小结
定义
病史和体格检查
关键诊断因素
- 间歇性腹痛
- 腹胀
- 恶心
- 呕吐
- 大便习惯改变
- 存在的危险因素
- 硬便
- 软便
- 空直肠
- 近期体重减轻
- 直肠出血
- 可触及的直肠肿块
- 可触及腹部包块
- 腹部鼓胀
- 发热
- 腹部压痛
- 腹部强直
其他诊断因素
- 里急后重
危险因素
- 结直肠腺瘤或息肉
- 当前或既往患恶性肿瘤
- 炎症性肠病
- 憩室病
- 当前或既往患疝
- 妇科疾病
- 糖尿病
- 既往腹部手术史
- 放疗既往史
- 肠癌家族史
- 年龄
- 男性
- 肥胖
- 巨结肠
- 泻药滥用
- 饮食
- 饮酒
- 吸烟
诊断性检查
首要检查
- 计算机断层扫描
- 全血细胞计数
- 电解质
- C 反应蛋白
- 尿素氮/肌酐比值
- 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
- 动脉血气(包括乳酸)
需考虑的检查
- β-人绒毛膜促性腺激素
- 尿液分析
- 心电图
- 水溶性造影剂检查
- 下消化道内镜或软式乙状结肠镜检查
治疗流程
疑似或即将发生的穿孔
恶性肿瘤
肠扭转
良性狭窄
憩室病
正在接受缓和医疗(亦称为安宁疗护)
撰稿人
专家顾问
John Abercrombie, FRCS
General and Colorectal Surgeon
Queen’s Medical Centre
Nottingham
UK
利益声明
JA is a member of the Council of the Royal College of Surgeons of England and Clinical Lead for General Surgery, Getting It Right First Time. JA provides expert advice regarding suitability of surgical treatments for Spire Healthcare.
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:
George Malietzis, MBBS, MSc, MRCS
Colorectal Registrar
Department of Coloproctology
St Mark's Hospital
London
UK
John T. Jenkins, MD
Consultant Colorectal Surgeon
Department of Coloproctology
St. Mark's Hospital
London
UK
同行评议者
Ceri Beaton, BMedsci, BMBS, MSc, FRCS
Consultant Colorectal and General Surgeon
North Devon Healthcare NHS Trust
Devon UK
利益声明
CB declares that she has no competing interests.
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.
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.
Annabel Sidwell
Comorbidities Editor, BMJ Best Practice
利益声明
AS 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.
鉴别诊断
- 急性结肠假性梗阻
- 慢性/特发性巨结肠
- 中毒性巨结肠
更多 鉴别诊断指南
- 结直肠癌
- 调试指南:急诊普外科(急性腹痛)
更多 指南Videos
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大肠梗阻
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