急腹症的影像学诊断课件.pptxVIP

Acute Abdomen 检 查 方 法 及 应 用 范 围 ： n 1 、 腹 部 平 片 ： 腹 症 n Congenital n Inflammatory n Lesion (extrinsic and intrinsic bowel) n Trauma n t e s t i n a l ss aa GG cc iinn a t cc ii rr ii tt o n uu oo t l e t i l o a n i l e a dd nn aa nn uu tt aa jj ee JJ cc iinn Cave: fluid-distended loops may lead one to overlook obstruction!!! Upright abdominal radiograph shows multiple air–fluid levels. Pneumobilia (arrow) is present, as is string-of pearls sign (arrowheads). i c o o n t r u c t ss bb ii nn oo tt aa ll oo CC cc iinn 大 转 肠 扭 转 nn 扭扭 oo ll CC cc iinn a s ii tt o l n oo oo o b p 机 阻 械 性 肠 梗 阻 n 单 纯 性 肠 梗 阻 ： 肠 管 通 畅 性 钡剂造影须慎重使用，钡剂吸收水分会加重梗阻 肠 梗 阻 n 阶梯状气液平 n 大跨度肠袢 n 鱼肋征 n 假肿瘤征： n 两端闭锁的绞锁肠段内充满大量液体，仰卧位呈肿块 影，而站立位或侧卧位水平位片上则在该肿瘤块影上 部见一短小的液面 n 咖啡豆征：闭襻 n 小跨度蜷曲肠襻：肠系膜增厚缩短 n 长液面征：张力低、血性液体 n 空回肠换位征：小肠扭转 肠梗阻 segment n Venous congestion of the involved loop n Abdominal plain film : n signs for volvulus (肠扭转) or closed-loop obstruction + bowel thickening n CT has 63%~100% detection rate!!! n Poor/no enhancement of bowel wall n Mesenteric haziness due to edema 小 转 肠 扭 转 ： 空 回 肠 换 位 、 花 瓣 样 nn 扭扭 n Causes: n postoperative n Intra-abdominal inflammation n ischemic bowel disease n Large + small bowel ±gastric distension n Decreased small bowel distension in serial films n Delayed but free passage of contrast material 观 I l e u s en C d s n a s ee tt ff oo uu ee :: ss ee ss ll ii uu aa 道穿孔 游离气腹 n 小 肠肠套叠 型 n 回 结 型 n 结 肠 型 n 腹 痛 / 套鞘(外筒)、套入部(中筒和内筒)； Intestinal Obstuction n a l o b s t r u c t n Mechanical intestinal obstruction n Simple obstruction：occlusion/constriction of bowel lumen n Strangulated obstruction：impaired blood supply of obstructed segment n Ileus (adynamic/non-obstructive) n Paralytic spasm n Derangement impairing proper distal propulsion of intestinal contents Cautionstobariumexam duetothepossibilityofobstructionaggravating G na s t - r i l c oo