【醫(yī)學(xué)生物】Present-課件

1、Morning meetingPresent：王又德醫(yī)師Supervisor：楊浚銘醫(yī)師1Morning meetingPresent：王又德醫(yī)師1IntroductionBowel obstruction, gastroenteritis Severe pain, especially visceral painSevere systemic illness (myocardial infarction, sepsis, or shock)Pregnancy (hormones)Increased intracranial pressure (central mechanism)Chemot

2、herapy (chemoreceptor trigger zone). 2IntroductionBowel obstruction,33HistoryContentTimeAssociated symptoms (fever, headache, abdominal pain.) Social history (drug or alcohol abuse)Past medical history (any GI disease, surgery)Medication list 4HistoryContent45566ComplicationHypovolemia Metabolic alk

3、alosis Hypokalemia Mallory-Weiss tears typically follow a forceful bout of retching and vomiting. The lesion itself is a 1- to 4-cm tear through the mucosa and submucosa; Boerhaaves syndrome - perforation of all layers of the esophagus - free passage of esophageal contents into the mediastinum and t

4、horax - 80% of cases involve the posterolateral aspect of the distal esophagus - surgical emergency. - Mortality is 50% if surgery is not performed within 24 hoursAspiration of gastric contents7ComplicationHypovolemia 788Hiatal hernia9Hiatal hernia9Introduction Frequent finding by radiologists and g

5、astroenterologists.10Introduction Frequent finding Type I: Sliding hernia 95 % of cases.Widening of the muscular hiatal tunnel and circumferential laxity of the phrenoesophageal membrane gastric cardia to herniate upward. The phrenoesophageal membrane remains intact Posterior mediastinum 11Type I: S

6、liding hernia 95 % o12121313Type I: Sliding herniaMost small hiatal hernias are asymptomatic and, even with larger type I herniasClinical implication is the propensity to develop gastroesophageal reflux disease (GERD). The likelihood of symptomatic gastroesophageal reflux increases with the size of

7、the hiatal hernia. 14Type I: Sliding herniaMost smaOther types of hiatal herniaLess common types of hiatal hernia, types II, III, and IV, are varieties of paraesophageal hernias up to 5 % of all hiatal hernias Surgical dissection of the hiatus as occurs during antireflux procedures, esophagomyotomy,

8、 or partial gastrectomy. 15Other types of hiatal herniaLeType II hernia Defect in the phrenoesophageal membraneGastroesophageal junction remains fixed to the preaortic fascia and the median arcuate ligament. Gastric fundus serves as the leading point of herniation16Type II hernia Defect in the p1717

9、Type III herniasBoth types I and II. 18Type III herniasBoth types I aType IV hiatus herniaLarge defect in the phrenoesophageal membraneAllowing other organs, such as the colon, spleen, pancreas, and small intestine, to enter the hernia sac. 19Type IV hiatus herniaLarge defSymptomsEpigastric or subst

10、ernal painPostprandial fullness, substernal fullness, Nausea, and retching. 20SymptomsEpigastric or substernComplicationGastric volvulus dysphagiaPostcibal pain gastric torsion. Within the incarcerated hernia pouch gastric ulceration, gastritis, or erosions BleedingRespiratory complications result f

11、rom mechanical compression of the lung by a large hernia or other organs herniating through the hiatus.21ComplicationGastric volvulus TreatmentHead of bed elevation Dietary modificationRefraining from assuming a supine position after meals and avoidance of meals before bedtimeAvoidance of tight fitt

12、ing garments Obesity is a risk factor Restriction of alcohol use 22TreatmentHead of bed elevationMedical treatmentAntacidsH2 blockerPPIProkinetic drugs23Medical treatmentAntacids23Surgical treatmentReduction of the herniated stomach into the abdomen Herniotomy (excision of the hernia sac) Herniorraphy (closure of the hiatal defect) An antireflux pro