalindicationobviousperitonitisbowelbleedingisdifficulttocontrolintestinalobstructionaggravationaftermedicaltherapyDiagnosisNOTclear小腸疾病分類和應用SmallIntestinalDiseasesurgicalindication小腸疾病分類和應用Sm129IntestinalObstructiondefinition：apartialorcompleteblockageofthebowelresultsinthefailureoftheintestinalcontentstopassthrough小腸疾病分類和應用SmallIntestinalDiseaseIntestinalObstruction小腸疾病分類和應130EtiologyandClassification（一）Accordingtotheobstructivecause