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 Posted: Thu 14:27, 10 Mar 2011 Post subject: clarks shoes outlet Infarction of ischemic bowel d |
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Infarction of ischemic bowel disease 26 cases
1O coronary heart disease patients with valvular heart disease in 6 cases, while 8 cases with atrial fibrillation, cerebral infarction, 3 cases of liver cirrhosis in 7 cases, combined intra-abdominal infections in 2 cases. 1 case of cancer were due to multi-source and the ascending colon rectal cancer resection. 2. Clinical manifestations: have severe abdominal pain, early abdominal soft, tender points is not fixed, bowel sounds active, or 24 cases of hyperthyroidism accompanied by nausea and vomiting in 12 cases, 9 cases of diarrhea, blood in the stool 1O cases. There were 1 ~ 3d intestinal paralysis, diffuse peritonitis, bloody ascites, systemic symptoms of poisoning and so on. 3. Laboratory tests: bloody ascites 80.8 (21/26), elevated WBC 84.6 (22/26), urine amylase increased 53.9 (14/26); color Doppler Ultrasound positive rate 50.0 (7 / 14), CT positive rate was 6 / 9 cases,[link widoczny dla zalogowanych], positive rate of 80 mesenteric angiography. O (12/15). Second, the results 1. Misdiagnosis: misdiagnosed as intestinal spasm in 2 cases, 6 cases of acute gastroenteritis, acute pancreatitis 1O cases, spontaneous bacterial peritonitis, 2 cases of acute appendicitis in 3 cases, 2 cases of perforated gastric or duodenal ulcer, intestinal obstruction in 1. Misdiagnosis of time ranging from 1 ~ 3d. 2. Surgery and prognosis: all cases were surgical treatment,[link widoczny dla zalogowanych], 6 died, the mortality rate was 23.1. See mesenteric artery ischemia surgery in 16 cases (61.5), mesenteric vein thrombosis, 9 (34.6), 1 case of abdominal adhesions in intestinal incarceration, strangulation, necrosis; were not resected small intestine 60cm ~ 4H1 and so on, the line of a bowel anastomosis or intestinal intestinal fistulization. Ischemic bowel infarction discussed according to etiology and pathology can be divided into: ① mesenteric artery embolization; ② mesenteric artery thrombosis; ③ mesenteric vein thrombosis; ④ nonobstructive mesenteric ischemia, refers to the pathology and angiography without vascular occlusion, and more Because of low cardiac output syndrome, or blood volume is too low, or mesenteric vascular spasm. Elderly, hypertension, diabetes, atrial fibrillation, high blood clotting disorder, portal hypertension,[link widoczny dla zalogowanych], abdominal infection, the disease often based incentives. No specific clinical features, the first symptom of severe abdominal pain often unbearable. In rapid-onset short 『artery, vein missing Author: 250021 Jinan, Shandong Provincial Hospital, Shandong University School of Medicine Department of Gastroenterology,[link widoczny dla zalogowanych], short of the clinical onset of bradycardia with blood, often a few days of non-specific prodromal symptoms, antispasmodic agents and opioid strong analgesic effect of class difference, the early signs of abdominal pain and inconsistent misdiagnosed. The rapid development of the disease in the general situation is deteriorating rapidly, there intestinal paralysis, diffuse peritonitis, bloody ascites and other manifestations, systemic poisoning symptoms, if not treated soon septic shock and high mortality. No specific laboratory tests, peripheral blood leukocytes and urine amylase can be elevated. Color Doppler ultrasound can show the case of mesenteric vessels to determine blood flow velocity, blood flow and cross-sectional area. CT can directly display the intestinal wall and m tube plugs, indicating venous collateral circulation and ischemic segments of the location of the intestinal wall, mesenteric ischemia diagnosis rate of 66.7. Oh angiography showed artery stenosis or interruption of the lesions, and the filling defect, filling slowly, do not develop such image changes accordingly. In suspected cases, angiography should be as early as possible, selective mesenteric angiography is the diagnosis of mesenteric artery ischemia the most reliable method. Because the clinical manifestations of this disease and no specific laboratory examinations, clinicians, lack of knowledge, vigilance is not high, l t misdiagnosed as acute clinical pancreatitis,[link widoczny dla zalogowanych], somatostatin-type drugs, drug-cho, a small contraction of visceral arteries, increase the lack of intestinal 『In, influence prognosis, the identification of the two diseases is very important. Success dependent on early diagnosis and prompt treatment of surgery. Once the diagnosis of ischemic bowel infarction, immediate surgery. Not diagnosed with the disease condition of the above checks, if there should be signs of peritonitis laparotomy, so as to avoid delayed diagnosis of unknown timing of surgery. Intravenous vasodilators such as papaverine 3O ~ 60mg / h, to prevent and reduce intestinal infarction, postoperative anticoagulation therapy can reduce recurrence, but the simple difference between thrombolytic effect. Nonobstructive mesenteric ischemia, should actively improve heart function, correct hypovolemia and timely application of vasodilators, in the event of infarction, surgery should also be timely. The mortality was 23.1, more than deaths due to misdiagnosis long time, thereby adversely affecting the timing of surgery, more complications and beef production of multiple organ failure caused by.
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