Skip to content

Ko te Hernia kua werohia, te aukati i te whekau whakapeka, me te Ischemia Intestinal

He rereke nga nama ohorere i ia whenua. Ka whakamahia e tenei wharangi te 911, te nama mo te United States me Canada. He maha nga whenua e whakamahi ana i te 112, 999, tetahi atu nama ranei. Kimihia te nama mo to whenua.

Ko te aukati i te whekau nui (he aukati katoa, he wahanga miihini ranei o te whekau iti, nui ranei), ** hernia kua werohia** (he kopiko o te whekau e mau ana i roto i te whao, i te pakitara puku ranei e tuwhera ana ka kowaowaotia ona toto), volvulus (he kopikopiko o te whekau e huri ana i te 180 ki te 360 nga nekehanga i roto i te kopu), me te urutomo i roto i tona ake ** ira mokupuku. ko te kapoketanga o te toto, te aukati totika ranei e tapahi ana i te rere o te toto ki roto i nga whekau, e kiia ana he "whakaekea ngakau o te whekau") he pokanga ohorere i te waa. Ina motuhia te tuku toto ki tetahi wahanga o te whekau iti, nui ranei, ka timata te mate o roto (mucosa) i roto i te 2 ki te 4 haora, ka ka puta te necrosis whekau gangrenous me te poka i roto i te 6 haora, ka maka te huakita fecal me te waikawa lactic ki roto i te toto me te kohao puku.

Ko o kawenga tonu ina kua whakapaehia he hernia kua werohia, he arai whekau, he volvulus, he ischemia intestinal ranei, ko te tirotiro i te riu, te puku, me nga nawe pokanoa tawhito mo tetahi puku, ngawari, e kore e taea te whakaheke (henia kua werohia), **kaore rawa e panaia te mamae ki roto i te puku ("whero,") (e pana ana i te mate, whekau gangrenous ki roto i te kohanga puku), mohio ki te tetrad matarohia o te mamae puku, te ruaki (ka huri kakariki/bilious, pouri parauri/fecal), te puku o te puku, me te kore e taea te paahi hau, te kutae ranei (pauke), **kaore e hoatu he ratonga hauora ma te waha, me te waea ohorere ranei.

Mahia tenei inaianei

  1. Waea atu ki nga ratonga hauora whawhati tata: Waea atu ki to nama whawhati tata (911 i te United States me Canada, 112 puta noa i te Kotahitanga o Europi, 999 i te United Kingdom, 000 i Ahitereiria) tirohia to maatau raarangi ingoa tau ohorere ki te mea ka te mamae nui o te puku ka haere tahi me te putunga tino mamae i roto i te riu, puku ranei e kore e hoki ki roto, mamae kua huri mai i te ngaru pupuhi ki te mamae tonu, mamae mamae, Te mamae ohorere 10/10 i runga i te ahua o te ngohe o te kopu, Kakariki (koe) he piro ranei te poihau i te puku-taapiri, ranei ** te mangere, te rangirua, te kirika, me te omaoma o te ngakau.
  2. Whakaahua me te tirotiro i te hiku, te puku, me nga whiu pokanga mo te mate pukupuku kua mau: He maha nga turoro (ina koa nga pakeke me nga kohungahunga) kua arai i te whekau, kare ratou e mohio kei te kowhakina mai he kohanga iti o te whekau ki roto i te inguinal (koe), te wahine (te huha o runga), te umbilical (te puku o roto). Titiro me te ata titiro mo tetahi putunga ngawari, ngawari.
  3. KAUA KAUA e pana kaha ki runga i te hernia mamae, whero, papura, kua mau roa ranei: Ki te mea kua he tino ngawari, he toka-toka, he mahana, he whero, he papura, he puru-pango ranei te pupuhi o te hernia, kaua e ngana ki te pana ki roto. Ko te kaha ki te hoki ki roto i te puku ("reduction en masse"**) ka huna i te kopu kua mate, ka pokai te whekau ki roto i te kohao peritoneal, ka mate tere.
  4. Kaore e hoatu he mea ma te waha (NPO: kore wai, kore kai, kore pire waha): I te wa e tutakina ana te whekau, ka horomia nga mea katoa ki runga ake i te parai, ka toro atu te pakitara o te whekau pakaru kia tata ki te pakaru, ka puta te ruaki o te kaupapa me te mate mate aspiration pneumonia.
  5. Kia kaha te aukati i nga rongoa rongoa katoa, te whakangawari o te kuemu, te rewharewha o te waka, me nga raau taero prokinetic: He maha nga wa ka kii nga tangata e mate whekau whakapeka kei te "paopao kino" na te mea kaore he mea e puta. Ko te tango i te rongoa whakaihiihi, te whakahaere i te enema ki te aukati i te whekau miihini kati, te volvulus ranei, ka puta nga uaua kino e pupuhi ana i roto i te whekau arai (stercoral or ischemic perforation).
  6. Te tuunga ki te taha (te tuunga whakaora) me te mahunga teitei me te piko o nga turi: Na te mea ko te ruaki ohorere, te nui, me te kahakore he tohu o te aukati i te whekau, kia rite te peera nui me te tuu i te turoro e ruaki ana, e ruaki ana ranei ki tana taha kia kore ai e uru te wai o te whekau pouri ki roto ki o ratau puku. Ki te oho me te kore e tino hongi, waiho kia whakanekehia o ratou mahunga kia 30 nga nekehanga me te urunga i raro i o ratou turi piko kia kore ai e raru te pakitara o te puku.
flowchart TD
    Start["Te mamae nui o te puku, te ruaki, te pupuhi/te paheketanga, te kore e taea ki te tuku hau, ki te putunga o te kopu ranei."] --> CheckHernia{"1. Tirohia te Poka, Te Riu Huha, te Pihi Pupu, me te Maaka: He Pupu Hernia Pumau, He ngawari, Kore e Whakaitihia?"}
    CheckHernia -->|Yes| HerniaRule["KAUA E panaia he Hernia Whero, Papura, Wera, Whakamamae ranei ki roto: Waea 911 / 112 / 999 mo te pokanga tere."]
    CheckHernia -->|No Visible Hernia| CheckIschemia{"2. Tirohia nga Kara Whero Ischemia / Volvulus: Te mamae Tonu, 10/10 Te mamae i waho o te taurite, te ruaki kakariki/fecal, te puku-pahu, te oho ranei?"}
    CheckIschemia -->|Yes| CallEMS["Waea atu ki nga Ratonga Ohotata (911 / 112 / 999) Inamata: Matapihi 6-Hora hei Tiaki i te Ischemic Bowel"]
    CheckIschemia -->|Cramping Waves Only| UrgentED["Kawea atu ki te Tari Ohotata o te Hohipera mo te CT Scan me te Nasogastric Decompression"]
    HerniaRule --> Protect["3. Karekau he mea ma te waha (Kaore he wai/kai), KAUA e hoatu he Laxatives, Enema ranei, Tiakina te Rererangi ki te taha ki te Ruaki."]
    CallEMS --> Protect
    UrgentED --> Protect

Ka taea te whakaheke me te mauhere me te Hernia kua werohia: Me pehea te korero rereke

Ka puta te te pakitara puku, te whanariki ranei ina puta mai te kopikopiko o te whekau, te ngako puku ranei na roto i te wahi ngoikore i roto i te uaua uaua, te nuinga kei roto i te inguinal canal (i runga ake i te riu riu), te femoral canal (i raro noa iho i te riu o te puku o runga o te huha o runga, otira e mau ana i te reiti o te huha o runga tae atu ki te 3 teitei. 40 ōrau nā te mea he whāiti, he mārō hoki te whakakai wahine, te ** umbilicus** (te puku), he ** pokanga poka tawhito** (incisional hernia).

He mea nui te mohio ki nga wahanga e toru o te ahu whakamua o te hernia na te mea ka taea e te hernia te whakawhiti mai i te kore kino ki te whakatuma ora i te ahiahi kotahi:

Te wahanga Hernia He aha te ahua o te tinana Te ahua me te ahua o te Pupu Nga tohu a te punaha me nga mahi e hiahiatia ana
1. Hernia Whakaitihia (Kaore i te ohorere) Ka marere mai te whekau, te ngako ranei i te tuwhera o te kanohi ina maremare, e hiki ana, e tu ana ranei, a ka ka hoki whakamuri ki roto ina takoto papa. Ko te pupuhi ngawari, te mamae, te mamae ngawari ranei ka ka tihorea ka ngaro katoa ina takoto te tangata ki tona tuara ka whakangawari. He tino noa te tae kiri. Karekau he nausea, karekau he ruaki, karekau he whekau. E hiahia ana ki te whakarite whare haumanu tuuroro mo waho mo te whakatikatika mata.
2. Hernia i mauheretia (Aromātai Haparapara) Ko te kowiri o te whekau ka ** ka mau (ka mau)** ki waho o te whakakai fascial na te huamo, te piri ranei, a kaore e taea te whakahoki ngawari ki roto, ahakoa kei te rere tonu te toto toto ki roto i te pakitara whekau mo tenei wa. He putunga pakari, pukoro, ngawari ngawari ** ka mau tonu ki waho ahakoa e takoto papa ana**. He tae noa te kiri o runga (kaore ano kia whero, papura ranei). I te nuinga o nga wa ka pa mai ** te arai i te whekau iti noa o te miihini** (te mamae o te puku, te nausea, te ruaki, te kore e puta te hau). Haere tonu ki te tari whawhati tata i mua i te pupuhitanga o te pupuhi toto (ka puta i roto i te 2 ki te 6 haora).
3. Hernia kua werohia (6-Haora Whakamate Huanga Ohotata) Ko te whakaheke toto ka uru mai te toto toto ki roto i te kohanga whekau kua mau ka tino kowaowaotia e te kaki piri o te pute hernia, ka tere te ischemic bowel necrosis, gangrene, me te perforation. He toka-pakeke, he tino mamae ki te pa ngawari, ka mahana, ka tetere, ka huri te kiri ki runga ki te kiri erythematous (whero kanapa), te papura papura, te pango kikorangi ranei. Te mamae mau tonu, te mamae nui, ** te ruaki tonu**, ** te kirika**, ** te ngakau tere (>100 bpm)**, te tangi o te whekau, me te ohorere septic. Waea 911 / 112 / 999 tonu; KAUA rawa e ngana ki te pana i te putunga ki roto.

Kia mataara mo te 'Richter Hernia' huna (Srangulation KORE he arai whekau)

I roto i te momo iti morearea e kiia nei ko te Richter hernia (te nuinga o te mate wahine o nga pakeke pakeke me te laparoscopic port-site hernias), ko ** anake te haurua o te porowhita (te pakitara antimesenteric)** o te whekau iti ka kowhakina ki roto i te mowhiti hernia kiki. Na te mea kei te tuwhera tonu te hongere o roto o te whekau, ka haere tonu te tangata ** ka pahemo i te hau me te mate korere**, ka whakapohehe i a ia ki te whakaaro kei te pai to whekau i te mea ka huri te kowhao o te pakitara whekau ki te kanga, ka poka i roto i nga haora. Ko nga putunga hou kei roto i te riu, i te huha o runga ranei, me arotake ohorere tonu ahakoa kei te pahemo tonu te tangata.

Te Arai Iwi Iti (SBO) ki te Aki Aki Nui (LBO) me te Volvulus

Ka purua te ngongo whekau mai i roto, i roto i tona pakitara, mai i te kopeketanga o waho ranei, ka horomia te hau, te huware, te waikawa o te puku, te papa, me te wai pancreatic (ko te nuinga o te waa 8 ki te 10 rita o te wai ia ra i roto i te pakeke hauora) e kore e rere ki raro. Engari, ko te wai me te puna hau kei runga ake i te aukati, ka pupuhi te whekau me te whakaoho i te 4 nga tohu matua o te aukati whekau:

  1. Te mamae o te puku o te puku (ka huri ** tonu** mena ka tupu te werohia)
  2. Ko te ruaki (moata me te nui i roto i nga poraka teitei; te mutunga me te hongi i roto i nga aukati iti)
  3. Te pupuhi o te puku (te pupuhi me te pupuhi rite te pahū tympanic)
  4. Maamaa (kaore e taea te paahi i te kumete, i te papapa ranei/hau)
Āhuatanga Haumanu Aukati Wēkau Iti Acute (SBO) Te Wēkau Nui Whakapeka (Kono) Aukati (LBO) Sigmoid or Cecal Volvulus (Koropiko Koropiko)
Ngā Take 3 Runga rawa (pūkete mō >80%) 1. Nga whakapiringa i muri i te pokanga (nga herenga o te kopa mai i tetahi pokanga puku/paunga o mua, 60-75%), 2. Te mauherehereherea (15-20%), 3. Nga pukupuku puku iti, Crohn strictures, gallstone ileus. 1. Te mate pukupuku / puku (60%, ka whakawhäiti haere i te kopirua tae noa ki te katinga o te kutae), 2. Volvulus (15-20%), 3. Ko te whakatiki i te rere (10%). He porowhita roa o te ** sigmoid colon** (e kitea ana i roto i nga pakeke pakeke, e noho ana i te whare nēhi, i te koroka roa, i nga rongoa neuropsychiatric ranei) ranei cecum ka huri 180 ki te 360 ​​nga nekehanga huri noa i tona turanga mesenteric whaiti, ka hanga he ** arai katia-kopiko**.
Tama me te ahua o te mamae Ka tere te tiimata o te ngaru koi, te ngaru paroxysmal ia 3 ki te 5 meneti huri noa i te puku o waenganui (periumbilical) i te wa e whakapakeke ana te whekau iti ki te aukati. Ka tiimata haere te pupuhi o te puku o raro ia 10 ki te 15 meneti i roto i nga ra maha, i te nuinga o nga wiki i mua i nga wiki o te whakawhäiti i te "pene angiangi" o te kumete, te paopao, te toto ranei i roto i te kutae. Ka paahure, te pahū o te mamae nui me te mamae totoro tonu i te mea kua mau nga huakita koroni ka rewa te kumete ki roto i te maha o te mewaro me te hauwai hauwai kei roto i te kowiri kati.
Tama me te ahua o te Rua Moata, auau, me te nui: Ka timata hei wai puku marama, ka tere ka huri he kaakaariki, he pouri kowhai-matomato ranei (ruaki bilious), a, i roto i te aukati i nga whekau iti i muri i te 12 ki te 24 haora ka huri he karaka-parauri me te hongi kino o te fecal (ruaki feculent) na te tipu o te huakita iti i roto i te wai kohu. Tino tomuri, kua ngaro ranei: Na te mea ko te ileocecal valve kei waenganui i te whekau iti me te whekau nui ka mahi hei arataki kotahi-ara i roto i te 75% o nga tangata, kaore e taea e nga ihirangi koroni te whakahoki mai ki roto i te puku tae noa ki te mutunga o te ahiahi. Ka roa te ruaki, i muri i te tipu o te puku o te puku.
Te Tohu o te Tototanga o te Puta (Te Putanga) He ngawari-ki-te-ahua i roto i nga arai teitei (tata tata) na te mea ka ruaki te wai ki runga tika; te pupuhi o te pokapū i roto i te iti (distal ileal) aukatinga. Te taha nui, whakaari me te paheketanga whaanui. Whakatupato: Ki te kaha te hikoi (kotahi te ara), ka rite nga poihau cecum ki te peera kua nui noa atu; kia tae te diameter o te cecal 10 ki te 12 henimita (4 ki te 4.7 inihi), kei te noho tata te pakitara cecal angiangi ki te putanga ischemic (LaPlace ture). Te kaha o te puku, te hangarite, te pahū ("tympanic") te pupuhitanga o te puku ka tupu i roto i nga haora, ka pana ki runga ki te diaphragm me te uaua ki te manawa.

Ko te mahanga 'Paradoxical Diarrhea' me te 'Moata te Paahitanga o te Stool' i roto i te arai katoa o te whekau.

Ko te tangata kua 100 paiheneti kua oti te aukati whekau iti, kua werohia wawe ranei ka taea tonu te haere 1, e 2 ranei nga kohu whekau noa, wetewete ranei i roto i nga haora 6 ki te 12 tuatahi, na te mea ka tukuna noa e te koroni i raro iho te parai i waho o nga kutukutu e noho ana ki roto i mua i te pakarutanga. I roto i te maatanga o te waahanga teitei, te paheketanga taie ranei, ko te wai wai anake ka taea te pehi i mua i te arai (pukepuke, matere paradoxical ranei). Kaua rawa e whakakore i te arai i te whēkau na te mea kua pahemo tetahi tangata, he mate korere wai ranei i mua i tenei ra.

Me pehea te mohio ki te wa kua huri te "Arai Ngawari" ki te "Strangulated / Ischemic Bowel"

I roto i te te aukati i te whekau ngawari noa (he waahi aukati kotahi kei te tuwhera tonu nga oko toto i roto i te mesentery), te whakahekenga o te hōhipera me te nasogastric (NG) ngongo me nga wai whakaroto ka taea e nga piri i muri i te pokanga kia wetekina me te kore e tapahia te puku.

Heoi, i roto i te Kati-Koropiko Obstruction (kei te kowhakina he wahanga o te whekau e katia ana ki e rua ka mutu i te wa kotahi, penei i roto i te whakakai hernia, i raro i te here piri piri, i roto ranei i te volvulus kopikopiko), e kore e taea e te kaokao mauhere te whakaheke whakamua ki roto i te toka, whakamuri ranei ki te puku. Ka piki ake te pehanga o roto i te kapiti kati, ka kopaki i nga uaua mesenteric pakitara angiangi i te tuatahi (ka pupuhi te toto o te pakitara whekau) katahi ka tapahia nga uaua mesenteric (kakao).

Kia mataara mo enei 5 haki whero haumanu e tohu ana kua uru te arai ngawari ki roto i te whekau kua mate, kua mate:

  1. Ka huri te mamae mai i nga ngaru e ngaru ana ki te TONU, te mamae kore e mutu: I te wa e arai ana, ka tae mai te mamae i roto i nga ngaru peristaltic 3-meneti me te waatea kore mamae i waenga. I te wa ka paheke te pakitara whekau, ka mate ranei, ka ka mau tonu, ka nui te mamae, karekau e mutu i waenga ngaru.
  2. Te whakawhanaketanga o nga tohu o te peritoneal (Te tiaki, te maro, te mare/mamae): Ka huri te puku mai i te ngohe me te pupuhi ki te ngawari me te maro ina pa marietia, maremarehia, ka werohia ranei (peritonitis).
  3. Systemic SIRS and Sepsis signs: Unexplained ** resting tachycardia (te auau o te ngakau >100 ki te 110 patiki ia meneti)**, hou kirika (>38.0 C / 100.4 F), te manawa tere, te whakaheke toto ranei.
  4. Hematochezia (He toto, maroon, he "currant-jelly" stools): I te wa e marere atu ai te ararewa mucosal o roto o te whekau mai i te ischemia, ka pahemo pea te hūpē whero pouri, maroon, toto ranei mai i te toka.
  5. Nga whakaoho taiwhanga a te hohipera: Te piki ake o te toto te serum lactate (>2.0 mmol/L), te waikawa metabolic (te iti o te bicarbonate/base deficit), me te tino piki ake o te tatau toto ma (>15,000 ki te 20,000/mm3).

E rua nga mate ohorere tino nui kia kaua e ngaro: Acute Mesenteric Ischemia me Pediatric Intussusception

1. Acute Mesenteric Ischemia ("Heart Attack of the Bowel" i roto i nga Pakeke)

I roto i te ischemia mesenteric acute, karekau rawa he hernia tinana, he nawe nawe ranei. Engari, ka rere te toto i roto i te Superior Mesenteric Artery (SMA) (te arai nui kotahi e whakarato ana i te whekau iti katoa me te haurua matau o te koroni) ka motu ohorere e:

  • Arterial Embolism (50% o nga keehi): He toto i whakarewahia tika mai i te atrium maui o te ngakau i roto i te tangata turoro me Atrial fibrillation (te paheketanga o te ngakau), tata whakaeke ngakau, ranei te mate mate manawa.
  • Arterial Thrombosis (25% o nga keehi): Ko te katinga ohorere o te tohu cholesterol i te takenga mai o te arai mesenteric teitei i roto i te turoro me te mate vascular peripheral (he maha nga marama o "intestinal angina": mamae puku puhoi 30 meneti i muri i te kai i ia kai me te mataku ki te kai).
  • Kore-Occlusive Mesenteric Ischemia (NOMI, 20%), Mesenteric Venous Thrombosis (5%): He kaha te whakaheke toto i te wa o te wiri/vasopressor te whakamahi cocaine ranei, te toto toto ranei i roto i nga uaua mesenteric i nga turoro he mate totika, cirrhosis ranei.

Ko te Tohu Matarohia o te Acute Mesenteric Ischemia: "Te mamae o te mamae ki te whakamatautau tinana"

I roto i te waa tino nui tuatahi 2 ki te 6 haora (i te wa e taea tonu ai e te tangohanga o nga whatukuhu endovascular ohotata, te pokai haere ranei ki te whakaora i te whekau iti katoa o te manawanui), ka hamama, ka wiri ranei te manawanui ki te ** ohorere, mate kino 10/10 te mamae o te puku o te puku**, te pupuhi o te whekau (he ruaki me te mate ohorere ka pa ki te puku me te mate korere), ahakoa ** ka pa ki te mamae o te puku, ka pa ki te taote. paku ngawari **. He aha? Na te mea ka timata te ischemia i runga i te i roto mucosal lining o te whekau, ka whakapataritari noa i nga nerves mamae visceral hohonu me te kore e whakapataritari i te peritoneum parietal o waho. I te wa ka pakeke, ka maro te puku (peritonitis), kua pango kee te whēkau iti katoa, he gangrenous, e mau ana te reiti matemate 60 ki te 80 ōrau. Mena ka tupu ohorere tetahi pakeke pakeke, tetahi tangata ranei e mate ana i te atrial fibrillation, i te mate ngongo ranei, i te mamae puku me te puku ngawari, waea atu ki te 911 / 112 / 999 ka tono ki nga taote ohorere ki te tirotiro i te CT Angiogram (CTA) o nga uaua mesenteric.

2. Te Intussusception Pediatric me te Neonatal Midgut Volvulus (I nga Pepi me nga Tamariki)

I roto i nga kohungahunga me nga tamariki nohinohi, e rua nga waahanga ohorere motuhake e hiahia ana ki te mohio wawe:

  • Ko te Intussusception (Ko te nui o te tau 3 marama ki te 3 tau, te take #1 o te aukati i te whekau i roto i nga pepi/kohungahunga): Kotahi te wahanga o te whekau (te nuinga o te ileum) ka whakaata i roto i te wahanga tata (te koroni) ano he karaihe karekau karekau, ka koowaotia te tuku toto.
  • Me pehea te kite: Ka tangi ohorere te peepi hauora i roto i te 15-ki-20-meneti nga ngaru o te mamae o te kopikopiko, ka toia nga turi e rua ki runga ki te uma** ka koma, ka mutu te tangi, ka he ngenge, he koma, he koma ranei mo te 20 ki te 30 meneti i mua i te pa o te ngaru tangi. I roto i nga haora, ka huri kakariki te ruaki, ka rongo pea koe he puke ahua hotiti kei roto i te puku matau, ka paahi te peepi "whero currant-jelly stool" (he toto whero pouri kua konatunatua ki te hūpē sloughed, he tohu tomuri o te ischemia whekau). Ka mau wawe i roto i te tari whawhati tata, ka taea e nga kai-whakaaro irirangi te turaki marie i te whekau karu kia noho ki roto i te 85 paiheneti o nga keehi ma te whakamahi i te hau arataki hikoi, he enema saline hydrostatic ranei kaore he pokanga.
  • Ko te Huritanga Neonatal me te Midgut Volvulus (Nga Whanau Hou me nga Kohungahunga kei raro iho i te 1 Tau):
  • Te Ture koura mo nga Tamariki: Ko te ruaki kaakaariki (bilious) i roto i te whanau hou, i te kohungahunga ranei he ohotata pokanoa kia kitea ra ano he rereke. Ki te tuwha te peepi kei raro iho i te 1 tau te pakeke ka ruaki ranei te wai kaakaariki, pouri ranei te tarutaru-matomato (ehara i te waiu kowhai kowhai/te waiu waiu), kua kopikopiko pea to ratou whekau iti katoa ki te whekau iti o te peepi (**) whekau i roto 3 ki te 6 haora. Haere tika ki te tari whawhati tata mo nga tamariki, waea atu ranei ki 911/112/999.

Te awhina tuatahi i mua i te hohipera me te whakaheke i te hohipera

Hipanga 1: Te tuunga haumaru me te whakamarumaru i te huarahi rererangi mai i te ruaki feculent

  1. Kia mau tonu te NPO ki te manawanui (kore wai, kore tio tio, kore rongoa waha): Ahakoa te 30 mira (1 hekere) o te wai ka puta te waiariki ohorere o te wai o te whekau parauri, he kakara kino i roto i te turoro he puku puku.
  2. Turanga hei aukati i te wawata:
  3. Ka taea e nga turoro he mate whekau teitei te ruaki 1 ki te 2 rita o te wai i roto i te whekau i roto i te pupuhi ngawari noa me te kore e puta he whakatupato o te nausea noa.
  4. Mēnā he momoe te tūroro, he ngoikore, he kaumātua, he tino nausea ranei, me takoto ki runga taha maui (te waahi whakaora) me te peera nui kei raro tonu i tona kauae.
  5. Mēnā kei te oho te tūroro me te mataara me te nui o te paheketanga o te puku (pērā i te sigmoid volvulus), ka noho ki te 30-ki-45-tohu koki āhua-tika me nga urunga e tautoko ana i nga turi piko ka whakangawari i te pehanga whakarunga ki te diaphragm (kia ngawari te manawa) me te pupuri i te esophagus ki runga ake i te puku.
  6. Te tiaki i te hernia i mauheretia i te wa e kawe ana:
  7. Me takoto tapapa te manawanui me o ratou hope me ona turi he paku piko (a mena he hernia kua mauheretia he **kare ano i te wera, he papura, he mamae ranei, ka okioki marie ki runga i te tuara me nga hope e tautokona paku ana i runga i te urunga, ka wetewete atu i te whakakai hernia, i etahi wa ka hoki mai te hernia i mauheretia moata i te wa o te kawe waka tūroro).
  8. Kaua rawa e pehi kaha, ka ngana ranei koe ki te raweke a-ringa.

Hipanga 2: He aha te mahi i roto i te tari ohorere

  1. Te Whakaoranga Tonu me te Whakatika Hikohiko: He kaikoi i te whekau kua araia 3 ki te 6 rita o te wai, te konutai, te pāhare pāporo, te pūhaumāota, me te bicarbonate kei roto i te pukoro me te pakitara o te whekau, i te ruaki ka puta he nui ** hypokalemic, hypochloremic metabolic alkalosis** ka timata i te kotahitanga ischemia metabolic alkalosis** (ko te ischemia metabolic alkalosis** ka timata i te kotahitanga ischemia metabolic acids** Ka tuu tonu e nga roopu ohorere e rua nga raina IV nui-whanau me te whakauru i nga crystalloids isotonic me te whakakapinga pāhare pāporo me te konupora.
  2. Nasogastric (NG) Tube Decompression: Ka tukuna marietia e nga nēhi me nga taote he ngongo ngongo ngohengohe Salem sump nasogastric tube i roto i te ihu ki roto i te puku ka hono atu ki te momi pakitara iti. I roto i te 60 hēkona, ka whakahekehia e te ngongo NG te 500 ki te 2,000 miririta o te hau mau me te wai bilious pouri ki waho o te puku, whakarere nui i te ruaki, whakangawari i te mamae totoro o te puku, me te aukati i te wawata mate i te wa e tirotirohia ana e te CT, i te whakaurunga whakamoanatanga ranei.
  3. Whakaritea te Matawai CT me te wawaotanga Tino:
  4. CT Abdomen/Pelvis with IV Contrast (me te CTA mena kei te whakapaehia te ischemia mesenteric): Ka tohu i te tika o te mirimita o te "rohe whakawhiti" i reira ka tutaki te whekau kua pakaru ki te whekau kua tiangi, ka kite i nga kopikopiko kati, nga tohu awhiowhio mesenteric, me te pakaru o te toto o te pakitara whekau.
  5. Te Whakahekenga Endoscopic mo te Sigmoid Volvulus: Mena he uaua noa te sigmoid volvulus karekau he gangrene, he pokai ranei, ka taea e te tohunga gastroenterologist, kaitoi rata ranei te tuku i tetahi sigmoidoscope ngawari ki roto i te toka i roto i te ruuma whawhati tata, ka wetewete i te koroni sigmoid kua piko ka tuku i roto i nga meneti, ka whai i te wai o te pokanga i muri mai i te werohanga o te taputapu ki raro. kopikopiko nui kia kore e korikori ano.
  6. Laparotomy Ohotata, Laparoscopy ranei: Mena kei te he ** hernia kua werohia**, cecal volvulus, te aukati i te kopa iti, he ischemia mesenteric acute ranei, ka haria e nga taote te manawanui ki te ruma poka i roto i te whare koura 6-haora matapihi ki te tuku i te whakakai toto i mua i te rere o te whekau, kia kore e taea te whakaora. he tangohanga, he putea ostomy ranei ka tika.

Te Arai Miihini i te Ileus me te Ogilvie Syndrome (Pseudo-Obstruction)

Ehara i te mea ko nga turoro katoa e pupuhi ana, e puku ana te kopu me nga kohu whekau karekau he kowiri tinana, he kowiri ranei i roto i o ratau whekau. I roto i te hōhipera, ka wehewehe nga taote ohorere me nga taote taaputa i waenga i te Mechanical Bowel Obstruction (he arai ara-a-tinana e hiahia ana kia whakahekehia, kia pokanga ranei) me Wunctional / Adynamic Ileus (kei te tuwhera whanui te ngongo intestinal, engari kua ngaro te pakitara o te uaua maeneene mo te wa poto i ona wehenga peristaltic hiko):

Āhuatanga Haumanu Te Arai Miihini Whanau (SBO / LBO / Volvulus) Paralytic (Adynamic) Ileus Acute Colonic Pseudo-Obstruction (Ogilvie Syndrome)
Te take o raro Te aukati a tinana mai i te whakapiringa o te nawe i muri i te mahi, te hernia kua mauheretia/te kaokao, te volvulus twist, te puku, te intussusception, te whare kowhatu kowhatu ranei. Paralysis rangitahi o te whekau iti me te whekau nui na te pokanga puku o mua tata nei, peritonitis, te ngoikoretanga o te electrolyte nui (te iti o te pāhare pāporo, te iti konupora ranei), te pneumonia/sepsis, te taumaha ranei ** nga rongoa mamae o te opioid**. Ko te koretake o te nerve autonomic nui e pararutiki ana anake te whekau nui (colon) i roto i nga turoro i te hohipera, i nga kaumātua, i nga turoro i muri mai i te orthopaedic/spinal surgery, ka nui te poihau cecal me te koroni kaore he aukati tinana.
Te ahua o te mamae o te puku Nga ngaru koi, manawataki, paroxysmal (ia 3 ki te 5 meneti i roto i te whekau iti; ia 10 ki te 15 meneti i roto i te kopirua) i te wa e whawhai ana te whekau ki te pana atu i te aukati rori; ka tino kaha, ka mau tonu mena ka werohia. Maamaa, marara, puhoi te mamae o te pupuhi na te totoro hau, **karekau he ngaru koi. Te mamae haere tonu, te mamae totoro o te puku mo te 2 ki te 5 ra; Mena ka toro atu te cecum ki tua atu i te 10 ki te 12 cm (4 ki te 4.7 inihi), ka tohu te mamae o te taha matau o raro o te taha matau mo te ischemia cecal me te kohao.
Ko te Oro o te Kopa (Whakarongo ki te Kopu) Moata: He reo nui, he reo teitei, he konganuku "tinkling" nga wiwi me te borborygmi e taurite ana ki ia ngaru o te mamae mamae. Kua Tomuri (Kua Kaia/Gangrenous): Te puku puku. Ka noho humarie, ka ngaro rawa ranei ("kopu puku") mai i te timatanga, na te mea kei te moe te peristalsis. Ka tangi te hau hypoactive, te tangi teitei ranei me te kopu rite te pahu (tympanic).
Whakaritea nga Whakaaturanga Matawai CT E whakaatu ana i te "Ira Whakawhiti" ka pakaru ohorere nga koropiko whakarunga kua whakakiia ki te wai ki roto ki te whekau papatahi, kau whakararo (me te "tohu ngutu", "tohu awhiowhio" ranei i roto i te volvulus). He rite tonu te pupuhi hau o te whekau iti me te whekau nui tae noa ki te toki, me te kaore he waahi whakawhiti. Te toronga nui o te cecum me te koroni matau/whakawhitinga, me te hau ka tae ki te toka, karekau he puku miihini, he korikori ranei ki te CT me te rereke o te tapau.
Maimoa i te hohipera Te momi nasogastric, te whakaora i te wai IV, te wero Gastrografin wairewa-wai (mo te whakapiri SBO kore uaua), he he pokanga ohorere/whakahekenga endoscopic. Whakaorangia te take: whakamutua te opioids me nga raau taero anticholinergic, whakakapi kaha i te IV pāhare pāporo me te konupora, whakatenatenahia te hīkoi moata, ka whakatā i te whekau tae noa ki te oho ake te moti. Whakamutua nga opioids/anticholinergics katoa, whakatikahia nga electrolytes, tuu he ngongo whakahekenga totika, a ki te neke atu te diameter o te cecal ki te 10 ki te 12 cm, tukuna he neostigmine (i raro i te aro turuki i te ngakau) ka mahia ranei te whakahekenga koroni.

Ko nga turoro motuhake kua rereke te ahua o te tinana: Ko te aukati o te Ostomy me nga mate o roto i muri i te bariatric (Roux-en-Y)

E rua nga roopu turoro e tipu tere ana ka wheako i nga momo momo whakararu o te whekau whakapeka e hiahia ana kia mohiohia:

1. Ko nga tangata e noho ana me te Ileostomy, Colostomy ranei ("Stoma Blockage")

Mo te tangata he ileostomy (he whekau iti ka mauria ki te pakitara puku) he colostomy ranei, he aukati miihini (he maha nga mea ka puta mai i nga kai kikoo penei i te popcorn, te harore, te herewi, te kokonati mata, te nati, te hua maroke ranei e pupuhi ana i te whakakai o te mata, na te **parastomal media ranei) he mate whawhati tata.

  • Nga tohu whakatupato mo te aukati ostomy whakapeka:
  • Ka mutu ohorere te putanga o te stoma mo ** neke atu i te 4 ki te 6 haora** (ina koa i roto i te whareostomy, e rere tonu ana te kumete wai puta noa i te ra), RĀNEI ka pupuhi ohorere mai te rehu wai piro ka whai muri ka kati katoa.
  • Ngaru o te mamae nui o te puku, te pupuhi o te puku, te nausea, me te ruaki.
  • Ka huri te ahua o te Stoma: Ka tere te pupuhi o te kopa mawhero, makuku makuku (ka tapahia ki roto i te kopa angiangi kirihou o te pukoro ostomy) ka huri ranei he koma, he papura pouri, he papura pouri, he pango ranei (e tohu ana i te stoma ischemia or strangulated parastomal hernia).
  • Te Awhina Tuatahi mo te Stoma Tetere, Kua Araia ranei:
  • Mehemea kei te koma, te papura, te pouri, te pango ranei te kopu, ki te mea he putunga mamae uaua kei te taha o te kopu: Waea atu ki 911 / 112 / 999 me haere ranei ki te tari ohorere.
  • Tangohia me te whakakapi i te flange angiangi ostomy piri tonu: I te mea e pupuhi ana te stoma arai ano he poihau, ko te whakakai kirihou o mua o te peeke ostomy o naianei ka rite ki te toroni me te ** ka werohia te stoma mai i waho**. Tangohia te punaha putea ka tapahia te whakatuwheratanga o te angiangi hou 3 ki te 5 mitamano (⅛ ki te ¼ inihi) te whanui huri noa i te puku tetere, ka hipokina ranei kia tae ra ano ki te hohipera.
  • Kaua rawa e tango i nga rongoa me te whakauru mai i nga maihao me nga ngongo pakeke ki roto i te kopu i te kainga; i roto i te tari whawhati tata, ka tukuna marietia e nga taote he ngongo ngongo Foley kua whakahinuhinu ki roto i te stoma kia whakamakuku marietia nga aukati kai.

2. Ko nga turoro kua pangia i mua i te Taapiri Peepi (Roux-en-Y Hernia Roto)

Ko te tangata kua pangia e te Roux-en-Y pokanga peepi pereti (mo te mate taumaha, te reflux ranei), ahakoa 5, 10, 20 ranei tau ki muri, kei te noho morearea mo te Mesenteric Hernia o roto (Petersen defect or jejunojejunostomy mesenteric defect):

  • He aha te mea he nui te hianga o te maataki puku i nga hernia o roto:
  • Ka paheke te kowiri o te whekau iti i roto i te matapihi pokanga o roto i roto i te puku, ka korikori, ka puta he katia-koropiko te strangulating arai o te biliopancreatic limb or Roux limb.
  • Na te mea kua wehea te pukoro iti o te puku o te manawanui mai i te toenga o te puku me te duodenum, he maha nga wa ka pa te tangata turoro me te hernia a-roto ka ** te mamae i waenganui o te puku, te tuara ranei me te HEAVES MATEO (kare e kaha ki te ruaki)** me te kore te puku o te puku kei waho.
  • He tino noa nga hihi X o roto o te puku, tae noa ki nga karapa CT paerewa ka ngaro te "tohu awhiowhio mesenteric" mena ka panuihia e te taote tarai. Ko nga turoro katoa e paopao ana i te kopu e tupu ohorere ana, te mamae nui, te mamae tonu o runga/waenganui o te puku, me haere tonu ki te tari whawhati tata, ka me kii atu ki te taote whakamatautau: "Kei a au a Roux-en-Y, te maataki o te puku; tirohia koa ahau mo te mate o roto."

Me whai tohu whakangungu awhina tuatahi

Ko te mohio ki nga mahi ohorere o te puku, te whakahaere i te ru hypovolemic me te septic ru, me te whakamarumaru i te ara hau o te turoro e ruaki ana nga pukenga awhina tuatahi. Whakaarohia te tango i tetahi awhina tuatahi me te akoranga CPR kua whakamanahia ma te Ripeka Whero, St John Ambulance, tetahi kaiwhakarato rohe ranei.

Pātai auau

Why must you never try to push a very painful, red, or purple hernia back into the abdomen at home?

When a hernia bulge becomes rock-hard, severely painful, warm, red, purple, or dark blue, the loop of intestine trapped inside has had its blood supply cut off (strangulation) and its wall may already be gangrenous and dying. Forcefully pushing a strangulated hernia back into the belly ("reduction en masse") shoves dead, leaking bowel inside the sterile abdominal cavity, causing rapid, fatal fecal peritonitis and hiding the dying segment from surgeons. Always go straight to the emergency department instead.

Can you still have a complete bowel obstruction if you passed stool or watery diarrhea earlier today?

Yes. During the first 6 to 12 hours after a complete small bowel obstruction occurs, the large intestine (colon) located downstream below the blockage can still contract and empty whatever stool was already sitting inside it. Also, in a high-grade partial obstruction or severe fecal impaction, only liquid can squeeze around the blockage, causing "paradoxical or overflow diarrhea." Never ignore severe cramping, bloating, and vomiting just because some stool came out earlier.

Why is taking a laxative or using an enema so dangerous when you have a bowel obstruction?

A mechanical bowel obstruction means the intestinal tube is physically pinched, twisted, or blocked shut by scar adhesions, a hernia, a volvulus, or a tumor. Taking a laxative or using an enema forces the intestine to contract violently and dumps extra fluid above a closed physical roadblock, which can literally burst the stretched, fragile bowel wall open and spill stool throughout the abdominal cavity.

Why is bright green vomit in a newborn or baby always treated as a surgical emergency?

Whereas harmless spit-up in babies is white or pale yellow milk curds from the stomach, bright green or dark grass-green (bilious) vomit means bile from the duodenum is backing up because the intestine is blocked below the bile duct opening. In newborns and infants, the most dangerous cause of green vomit is malrotation with midgut volvulus, where the entire small intestine twists around its main blood vessel and can completely die from lack of blood flow within 3 to 6 hours without emergency surgery.

Kua tirohia nga puna

  • World Society of Emergency Surgery (WSES): Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO), WSES Guidelines for Emergency Repair of Complicated Abdominal Wall Hernias, and WSES Guidelines on Acute Mesenteric Ischemia.
  • American Society of Colon and Rectal Surgeons (ASCRS, United States): He Aratohu Mahinga Haumanu mo te Whakahaerenga o te Koroni Volvulus me te Acute Large Bowel Obstruction.
  • Te Röpü Rawhiti mo te Tähungatanga o te Trauma (EAST, United States): Whakamahia Nga Aratohu Whakahaere mo te Aromatawai me te Whakahaere o te Aki-Iwi-iti.
  • National Institute for Health and Care Excellence (NICE) and Royal College of Surgeons (United Kingdom): Huapapa Whanaketanga Whanui: Acute Bowel Obstruction and Strangulated Hernia Pathways.
  • American Academy of Pediatrics (AAP): Whakaaetanga me te Whakahaere Ohotata o te Emesis Bilious, Malrotation me Midgut Volvulus, me te Intussusception i roto i nga Kohungahunga me nga Tamariki.

Nga kaiarahi e pa ana