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Chiratidzo chaMurphy, Charcot's triad… pfupiso yezviratidzo zvakajairika (zvirwere) mugastroenterology!

1. Hepatojugular reflux chiratidzo

Kana kutadza kwemoyo wekurudyi kuchikonzera kusangana kwechiropa uye kuzvimba, chiropa chinogona kudzvanywa nemaoko kuita kuti tsinga dzejugular dzinyanye kunyungudika. Zvikonzero zvinonyanyozivikanwa ndezvekushaya ventricular insufficiency uye congestion hepatitis.

2.Chiratidzo chaCullen

Iyo inozivikanwawo sechiratidzo cheCoulomb, yepepuru-blue ecchymosis paganda rakatenderedza guvhu kana kuzasi kweguvhu madziro chiratidzo chekubuda ropa mukati memudumbu, izvo zvinowanzoitika mukudzoka kweropa retroperitoneal, acute hemorrhagic necrotizing pancreatitis, kuputika kweabdominal aortic aneurysm, nezvimwe.

3.Grey-Turner chiratidzo

Kana murwere aita pancreatitis yakaoma, muto wepancreatic unopfachukira munzvimbo yechiuno nechiuno, ichinyungudutsa mafuta ari pasi peganda, uye macapillaries anotsemuka uye kubuda ropa, zvichikonzera bluish-purple ecchymosis paganda munzvimbo idzi, iyo inonzi Grey-Turner's. sign.

4.Courvoisier sign

Kana kenza yemusoro wepancreas ikamanikidza iyo yakajairika bile duct, kana kenza yepakati nepasi zvikamu zve bile duct ichikonzera kuvharika, zviri pachena jaundice inoitika. Gall bladder yakazvimba iyo ine cystic, isiri-nyoro, ine nzvimbo yakatsetseka uye inogona kufambisa inonzwika, inodaidzwa kuti Courvoisier's sign, inozivikanwawo sekuvharirwa kunoenderera mberi kwe common bile duct. levy.

5.Peritoneal irritation sign

Kuvapo panguva imwe chete yehunyoro, kunyorova uye kushushikana kwemhasuru mudumbu kunonzi peritoneal irritation sign, inozivikanwawo se peritonitis triad. Icho chiratidzo chechiratidzo che peritonitis, kunyanya nzvimbo yeronda rekutanga. Iyo nzira yekushushikana kwetsandanyama yemudumbu zvinoenderana nechikonzero uye mamiriro emurwere. Mamiriro ehuzhinji anosiyana, uye kuwedzera kwedumbu redumbu chiratidzo chakakosha chekuipa mamiriro.

6.Murphy chiratidzo

Chiratidzo chakanaka cheMurphy chimwe chezviratidzo zvakakosha mukuongororwa kwekliniki yeacute cholecystitis. Pakupuruzira gallbladder pazasi perudyi, gallbladder yakazvimba yakabatwa uye murwere akakumbirwa kuti afemere zvakadzika. Gallbladder yakazvimba nekuzvimba yakafamba ichidzika. Murwere akanzwa marwadzo achiwedzera uye akaerekana abata mweya wake.

7.Chiratidzo chaMcburney

Hunyoro uye kudzoreredza kunyorova panzvimbo yeMcBurney mudumbu rezasi rekurudyi (kusangana kweguvhu nepakati nekunze 1/3 yekurudyi anterior superior iliac musana) zvinowanzoitika muacute appendicitis.

8.Charcot's triad

Acute obstructive suppurative cholangitis inowanzoitika nekurwadziwa mudumbu, kutonhora, kupisa kwakanyanya, uye jaundice, inozivikanwawo seChaco's triad.

1) Marwadzo emudumbu: Inoitika pasi pechirongwa chexiphoid uye nechekurudyi chepamusoro quadrant, kazhinji colic, nekurwisa kweparoxysmal kana kurwadziwa kunoramba kuripo nekuwedzera kweparoxysms, iyo inogona kupenya kufudzi rekurudyi uye kumashure, pamwe chete nekunyunyuta uye kurutsa. Inowanzotangwa mushure mekudya chikafu chine mafuta.

2) Chills uye fever: Mushure me bile duct kuvharwa, kudzvanywa mukati me bile duct kunowedzera, kazhinji zvichikonzera hutachiona hwechipiri. Utachiona uye chepfu zvinogona kuyerera zvichidzokera muropa kuburikidza necapillary bile ducts uye hepatic sinusoids, zvichikonzera biliary chiropa abscess, sepsis, septic shock, DIC, nezvimwewo, kazhinji inotaridza sefivha inopera, nekupisa kwemuviri kwakakwira kusvika 39 kusvika 40 °. C.

3) Jaundice: Mushure mekunge matombo avhara bile duct, varwere vanogona kugadzira weti yakasviba yero uye kusvibiswa kweyero paganda uye sclera, uye vamwe varwere vanogona kusangana neganda.

9.Reynolds (Renault) zviratidzo zvishanu

Kusungwa kwedombo hakurerutsirwe, kuzvimba kunowedzera, uye murwere anotanga kusagadzikana kwepfungwa uye kuvhunduka kunobva pautatu hwaCharcot, hunodaidzwa kuti Raynaud's pentalogy.

10.Chiratidzo cheKehr

Ropa mudumbu remudumbu rinokurudzira diaphragm yekuruboshwe, zvichikonzera marwadzo epafudzi rekuruboshwe, izvo zvinowanzoitika mukuputika kwesplenic.

11. Obturator chiratidzo (obturator internus muscle test)

Murwere akanga ari panzvimbo yepamusoro, nehudyu yekurudyi uye chidya zvakanyunguduka uye zvino zvisingatauriki zvichitenderera mukati, zvichikonzera marwadzo ezasi mudumbu, izvo zvinoonekwa mu appendicitis (appendix iri pedyo ne obturator internus muscle).

12. Chiratidzo cheRovsing (colon inflation test)

Murwere ari panzvimbo ye supine, neruoko rwake rworudyi ruchimanikidzira kuruboshwe rwezasi kwedumbu uye ruoko rwake rworuboshwe ruchisvina proximal colon, zvichikonzera marwadzo mudumbu rezasi rekurudyi, rinoonekwa mu appendicitis.

13.X-ray barium kushatirwa chiratidzo

Barium inoratidza zviratidzo zvekutsamwa muchikamu chemukati chechirwere, nekukurumidza kubvisa uye kuzadza kusina kunaka, apo kuzadza kwakanaka muzvikamu zvepamusoro uye nechepasi mumatumbo. Izvi zvinonzi X-ray barium irritation sign, iyo inowanzoitika kune varwere vane ulcerative intestinal tuberculosis. .

14. Chiratidzo che halo kaviri/chiratidzo chechinangwa

Muchikamu chinoshanda cheCrohn's disease, iyo yakagadziridzwa CT enterography (CTE) inoratidza kuti rusvingo rwemukati rwakanyanya kusimba, mucosa yemukati inowedzerwa zvakanyanya, chikamu chemadziro emukati chinoparadzaniswa, uye mhete yemukati mucosal uye yekunze serosa mhete zvakanyanya. yakawedzerwa, ichiratidza halo mbiri. chiratidzo kana chiratidzo chechinangwa.

15. Muzinga wemapuranga chiratidzo

Muchikamu chekushanda cheCrohn's disease, CT enterography (CTE) inoratidza kuwedzera kweropa re mesenteric, zvichienderana nekuwedzera mesenteric mafuta density uye blurring, uye mesenteric lymph node kuwedzera, kuratidza "chiratidzo chemuti wemuti".

16. Enterogenic azotemia

Mushure mekubuda ropa kukuru muchikamu chepamusoro chegumbo, zvigadzirwa zvekugaya zvemapuroteni eropa zvinonyudzwa mumatumbo, uye kuwanda kwe urea nitrogen muropa kunogona kuwedzera kwechinguva, iyo inonzi enterogenic azotemia.

17.Mallory-Weiss syndrome

Chikuru chekiriniki kuratidzwa kwechirwere ichi kunowedzera kamwe kamwe mumukati-mudumbu kumanikidzwa nekuda kwekunyanya kuda kurutsa, kurutsa uye zvimwe zvikonzero, izvo zvinokonzeresa kubvarura kwenguva refu yemucosa uye submucosa ye distal cardiac cardia uye gurokuro, nekudaro zvichikonzera kubuda kwepamusoro mudumbu. Iwo maratidziro makuru akaerekana Acute hematemesis, inotungamirwa nekudzokorora kudzokorora kana kurutsa, inonziwo esophageal uye cardia mucosal tear syndrome.

18. Zollinger-Ellison syndrome (gastrinoma, Zollinger-66Ellison syndrome)

Imhando ye gastroenteropancreatic neuroendocrine tumor inoratidzwa nemaronda akawanda, atypical locations, sceptibility to ulcer complications, uye kutadza kupindura kune nguva dzose anti-ulcer drugs. Diarrhea, high gastric acid secretion, uye kukwirira kweropa gastrin mazinga anogona kuitika. kumusoro.

Gastrinomas kazhinji idiki, uye inosvika 80% inowanikwa mukati me "gastrinoma" triangle (kureva, kusangana kwe gallbladder uye common bile duct, yechipiri nechitatu zvikamu zve duodenum, uye mutsipa nemuviri wepancreas). Mukati megonyonhatu yakaumbwa nepanobatanidzwa), inopfuura 50% yegastrinomas ine hutsinye, uye vamwe varwere vane metastasized pavakawanikwa.

19. Dumping syndrome

Mushure me subtotal gastrectomy, nekuda kwekurasikirwa kwebasa rekutonga kwepylorus, mukati megastric inodururwa nekukurumidza, zvichikonzera kutevedzana kwezviratidzo zvekiriniki zvinonzi dumping syndrome, iyo inowanzoitika muPII anastomosis. Maererano nenguva iyo zviratidzo zvinoonekwa mushure mekudya, zvakakamurwa kuva marudzi maviri: kutanga uye kunonoka.

●Early dumping syndrome: Zviratidzo zvechinguva chidiki diki zvakadai sekurwadziwa nemwoyo, kudikitira, kupera simba, uye kucheneruka kweganda zvinoonekwa papera hafu yeawa mushure mekudya. Inoperekedzwa nekusvotwa uye kurutsa, dumbu remudumbu, uye manyoka.

●Late dumping syndrome: inoitika maawa maviri kusvika ku4 mushure mekudya. Chiratidzo chikuru idzungu, ruvara rwakacheneruka, dikita rinotonhora, kuneta, uye kukurumidza kurova. Iyo nzira ndeyokuti mushure mokunge chikafu chichipinda mumatumbo, chinokurudzira huwandu hwakawanda hwe insulin secretion, iyo inotungamirira kune reactive hypoglycemia. Inonziwo hypoglycemia syndrome.

20. Absorptive dystrophy syndrome

Ikiriniki syndrome umo kudya kunoshaikwa nekuda kwekusashanda kwemukati mudiki mukugaya uye kutora chikafu, zvichiita kuti chikafu chisakwanise kubatwa zvakajairika uye kubuda mutsvina. Mukiriniki, inowanzo ratidza semanyoka, mutete, anorema, ane mafuta uye zvimwe zviratidzo zvekutora mafuta, saka inonziwo steatorrhea.

21.PJ chirwere (pigmented polyposis syndrome, PJS)

Iyo isingawanzo autosomal dominant tumor syndrome inoratidzwa neganda uye mucosal pigmentation, akawanda hamartomatous polyps mudumbu turakiti, uye bundu susceptibility.

PJS inoitika kubva paudiki. Sezvo varwere vachikura, mapolyps emudumbu anowedzera zvishoma nezvishoma uye anowedzera, zvichikonzera matambudziko akasiyana-siyana, akadai se intussusception, kuvhara kwematumbo, kubuda ropa mudumbu, kenza, kushaya zvokudya zvinovaka muviri, uye kuderera kwekukura kwevana.

22. Abdominal compartment syndrome

Kumanikidzwa kwemukati-mudumbu kwemunhuwo zvake kuri pedyo nemhepo, 5 kusvika 7 mmHg.

Intra-abdominal pressure ≥12 mmHg is intra-abdominal hypertension, uye intra-abdominal pressure ≥20 mmHg inoperekedzwa nekukundikana kwenhengo ine chokuita ne-intra-abdominal hypertension is abdominal compartment syndrome (ACS).

Clinical zviratidzo: Murwere ane chipfuva chakaoma, kupfupika kwekufema, kunetseka kufema, uye kumhanya kwemoyo nekukurumidza. Kuputika kwepamuviri uye kukwirira kwepamusoro kunogona kufambidzana nekurwadziwa kwepamuviri, kurira kwehutu kunopera simba kana kunyangarika, etc. Hypercapnia (PaCO?> 50 mmHg) uye oliguria (urine kubuda kweawa <0.5 mL / kg) inogona kuitika mukutanga kweAACS. Anuria, azotemia, kutadza kufema uye kuderera kwemoyo kubuda kwechirwere kunoitika mune inotevera nhanho.

23. Superior mesenteric artery syndrome

Iyo inozivikanwawo se benign duodenal stasis uye duodenal stasis, nhevedzano yezviratidzo zvinokonzerwa neabnormal position ye superior mesenteric artery compressing the horizontal segment of the duodenum, zvichikonzera kuvharika kwechidimbu kana kuperera duodenum.

Inowanzoonekwa muvakadzi vakuru vane asthenic. Hiccups, kuda kurutsa, uye kurutsa zvinowanzoitika. Chinhu chakakurumbira chechirwere ichi ndechokuti zviratidzo zvine chokuita nechinzvimbo chemuviri. Kana iyo supine chinzvimbo ichishandiswa, zviratidzo zvekumanikidza zvinowedzerwa, nepo kana nzvimbo yakatenderedza, mabvi-chest chinzvimbo, kana kuruboshwe kuruboshwe, zviratidzo zvinogona kudzikiswa. .

24. Blind loop syndrome

A syndrome yemanyoka, anemia, malabsorption uye kuora muviri kunokonzerwa nekumira kwemukati memukati memukati uye kuwedzera kwebhakitiriya mumatumbo lumen. Inonyanya kuonekwa mukugadzirwa kwemapofu kana mabhegi emapofu (kureva matumbo ematumbo) mushure mekuita gastrectomy uye gastrointestinal anastomosis. Uye zvinokonzerwa ne stasis.

25. Short bowel syndrome

Zvinoreva kuti mushure mekukura kwematumbu madiki kana kubviswa nekuda kwezvikonzero zvakasiyana, iyo inobudirira yekunyura nzvimbo yeura inoderedzwa zvakanyanya, uye yakasara ura ura haugone kuchengetedza hutano hwemurwere kana kukura kwezvinodiwa zvemwana, uye zviratidzo. zvakadai semanyoka, acid-base/water/electrolyte disorders, uye syndromes inodzorwa nekukanganisika kwekutora uye metabolism yezvakasiyana zvinovaka muviri.

26. Hepatorenal syndrome

Iyo huru yekiriniki kuratidzwa ndeye oliguria, anuria uye azotemia.

Itsvo dzemurwere dzakanga dzisina maronda akanyanya. Nekuda kweyakanyanya portal hypertension uye splanchnic hyperdynamic circulation, kuyerera kweropa kwakadzikira zvakanyanya, uye zvakasiyana-siyana zvevasodilator zvinhu zvakaita seprostaglandin, nitric oxide, glucagon, atrial natriuretic peptide, endotoxin, uye Calcium gene-inoenderana peptides haigone kuvharwa neiyo. chiropa, zvichiita kuti systemic vascular bed iwedzere; yakawanda ye peritoneal fluid inogona kukonzera kuwedzera kukuru kwemukati-mudumbu kudzvinyirira, izvo zvinogona kuderedza renal kuyerera kweropa, kunyanya renal cortex hypoperfusion, zvichiita kuti renal kukundikana.

80% yevarwere vane chirwere chinokurumidza kukura vanofa mukati memavhiki maviri. Rudzi runofambira mberi zvishoma nezvishoma rinowanzoonekwa mukiriniki, kazhinji rinoratidza nerefractory abdominal effusion uye zvishoma nezvishoma nzira yekutadza kushanda kwetsvo.

27. Hepatopulmonary syndrome

Pahwaro hwechiropa cirrhosis, mushure mekusasanganisa primary cardiopulmonary disease, dyspnea uye zviratidzo zve hypoxia zvakadai se cyanosis uye clubbing yezvigunwe (zvigunwe) zvinoonekwa, izvo zvine chekuita neintrapulmonary vasodilation uye arterial blood oxygenation dysfunction, uye kufungidzira kwakashata.

28.Mirizzi syndrome

Gallbladder neck kana cystic duct stone impaction, kana kusanganiswa ne gallbladder kuzvimba, pressure

Zvinoitika nekumanikidzira kana kukanganisa nzira yakajairika yehepatic duct, zvichikonzera kuwanda kwenyama yakapoteredza, kuzvimba kana stenosis yekazhinji hepatic duct, uye kliniki inoratidzira senhevedzano yekiriniki syndromes inoratidzirwa ne obstructive jaundice, biliary colic kana cholangitis.

The anatomical hwaro pakuumbwa kwayo ndeyekuti cystic duct uye common hepatic duct zvakanyanyorebesa pamwechete kana nzvimbo yekusangana kweiyo cystic duct uye common hepatic duct yakadzikira.

29.Budd-Chiari syndrome

Budd-Chiari syndrome, inozivikanwawo seBudd-Chiari syndrome, inoreva boka re portal hypertension kana portal uye inferior vena cava hypertension inokonzerwa nekuvharika kwehepatic vein kana inferior vena cava pamusoro pekuvhurwa kwayo. chirwere.

30.Caroli chirwere

Congenital cystic dilation ye intrahepatic bile ducts. Iyo michina haina kujeka. Inogona kunge yakafanana necholedochal cyst. Chiitiko checholangiocarcinoma chakakura kudarika chehuwandu hwevanhu. Zviratidzo zvekutanga zvekiriniki ndeye hepatomegaly uye marwadzo emudumbu, zvakanyanya senge biliary colic, yakaoma nebhakitiriya bile duct chirwere. Fever uye intermitten jaundice inoitika panguva yekuzvimba, uye chiyero chejaundice chinowanzo nyoro.

31. Puborectal syndrome

Chirwere chetsvina chinokonzerwa nekuvharika kwepilvic floor yekubuda nekuda kwekutsemuka kana hypertrophy ye puborectalis muscles.

32. Pelvic floor syndrome

Inoreva boka rema syndromes anokonzerwa neuromuscular abnormalities mu pelvic floor structures kusanganisira rectum, levator ani muscle, uye kunze kweanal sphincter. Makiriniki makuru anoratidza kuoma kwetsvina kana incontinence, pamwe nepelvic floor pressure uye kurwadziwa. Aya dysfunctions dzimwe nguva anosanganisira kunetseka kuita tsvina, uye dzimwe nguva fecal incontinence. Muzviitiko zvakanyanya, zvinorwadza zvakanyanya.

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Nguva yekutumira: Sep-06-2024