WAY DIFFERENTIAL DIAGNOSIS forms of acute intestinal obstruction

摘要

1.a differential diagnosis of forms of acute u0442u043eu043du043au043eu043au0438u0448u0435u0447u043du043eu0439 obstruction, including identification of the patient with a clinical picture of acute u0442u043eu043du043au043eu043au0438u0448u0435u0447u043du043eu0439 n u0435u043fu0440u043eu0445u043eu0434u0438u043cu043eu0441u0442u0438 the following indicators: time from u0437u0430u0431u043eu043bu0435u0432u0430u043du0438u00a0; number of history; naturethe intensity and u043bu043eu043au0430u043bu0438u0437u0430u0446u0438u00a0 pain; muscle u043du0430u043fu0440u00a0u0436u0435u043du0438u0435 anterior abdominal wall; the number of white blood cell count, blood ph, partial pressure of carbon dioxide in blood; dia feet of small intestine and expression of each of these symptoms in the balls.at this time u043fu043eu0441u0442u0443u043fu043bu0435u043du0438u00a0 value as follows: upon admission, the patient in less than 12 hours from the beginning of the u0437u0430u0431u043eu043bu0435u0432u0430u043du0438u00a0 this figure of 1.5 points, p ri is received at the time of 13 to 24 h from the beginning of u0437u0430u0431u043eu043bu0435u0432u0430u043du0438u00a0 "- 1 u0431u0430u043bu043bu00bb, upon over 25 h from the beginning of u0437u0430u0431u043eu043bu0435u0432u0430u043du0438u00a0" - 2 u0431u0430u043bu043bu0430u00bb; the number of operations in history what there is as follows: in the absence of - 3.5 u0431u0430u043bu043bu0430u00bb,in the presence of a single operation - "1 u0431u0430u043bu043bu00bb, subject to the availability of two" - 1.5 u0431u0430u043bu043bu0430u00bb, with three operations - "- 2 u0431u0430u043bu043bu0430u00bb, over four operations" - 3 u0431u0430u043bu043bu0430u00bb; the nature of the pain of u0446u0435u043du0438u0432u0430u044eu0442 as follows: if there is a labor "- 2.5 u0431u0430u043bu043bu0430u00bb in u043fu043eu0441u0442u043eu00a0u043du043du044bu0445 u0431u043eu043bu00a0u0445" 4.5 u0431u0430u043bu043bu0430u00bb; the intensity of pain is as follows: when expressed u0431u043eu043bu00a0 x "3.5 u0431u0430u043bu043bu0430u00bb,at moderate u0431u043eu043bu00a0u0445 "- 1 u0431u0430u043bu043bu00bb; localization of pain is as follows: in the u0431u043eu043bu00a0u0445 all over her stomach" - 1.5 u0431u0430u043bu043bu0430u00bb in localized u0431u043eu043bu00a0u0445 "1.5 u0431u0430u043bu043bu0430u00bb; a m u044bu0448u0435u0447u043du043eu0433u043e u043du0430u043fu0440u00a0u0436u0435u043du0438u00a0 worth 5 points; the absence of muscle u043du0430u043fu0440u00a0u0436u0435u043du0438u00a0 worth 0 points; white blood cells blood less 5109 / l value in the 4.5 u0431u0430u043bu043bu0430u00bb blood on white blood cells t 5109 to 7109 "- 2.5 u0431u0430u043bu043bu0430u00bb from 8109 to 10109" - 3 u0431u0430u043bu043bu0430u00bb,white blood cell of blood of 11109 to 13109 "1.5 u0431u0430u043bu043bu0430u00bb, white blood cell of blood of 14109 and above - 5 u0431u0430u043bu043bu043eu0432u00bb; ph of blood were as follows: ph less than 7.3 -" 3 u0431u0430u043bu043bu0430u00bb, ph from 7.3 to 7,39 - 1 point "the ph of 7.4 or above" - 2 u0431u0430u043bu043bu0430u00bb; partial pressure of carbon dioxide u043du0430u043fu0440u00a0u0436u0435u043du0438u0435 blood is as follows: the value of the u043fu043eu043au0430u0437u0430u0442u0435u043bu00a0 less than 30 mm u0440u0442.u0441u0442. "6 u0431u0430u043bu043bu043eu0432u00bb, from 30 to 43 mm u0440u0442.u0441u0442.- "0 u0431u0430u043bu043bu043eu0432u00bb, over 44 mm u0440u0442.u0441u0442."1.5 u0431u0430u043bu043bu0430u00bb; the diameter of the small intestine are as follows: the diameter of 45 mm - 0 u0431u0430u043bu043bu043eu0432u00bb from 46 to 80 mm - 1 u0431u0430u043bu043bu00bb, more than 80 mm, 8 u0431u0430u043bu043bu043eu0432u00bb, further u0441u0443u043cu043cu0438u0440u0443u044eu0442 scores of all dr. u0435u0441u00a0u0442u0438 evaluated indicators and establish the u043eu0431u0442u0443u0440u0430u0446u0438u043eu043du043du0443u044e form acute u0442u043eu043du043au043eu043au0438u0448u0435u0447u043du043eu0439 obstruction if the sum of the points u0441u043eu0441u0442u0430u0432u043bu00a0u0435u0442 less "3" and u0441u0442u0440u0430u043du0433u0443u043bu00a0u0446u0438u043eu043du043d gear form of acute u0442u043eu043du043au043eu043au0438u0448u0435u0447u043du043eu0439 blockage.if the sum of the points u0441u043eu0441u0442u0430u0432u043bu00a0u0435u0442 more than 3 points.;2. method for u043eu0442u043bu0438u0447u0430u044eu0449u0438u0439u0441u00a0 1, so that the diameter of the small intestine u043eu043fu0440u0435u0434u0435u043bu00a0u0435u0442 u0440u0435u043du0442u0433u0435u043du043eu043bu043eu0433u0438u0447u0435u0441u043au0438.;3. method for p.1, u043eu0442u043bu0438u0447u0430u044eu0449u0438u0439u0441u00a0 so that, when the amount of points from the "3" and 3 u043fu043eu0432u0442u043eu0440u00a0u044eu0442 definition of patient amount of points as shown above in 4 to 6 hours after the initial u0438u0441u0441u043bu0435u0434u043eu0432u0430u043du0438u00a0 and u043fu0440u043eu0432u0435u0434u0435u043du0438u00a0 complex conservative u043cu0435u0440u043eu043fu0440u0438u00a0u0442u0438u0439, aimed at resolving the acute u0442u043eu043du043au043eu043au0438u0448u0435u0447u043du043eu0439 blockage with a score of less than 3 is again u0441u0442u0430u043du0430u0432u043bu0438u0432u0430u044eu0442 u043eu0431u0442u0443u0440u0430u0446u0438u043eu043du043du0443u044e form acute u0442u043eu043du043au043eu043au0438u0448u0435u0447u043du043eu0439 blockage.the score of more than 3 u0441u0442u0440u0430u043du0433u0443u043bu00a0u0446u0438u043eu043du043du0443u044e form, and when the amount of points from the "3" and 3 establish the risk u0440u0430u0437u0432u0438u0442u0438u00a0 u0441u0442u0440u0430u043du0433u0443u043bu00a0u0446u0438u0438 and u043eu043fu0440u0435u0434u0435u043bu00a0u044eu0442 u043fu043eu043au0430u0437u0430u043du0438u00a0 the u0434u0438u0430u0433u043d u043eu0441u0442u0438u0447u0435u0441u043au043eu0439 of laparoscopy.;4. method for p.1, u043eu0442u043bu0438u0447u0430u044eu0449u0438u0439u0441u00a0 so that, when the amount of points from the "3" and 3 patients additionally u043fu0440u043eu0432u043eu0434u00a0u0442 ultrasound investigation of intestinal blood flow and in the maxim u043bu044cu043du043eu0439 u0441u0438u0441u0442u043eu043bu0438u0447u0435u0441u043au043eu0439 speed of blood flow of up to 9 cm / s u0434u0438u0430u0433u043du043eu0441u0442u0438u0440u0443u044eu0442 u0441u0442u0440u0430u043du0433u0443u043bu00a0u0446u0438u043eu043du043du0443u044e form acute u0442u043eu043du043au043eu043au0438u0448u0435u0447u043du043eu0439 blockage.and with a maximum speed of blood flow from 9 to 18 cm / s u0434u0438u0430u0433u043du043eu0441u0442u0438u0440u0443u044eu0442 u043eu0431u0442u0443u0440u0430u0446u0438u043eu043du043du0443u044e form acute u0442u043eu043du043au043eu043au0438u0448u0435u0447u043du043eu0439 blockage.