急腹癥AcuteAbdomen影像學(xué)表現(xiàn)課件

1、急腹癥AcuteAbdomen影像學(xué)表現(xiàn)急腹癥AcuteAbdomen影像學(xué)表現(xiàn)急腹癥AcuteAbdomen影像學(xué)表現(xiàn)一 急腹癥檢查方法與應(yīng)用范圍：1、腹部平片：主要應(yīng)于胃腸道穿孔性或梗阻性急腹癥。2、鋇灌腸造影：應(yīng)用于腸套疊、扭轉(zhuǎn)等梗阻性急腹癥的診治。3、CT檢查：可應(yīng)用于所有急腹癥檢查，價(jià)值較高。4、超聲檢查：主要應(yīng)用于實(shí)質(zhì)性臟器外傷、腹腔積液、局限性膿腫、結(jié)石與梗阻、腸套疊及急性炎癥的檢查。 2”通過(guò)閱讀科技書籍，我們能豐富知識(shí)，培養(yǎng)邏輯思維能力；急腹癥AcuteAbdomen影像學(xué)表現(xiàn)急腹癥AcuteAb一 急腹癥檢查方法與應(yīng)用范圍：1、腹部平片：主要應(yīng)于胃腸道穿孔性或梗阻性急腹癥。

2、2、鋇灌腸造影：應(yīng)用于腸套疊、扭轉(zhuǎn)等梗阻性急腹癥的診治。3、CT檢查：可應(yīng)用于所有急腹癥檢查，價(jià)值較高。4、超聲檢查：主要應(yīng)用于實(shí)質(zhì)性臟器外傷、腹腔積液、局限性膿腫、結(jié)石與梗阻、腸套疊及急性炎癥的檢查。 2一 急腹癥檢查方法與應(yīng)用范圍：2Possible causes of intestinal obstuctionCongenitalInflammatoryLesion (extrinsic and intrinsic bowel)Trauma3Possible causes of intestinal 44ClassificationGastric outlet obstruction:

3、only one/two air-fluid levelsHomogeneous mass displacing transverse colonDuodenal obstruction: double-bubble sign; Frequently normal due to absence of gas from vomiting5ClassificationGastric outlet o66ClassificationJejunal and ileal obstruction: Candy cane: 3 loops+3cm gas-fluid levels+35 hours onse

4、tDisparity in size between obstructed and normal loopsLittle/no gas + stool in colon with complete mechanical obstruction after 12-24 hoursStepladder appearance; string-of-bead;Cave: fluid-distended loops may lead one to overlook obstruction!7ClassificationJejunal and ilea Upright abdominal radiogra

5、ph shows multiple airfluid levels. Pneumobilia (arrow) is present, as is string-of pearls sign (arrowheads).8 Upright abdominal radiograp99ClassificationColonic obstructionDilated colon onlyDilated small bowel (incompetent ileo-cecal valve)Gas-fluid levels distal to hepatic flexure (fluid is normal

6、in cecum and ascending colon)Cecum most dilated portion (10cm will be critical)10ClassificationColonic obstruct腸扭轉(zhuǎn)大腸扭轉(zhuǎn)11腸扭轉(zhuǎn)大腸扭轉(zhuǎn)11ClassificationClosed-loop obstructionFixation of bowel loop:Coffee bean sign: gas filled looppseudotumor: fluid-filled loopU-shaped dilated bowel loopIncreasing intralumin

7、al fluidBeak sign: point of obstructionWhirl sign: twisting of bowel12ClassificationClosed-loop obst腸梗阻機(jī)械性腸梗阻單純性腸梗阻：腸管通暢性障礙絞窄性腸梗阻：腸管通暢性障礙伴有血運(yùn)障礙動(dòng)力性腸梗阻麻痹性腸梗阻：痙攣性腸梗阻：血運(yùn)性腸梗阻：腸系膜動(dòng)脈血栓或栓塞所致 鋇劑造影須慎重使用，鋇劑吸收水分會(huì)加重梗阻13腸梗阻機(jī)械性腸梗阻鋇劑造影須慎重使用，鋇劑吸收水分會(huì)加重梗阻單純性腸梗阻階梯狀氣液平大跨度腸袢魚肋征14單純性腸梗阻階梯狀氣液平141515絞窄性腸梗阻假腫瘤征：兩端閉鎖的絞鎖腸段內(nèi)充滿大

8、量液體，仰臥位呈腫塊影，而站立位或側(cè)臥位水平位片上則在該腫瘤塊影上部見一短小的液面 咖啡豆征：閉襻小跨度蜷曲腸襻：腸系膜增厚縮短長(zhǎng)液面征：張力低、血性液體空回腸換位征：小腸扭轉(zhuǎn)16絞窄性腸梗阻假腫瘤征：16絞窄性腸梗阻Strangulated obstructionTriad: closed-loop obstruction of the involved segment (majority of cases)Mechanical obstruction proximal to the involved segmentVenous congestion of the involved loop

9、Abdominal plain film :signs for volvulus（腸扭轉(zhuǎn)） or closed-loop obstruction + bowel thickeningCT has 63%100% detection rate!Poor/no enhancement of bowel wallMesenteric haziness due to edema17絞窄性腸梗阻Strangulated obstructio腸扭轉(zhuǎn)小腸扭轉(zhuǎn)：空回腸換位、花瓣樣或香蕉樣排列 18腸扭轉(zhuǎn)小腸扭轉(zhuǎn)：空回腸換位、花瓣樣或香蕉樣排列 181919麻痹性腸梗阻Ileus Causes: postope

10、rativeIntra-abdominal inflammationischemic bowel diseaseLarge + small bowel gastric distensionDecreased small bowel distension in serial filmsDelayed but free passage of contrast material20麻痹性腸梗阻Ileus Causes: 202121Localized ileusCauses: often associated with adjacent acute inflammatory process (acute pancreatitis, acute appendicitis, etc.)Isolated distended loop of small/large bowelSentinel loop: loops near the local peritonitis22Localized ileusCauses: often a胃腸道穿孔游離氣腹23胃腸道穿孔游離氣腹232424