小结
定义
病史和体格检查
关键诊断因素
- 便秘/排气或排便停止
- 危险因素
- 间歇性腹痛
- 呕吐
- 腹胀
- 腹部压痛
- 腹部肿块
- 可触及的直肠肿块
- 腹膜炎
其他诊断因素
- 发热
- 恶心(伴或不伴呕吐)
- 心动过速
- 腹股沟肿胀
危险因素
- 既往腹部手术史
- 肠旋转不良
- 克罗恩病
- 疝
- 阑尾炎
- 肠道恶性肿瘤
- 肠套叠
- 肠扭转
- 肠扭转
- 摄入异物
诊断性检查
首要检查
- 计算机体层成像
- 水溶性造影剂检查
- 动脉血气(包括乳酸)
- 全血细胞计数
- 电解质
- C 反应蛋白
- 尿素氮/肌酐比值
- 血清脂肪酶或者淀粉酶
- 葡萄糖
- 凝血、血型鉴定和不规则抗体筛查(group and save),或交叉配血
需考虑的检查
- 尿液或血清 β–人绒毛膜促性腺激素(human chorionic gonadotrophin, HCG)
- 尿液分析
- 心电图(ECG)
- 磁共振成像 (magnetic resonance imaging, MRI)
治疗流程
完全性或复杂性小肠梗阻:适合手术治疗
完全性或复杂性小肠梗阻:不适合手术治疗
不完全性小肠梗阻或无并发症的完全性小肠梗阻
撰稿人
专家顾问
John Abercrombie, FRCS
General and Colorectal Surgeon
Queen’s Medical Centre
Nottingham
UK
简介
JA is Clinical Lead for General Surgery, Getting It Right First Time.
利益声明
JA is trustee and council member of the Royal College of Surgeons of England.
Neena Randhawa, BSc (Hon), MSc, MBChB, FRCS
Consultant Colorectal Surgeon
Royal Victoria Infirmary
Newcastle-upon-Tyne
UK
利益声明
NR declares she has no competing interests.
鸣谢
BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work is retained in parts of the content:
John T. Jenkins MD
Consultant Colorectal Surgeon
Department of Coloproctology
St. Mark's Hospital
London
UK
Disclosures: JTJ declares that he has no competing interests.
Edward T. Pring BSc(Hons), MBChB, MRCS
Surgical Registrar and Clinical Research Fellow
St. Mark's Hospital
London
UK
Disclosures: ETP declares that he has no competing interests.
George Malietzis
MBBS, MSc, MRCS
Honorary Clinical Lecturer
Department of Surgery and Cancer
Imperial College London
UK
Disclosures: GM declares that he has no competing interests.
同行评议者
Malcolm McFall, FRCS
Consultant Colorectal Surgeon
Western Sussex Hospitals NHS Foundation Trust
Chichester
West Sussex
UK
利益声明
编辑
Emma Quigley
Section Editor, BMJ Best Practice
利益声明
EQ declares that she has no competing interests.
Tannaz Aliabadi-Oglesby
Lead Section Editor, BMJ Best Practice
利益声明
TAO declares that she has no competing interests.
Anna Ellis
Head of Editorial, BMJ Best Practice
利益声明
AE declares that she has no competing interests.
Julie Costello
Comorbidities Editor, BMJ Best Practice
利益声明
JC declares that she has no competing interests.
Adam Mitchell
Drug Editor, BMJ Best Practice
利益声明
AM declares that he has no competing interests.
Sue Mayor
Lead Section Editor, BMJ Best Practice
利益声明
SM works as a freelance medical journalist and editor, video editorial director and presenter, and communications trainer. In this capacity, she has been paid, and continues to be paid, by a wide range of organisations for providing these skills on a professional basis. These include: NHS organisations, including NICE, NHS Choices, NHS Kidney Care, and others; publishers and medical education companies, including the BMJ Group, the Lancet group, Medscape, and others; professional organisations, including the British Thoracic Oncology Group, the European Society for Medical Oncology, NCEPOD, and others; charities and patients’ organisations, including the Roy Castle Lung Cancer Foundation and others; pharmaceutical companies, including Bayer, Boehringer Ingelheim, Novartis, and others; and communications agencies, including Publicis, Red Healthcare, and others. She has no stock options or shares in any pharmaceutical or healthcare companies; however, she invests in a personal pension, which may invest in these types of companies. She is managing director of Susan Mayor Limited, the company name under which she provides medical writing and communications services.
鉴别诊断
- 肠梗阻
- 感染性胃肠炎
- 大肠梗阻
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