大肠梗阻

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最后审阅: 29 Aug 2024
最后更新: 31 Jan 2023

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
完整详情

其他诊断因素

  • 里急后重
完整详情

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
完整详情

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)
完整详情

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
完整详情

治疗流程

初步治疗

疑似或即将发生的穿孔

急症处理

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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    更多 操作视频
  • 患者教育信息

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    更多 患者教育信息
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