1、(Acute Suppurative Peritonitis) 1ppt课件腹膜腹膜 Peritoneum peritunim 壁腹膜壁腹膜 Parietal Peritoneum praiitl peritunim 脏腹膜脏腹膜 Visceral Peritoneum visrl peritunim 腹腔腹腔 Peritoneal Cavity ,perituni:l kviti大腹腔大腹腔 Peritoneal Cavity 小腹腔小腹腔 Lesser Peritoneal Cavity 2ppt课件3ppt课件4ppt课件神经支配神经支配（Nerve Supply）壁腹膜壁腹膜 Pari
2、etal Peritoneum praiitl peritunim 躯体神经躯体神经 Somatic N sumtik n:v 对刺激敏感，疼痛定位准确对刺激敏感，疼痛定位准确 锐痛锐痛sharp pain :p pein 腹膜炎体征腹膜炎体征 Peritoneal signs ,perituni:l sainz 压痛压痛 Tenderness tendnis 反跳痛反跳痛 Rebound Tenderness ribaund tendnis 腹肌紧张腹肌紧张 Involuntary muscle spasm invlntri msl spzm rigidity rididti 脏腹膜脏腹膜
3、Visceral Peritoneum visrl peritunim 自主神经自主神经Automatic N ,:tmtik n:v 对牵引、张力、炎症刺激敏感，对牵引、张力、炎症刺激敏感， 定位差（定位差（poorly localized pain） 钝痛钝痛 Dull pain dl pein 消化道症状：恶心消化道症状：恶心 nausea n:sj 呕吐呕吐 Vomiting vmiti 5ppt课件腹膜结构和功能腹膜结构和功能 Structure and Function of the Peritoneum） 结构（结构（Structure） 一层扁平的间皮细胞一层扁平的间皮细胞 M
4、esothelium ,mes(z)ui:ljm 面积约面积约1.8m2双向的半透性膜。双向的半透性膜。 功能（功能（Function） 分泌功能分泌功能 Secretion sikri:n 吸收功能吸收功能 Absorption bs:pn 防御功能防御功能 defense difens 修复功能修复功能 Repair rip 6ppt课件病因（病因（Etiology）原发性腹膜炎原发性腹膜炎 Primary Peritonitis praimri ,peritunaitis (无原发病灶无原发病灶) Spontaneous spnteinjs ,peritunaitis 1. 血行播散血行
5、播散Hematogenous invasion ,he(i:)mtdins invein 溶血性链球菌溶血性链球菌streptococcus ,streptukks 肺炎双球菌肺炎双球菌 pneumococcus ,nju:mkks 2. 生殖、泌尿系感染扩散生殖、泌尿系感染扩散urogenital infection ,jurudenitl infekn genitourinary infection ,denitujurinri infekn 3. 肝硬化腹水、肾病等肝硬化腹水、肾病等， 肠道细菌易位肠道细菌易位 Bacterial Translocation bktiril ,trnsl
6、ukein 7ppt课件 继发性腹膜炎继发性腹膜炎Secondary Peritonitis sekndri ,peritunaitis 1、脏器穿孔脏器穿孔 化学性腹膜炎（化学性腹膜炎（Chemical Peritonitis） 细菌性腹膜炎（细菌性腹膜炎（Bacterial Peritonitis）2、炎症扩散、炎症扩散 inflammation ,inflmein 3、损伤、损伤Injury4、坏死、坏死 necrosis nekrusis 5、手术污染、手术污染Contamination kn,tminein 吻合口漏吻合口漏 anastomosis Leakage nstmusis
7、li:kid 8ppt课件病理生理病理生理 Pathophysiology ,pu,fizildi 急性腹膜炎急性腹膜炎Acute Peritonitis局限性腹膜炎局限性腹膜炎Localized Peritonitis腹腔脓肿腹腔脓肿Peritoneal Abscesses弥漫性腹膜炎弥漫性腹膜炎Diffuse Peritonitis治愈治愈Healing腹腔粘连腹腔粘连Peritoneal Adhesions休克休克,多器官衰竭多器官衰竭Shock, MSOF死亡死亡Death,perituni:l dhi:n 9ppt课件10ppt课件临床表现临床表现（Clinical Manifest
8、ations） 症状症状 Symptoms 腹痛腹痛 Abdominal Pain 恶心恶心 Nausea 、呕吐、呕吐 Vomiting 腹胀腹胀 Abdominal Distension 全身症状全身症状 systemic symptoms11ppt课件腹部体征（腹部体征（Abdominal signs）望诊望诊（Inspection） 腹胀（腹胀（Abdominal Distention），腹式呼吸减弱或消失），腹式呼吸减弱或消失触诊触诊（Palpation） 压痛压痛 Tenderness tendnis 反跳痛反跳痛 Rebound Tenderness ribaund tendni
9、s 肌紧张肌紧张 Muscle Spasm msl spzm 肌卫肌卫 Muscle Guarding msl ga:di 腹膜炎体征腹膜炎体征（Peritoneal signs) ,perituni:l sainz12ppt课件叩诊叩诊 Percussion p:kn 鼓音鼓音 Tympany 移动性浊音移动性浊音 Shifting Dullness 听诊听诊 Auscultation ,:skltein 肠鸣音肠鸣音 Bowel Sounds 减弱减弱 Diminished 消失消失 Disappear 直肠、阴道检查直肠、阴道检查 Rectal & Vaginal Examination
10、s 盆腔感染盆腔感染 Pelvic Infection 盆腔脓肿盆腔脓肿 Pelvic Abscess 13ppt课件辅助检查辅助检查 Accessory Examination ksesri i,zminein 血象血象 Hemogram hi:mgrm WBC伴核左移伴核左移 leukocytosis with left shift of differential ,lju:ksaitusis w left ift v ,difrenl 腹部立位平片腹部立位平片 Abdominal Plain film 膈下游离气体膈下游离气体 Free Air beneath the Diaphragm
11、 daifrm 腹腔穿刺腹腔穿刺 Abdominal Paracentesis bdminl ,prsenti:sis B超超 CT14ppt课件腹腔穿刺液的鉴别诊断病 因外观、嗅味显微镜检查原发性腹膜炎脓性，呈白、黄或草绿色，无臭味大量中性粒细胞，G+球菌阑尾炎穿孔脓性，较稀，色白或微黄，混浊，稍臭或无臭味大量中性粒细胞，G-杆菌胃十二指肠溃疡穿孔黄色混浊，含胆汁，食物残渣，不臭大量中性粒细胞 ，早期细菌少胆囊炎穿孔色黄，胆汁，混浊，无臭味大量中性粒细胞，G-杆菌小肠穿孔黄色稀粪样，混浊，稍臭大量中性粒细胞，G-杆菌多重症胰腺炎血性，无臭，淀粉酶1500 Somogy 单位大量中性粒细胞，早
12、期无细菌肝脾破裂不凝血大量红细胞15ppt课件诊断诊断 Diagnosis 病史病史 History 体格检查体格检查 Physical Examination 腹膜炎体征腹膜炎体征 Peritoneal Signs ,perituni:l sainz 压痛压痛 Tenderness tendnis 反跳痛反跳痛 Rebound Tenderness ribaund tendnis 肌紧张肌紧张 Muscle Spasm msl spzm 辅助检查（辅助检查（Accessory Examination） 目的在于鉴别原发病和腹膜炎的类型目的在于鉴别原发病和腹膜炎的类型16ppt课件治疗（治疗（
13、Treatment） 非手术治疗非手术治疗（Nonoperative Treatment） 1、体位、体位 Posture pst 半卧位半卧位semisupine position semi - sju:pain / sju:pain pzin 2、禁食、胃肠减压、禁食、胃肠减压fasting, gastrointestinal decompression f:sti struintestinl ,di:kmpren 3、纠正水电解质紊乱、纠正水电解质紊乱 Fluid and Electrolyte Imbalance flu(:)id nd ilektrulait imbln 4、抗生素治
14、疗、抗生素治疗 Antibiotic Therapy 5、营养支持、营养支持 Nutritional Support nju(:)trinl sp:t17ppt课件 手术治疗（手术治疗（Operative Treatment）1.去除病因（去除病因（Removing the cause） 剖腹探查剖腹探查 explorative laparotomy iksplrtiv lprtmi 2.清理腹腔（清理腹腔（Cleaning the Abdominal Cavity） (1)清洁腹腔清洁腹腔 Cleaning (2)腹腔灌洗腹腔灌洗 lavage lv:d 3.充分引流充分引流 Drainag
15、e dreinid 4.术后处理术后处理 Postoperative Management 18ppt课件Peritoneal abscess ,perituni:l bsis 腹腹 腔腔 脓脓 肿肿膈下脓肿膈下脓肿 subphrenic sbfrenik bsis 盆腔脓肿盆腔脓肿 Pelvic Abscess pelvik bsis 肠间脓肿肠间脓肿 Interloop Abscess intlu:p bsis 19ppt课件膈下脓肿膈下脓肿 Subphrenic Abscess sbfrenik bsis 临床表现临床表现 Clinical Manifestations 全身症状：全身症
16、状： 不明原因持续发热不明原因持续发热Unexplained Persistent Fever toxic symptoms tksik simptm 局部症状：不典型，可有疼痛（腹痛、胸痛、肩痛）局部症状：不典型，可有疼痛（腹痛、胸痛、肩痛） 呃逆呃逆hiccup / hiccough hkp / hkp 诊断诊断 Diagnosis B超引导诊断性穿刺超引导诊断性穿刺 CT 20ppt课件治疗治疗 Treatment 1、经皮穿刺插管引流术、经皮穿刺插管引流术Percutaneous Abscess Drainage, PAD ,p:kju(:)teinjs bsis dreinid 2、
17、切开引流术、切开引流术 Open Transabdominal incision and drainage ,trnsbdminl insin nd dreinid 21ppt课件盆腔脓肿盆腔脓肿 Pelvic Abscess pelvik bsis 临床表现（临床表现（Chinical Manifestions） 全身症状：全身症状： toxic symptoms tksik simptm 直肠刺激症状直肠刺激症状 Irritation of the rectum iritein rektm 里急后重里急后重 rectal tenesmus rektl tinezms 尿路刺激症状尿路刺激症
18、状urinary irritation jurinri iritein 诊断诊断 Diagnosis 直肠或阴道检查直肠或阴道检查 Rectal， Vaginal Exam B超超 & CT治疗治疗 Treatment 盆腔引流盆腔引流 Pelvic Drainage pelvik dreinid 22ppt课件肠间脓肿肠间脓肿 Interloop Abscess intlu:p bsis 单发脓肿（单发脓肿（Single Abscess）多发脓肿（多发脓肿（Multiple Abscess）症状体征不典型症状体征不典型toxic symptoms tksik simptm 粘连性肠梗阻粘连性
19、肠梗阻intestinal obstruction due to adhesions intestinl bstrkn dju: tu dhi:n 诊断诊断 Diagnosis B超超 & CT治疗：治疗：23ppt课件Abstract of a Medical History A male patient of 30 was admitted, complaining of intermittent abdominal pain for 10 years which was more marked in the past 6 hours. Ten years ago, he began to
20、 have episodes of pain over the epigastrium persisted for days or even weeks at each time & often associated with dietary indiscretion. Sometimes he had nocturnal abdominal pain, severe enough to wake up him from sleep at times, but both food & alkaline medicines may relieve the pain. Such episodes
21、occurred almost once a year. 6 hours ago, he suddenly suffered from severe upper abdominal pain which spread to the whole abdomen, accompanied with nausea & vomiting.24ppt课件P.E: T38.5, P 105/min, R 21/min, BP 120/80mmHg Normally developed & mentally clear but acutely ill-looking. No jaundice on skin
22、 or sclerae. Superficial lymph nodes not palpable. Neck soft and supple. Trachea in midline. Thyroid not enlarged. Heart & lungs not abnormal. Abdomen flat & board-like rigid with marked tenderness & rebound tenderness especially in epigastrium, together with decreased liver dullness. Spleen not pal
23、pable. Bowel sounds decreased. No pathological reflexes found. X-ray & Laboratory findings reveal: 1.X-ray: free air under diaphragm 2.Blood picture: Hb 98g/l, WBC 15.6109/L N 0.89, L0.11Discuss the diagnosis, criteria &thrapeutic plan? 25ppt课件 Abstract of a Medical History A male patient of 30 was
24、admitted, complaining of intermittent abdominal pain for 10 years which was more marked in the past 6 hours. Ten years ago, he began to have episodes of pain over the epigastrium persisted for days or even weeks at each time & often associated with dietary indiscretion. Sometimes he had nocturnal ab
25、dominal pain, severe enough to wake up him from sleep at times, but both food & alkaline medicines may relieve the pain. Such episodes occurred almost once a year. 6 hours ago, he suddenly suffered from severe upper abdominal pain which spread to the whole abdomen, accompanied with nausea & vomiting
26、.26ppt课件P.E: T38.5, P 105/min, R 21/min, BP 120/80mmHg Normally developed & mentally clear but acutely ill-looking. No jaundice on skin or sclerae. Superficial lymph nodes not palpable. Neck soft and supple. Trachea in midline. Thyroid not enlarged. Heart & lungs not abnormal. Abdomen flat & board-l
27、ike rigid with marked tenderness & rebound tenderness especially in epigastrium, together with decreased liver dullness. Spleen not palpable. Bowel sounds decreased. No pathological reflexes found. X-ray & Laboratory findings reveal: 1.X-ray: free air under diaphragm 2.Blood picture: Hb 98g/l, WBC 1
28、5.6109/L N 0.89, L0.11Discuss the diagnosis, criteria &thrapeutic plan?27ppt课件 Answers1.Diagnosis: Perforation of peptic ulcer complicated with acute generalized peritonitis28ppt课件2.Diagnostic evidenceintermittent abdominal pain, relieved by food & alkaline medicines. rhythmic & nocturnal abrupt sev
29、ere upper abdominal pain , spread to the whole abdomen, with nausea & vomiting.29ppt课件P.E: T38.5, P 105/min, acutely ill-looking, Abdomen board-like rigid with marked tenderness & rebound tenderness especially in epigastrium, liver dullness & bowel sounds Accessory examinations: 1.X-ray: free air under diaphragm 2.Blood picture: Hb 98g/l, WBC 15.6109/L N 0.89, L0.1130ppt课件3.Therapeutic planActive preoperative preparation & treatmentEmergency operation (Explorative laparotomy ) 31ppt课件Thank You ! 32ppt课件
