胃肠结构与保护.ppt

第三讲  胃肠的结构与保护授   课   内  容•胃肠器官的基本结构及主要功能•常见的急腹症种类•急性肠炎的临床表现•阑尾炎的病因及症状•胃肠溃疡及穿孔的主要症状一、一、胃肠器官的基本结构及主要功能•胃的解剖形态和结构功能•小肠的结构特点和生理作用•大肠的形态学特点和生理功能1  胃的解剖形态、结构和功能•胃的概况•胃的形态•胃的位置•胃的分部•胃壁的结构① 胃的概况•特征：是消化管中最膨大的部分， 上连食管；下续十二指肠•容量：1500ml•功能：收纳食物； 分泌胃液（胃酸；胃蛋白酶等）； 内分泌功能（胃泌素、生长抑素等）② 胃的形态•形    态：空虚时呈管；充盈时呈球囊状•前    面：胃前壁•后    面：胃后壁•右上缘：胃小弯（胃角）•左下缘：胃大弯•入    口：贲门•出    口：幽门③ 胃的位置•位置：中等充盈时大部分位于左季肋区； 小部分位于腹上区•比邻：前邻肝、膈、肋弓和腹前壁； 后邻胰、横结肠、左肾和左肾上腺； 胃底邻膈和脾； 贲门在第11胸椎体的左侧； 幽门在第1腰椎体的右侧。

④ 胃的分部•贲门部•胃底（胃穹隆）•胃体 幽门管•幽门部： 中间沟 幽门窦 ⑤ 胃壁的结构•层次结构：粘膜层、 粘膜下层、 肌层、 外膜层•解剖结构：胃皱襞、 胃道、 食管胃粘膜线、 幽门瓣、 幽门括约肌 2  小肠的结构特点和生理作用•小肠的概况•十二指肠的形态特征•空肠与回肠的形态异同① 小肠的概况•起止：上连幽门；下续盲肠•长度：消化管中最长，成人平均长5-7米•分部：十二指肠、空肠、回肠•功能：是消化和吸收的重要器官，并具 有内分泌功能② 十二指肠的形态特征•位置：胃与空肠之间；腹腔上深部，包绕胰头•长度：25cm•分部：上部（3cm)、 降部(7-8cm)、 水平部(10cm)、 升部(2-3cm)•结构：十二指肠上曲、十二指肠球、 十二指肠下曲、十二指肠纵襞、 十二指肠大乳头（小乳头）、 十二指肠空肠曲③ 空肠与回肠形态异同•起止：起于十二指肠空肠曲，止于盲肠。

•系膜：均有肠系膜悬于腹后壁，                 合称系膜小肠•缘：    系膜缘、独立缘•界限：不明显空肠和回肠的比较 位位置置长长度度管管径径粘粘膜膜皱皱襞襞供供血血脂脂肪肪肠肠袢袢淋淋巴巴滤滤泡泡特殊特殊结构结构空空肠肠左左上上腹腹2/5大大高高而而密密丰丰富富少少横横行行孤孤立立 回回肠肠右右下下腹腹3/5小小低低而而疏疏较较少少多多纵纵行行集集合合Meckel憩室憩室3 大肠的形态学特点和生理功能•大肠的基本情况•大肠的位置与分布•盲肠的形态结构•阑尾的解剖特点•结肠的形态与结构•直肠和肛管的形态特点 ① 大肠的基本情况•位置：消化管末端；围绕于空回肠周围•长度：1.5m•结构特征：结肠袋、结肠带、肠脂垂•功能：吸收水份、维生素和无机盐；将食 物残渣派出体外② 大肠的分部•盲肠•阑尾 升结肠•结肠 横结肠 降结肠 乙状结肠•直肠•肛管③ 盲肠的解剖结构•位置：右髂窝内；大肠的起始端•连接：下为盲端；上续升结肠、 左连回肠、左下连阑尾•长度：6－8cm•结构：回盲口、回盲瓣、阑尾开口。

④ 阑尾的解剖特点•形态：似蚯蚓，属盲肠一段肠管•长度：6－8cm•位置：居右髂窝；根部连于盲肠， 尖端不固定•结构：阑尾系膜、阑尾根部体表 投影（mcburney点）⑤ 结肠的形态与特征•位置：介于盲肠与直肠之间的一段大肠•形态：呈“M”形包绕空、回肠周围•管径：由粗到细（6－－2.5cm)•分部：升结肠（15cm)、横结肠(50cm)、 降结肠(20cm)、乙状结肠(45cm)•结构：结肠右曲（肝曲）、结肠左曲（脾曲） ⑥ 直肠的形态特征•位 置：消化管位于盆腔下部一段•连 接：上在第3骶椎前起于乙状结肠；穿 盆隔移行为肛管•长 度：10－14cm•弯 曲：矢状位－－骶曲、会阴曲•冠状位：右凸、左凸、右凸•结 构：直肠壶腹、直肠横襞（3条）肛管的形态特征•长度：3－4cm•连接：上在盆隔续于直肠；下终于肛门•结构：肛柱（6－10条）、肛辬、肛窦、 肛直肠线、齿状线（肛皮线）肛梳 （痔环）、白线（Hilton线）肛管的静脉分布肛管的位置二、常见的急腹症种类•急腹症定义•吵闹型（阵发性）急腹症•安静型（持续性）急腹症•腹痛主要位置及可能的病症1  急腹症定义         急腹症是指一组以急发腹痛为主要表现的腹部外科疾病，种类很多，表现多样，共性为临床表现变化大，进展快，延误会给病人带来严重后果。

2  吵闹型急腹症•特征表现：病人出现阵发性剧烈腹痛，大吵大闹，              翻身打滚或屈身而卧•常见病因：             肠梗阻引起肠绞痛             胆囊炎、胆结石、胆道蛔虫引起胆绞痛             肾结石和输尿管结石引起肾绞痛3  安静型急腹症•特征表现：病人平卧，静静呻吟，呼痛，不敢 随意翻身或大口呼吸，拒压腹部•主要病因：消化道炎症 胃肠穿孔 腹腔脏器出血 腹腔脏器扭转导致缺血4   腹痛主要位置及可能的病症•右上腹痛：十二指肠溃疡穿孔、急性胆囊炎、胆石 症、急性肝炎、急性腹膜炎、右膈下脓肿、右下 肺及胸膜炎症、右肾结石及肾盂肾炎等•中上腹痛：胆道蛔虫、溃疡病穿孔、胃痉挛、急性胰 腺炎、阑尾炎早期、裂孔疝、心绞痛、糖尿病、 酸中毒等4   腹痛主要位置及可能的病症•左上腹痛：急性胰腺炎、胃穿孔、脾曲综合症、 脾周围炎、脾梗死、左膈下脓肿、左下肺及胸 膜炎症、左肾结石或肾盂肾炎、心绞痛等。

•左下腹痛：左腹股沟嵌顿疝、乙状结肠扭转、痢疾、 阿米巴性结肠穿孔、结肠癌、左输尿管结石等4   腹痛主要位置及可能的病症•脐周腹痛：小肠梗阻、肠蛔虫症、小肠痉挛、阑尾 炎早期、回肠憩室炎、慢性腹膜炎、药物毒素性 腹痛等•右下腹痛：阑尾炎、盲肠炎、右腹股沟嵌顿疝、局 限性肠炎、肠系膜淋巴结炎、回肠穿孔和回肠梗 阻、肠结核、肠肿瘤、右输尿管结石等4   腹痛主要位置及可能的病症•下腹腹痛：宫外孕破裂、卵巢囊肿扭转、盆腔及 盆腔脏器炎症、盆腔脓肿、痛经、尿潴留、 膀胱炎、急性前列腺炎等三、急性肠炎•病因及发病机理•主要的临床表现•实验室检查和判断•预防与治疗1 急性肠炎病因及发病机理•误食细菌毒素：如沙门氏菌属、副溶血弧菌、幽门螺旋        杆菌、感冒病毒、肠道病毒、葡萄球菌肠毒素等；•物理性刺激：进食过热、过冷、过粗；X线照射等；•化学性刺激：过量摄入酒精、咖啡、浓茶、药品等；•机体抵抗力下降：暴饮暴食、过度疲劳、受凉等2  急性肠炎的临床表现           上腹不适、腹痛（脐周绞痛）、恶心、呕吐、糊状或水样便腹泻(数次或数十次）、发热、脱水、电解质紊乱、酸中毒、休克等。

3 急性肠炎实验室检查和判断•白细胞正常或增高•细菌培养阳性•有明显病史•典型的临床症状4  急性肠炎预防与治疗•对致病因素正确认识•一般治疗•纠正水电解质平衡•抗菌治疗•对症治疗四、阑尾炎的病因及症状•病因和发病机制•病理类型病变发展趋势•临床表现和体征•诊断与鉴别诊断•预防与治疗1   阑尾炎的病因和发病机制•梗阻：粪石、蛔虫等引起阑尾腔阻塞；                阑尾壁损伤后管腔狭窄；                阑尾壁淋巴增生使管腔狭窄；                阑尾扭曲；阑尾口炎症、受压等•其它：细菌感染；胃肠道功能紊乱；遗传因素等2   阑尾炎的病理类型病变发展趋势•单纯性阑尾炎•化脓（蜂窝织炎）性阑尾炎•穿孔（坏疽）性阑尾炎2   阑尾炎的病理类型病变发展趋势•炎症消散•感染局限•感染扩散3  阑尾炎的临床表现和体征•腹痛：部位、特点、缓解及意义•胃肠道症状：恶心、呕吐、便秘或腹泻•全身症状：疲乏、无力、头痛、头晕、发烧3  阑尾炎的临床表现和体征•步态缓慢、上身前屈偏患侧、手扶患部•腹部压痛、反跳痛、腹肌紧张•腹部包块4  阑尾炎的诊断与鉴别诊断•转移性右下腹痛•固定压痛区和不同程度的腹膜刺激征•实验室检查4  阑尾炎的诊断与鉴别诊断•回盲部疾病：急性肠系膜淋巴结炎、局限性回肠炎、                             Meckel憩室炎。

•盆腔部疾病：宫外孕破裂、卵巢囊肿扭转•右上腹疾病：溃疡病穿孔、急性胆囊炎•内科类疾病：胃肠炎、右侧胸膜炎、右下肺炎、心包炎、                            过敏性紫癜、铅中毒等5  阑尾炎的预防与治疗•饭后活动适量：•非手术治疗：卧床、禁食、补液、抗菌、                            止痛、镇静、止吐等•手术治疗：切除五、胃肠溃疡及穿孔的主要症状•消化性溃疡病因和发病部位•消化性溃疡的典型症状•消化性溃疡的并发症•胃肠溃疡穿孔的表现和危害•胃肠溃疡的预防                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 1  消化性溃疡病因和发病部位•感染：幽门螺旋杆菌感染；•非甾体类抗炎药：如阿司匹林类药物；•自体：胃液中胃酸和胃蛋白酶的消化作用；•遗传：家庭群体现象；•心理：长期精神紧张、焦虑、情绪波动人群易感；•其他：吸烟、饮食、病毒感染等。

1  消化性溃疡病因和发病部位•好发：男性：女性 == 3-8：1•部位：胃、十二指肠、食管下段、Meckel憩室； 99%发生在胃和十二指肠•年龄：20—50岁2  胃肠溃疡的典型症状•疼痛：部位、程度和性质、节律性、周期性•其他：反酸、嗳气、烧心、上腹饱胀、恶心、                呕吐、食欲减退等•体征：上腹局部压痛、贫血、体质瘦弱•胃镜检查所见（溃疡图片）胃镜下的胃溃疡胃镜下的胃溃疡胃镜下的十二指肠溃疡胃镜下的十二指肠溃疡3  消化性溃疡的并发症•上消化道出血•穿孔•幽门梗阻•癌变4  胃肠溃疡穿孔的表现和危害•穿孔率：1-2%（18%）；有些病人有诱因•剧烈腹痛（自上腹沿到脐周）•导致急性弥漫性腹膜炎•腹膜刺激症状和气腹征•休克症状5  胃肠溃疡的预防 •注意精神情绪•锻炼身体，增强体质•良好的饮食习惯。