腹痛李海.ppt

9.急性心肌梗塞 见于中老年人，梗塞的部位如在膈面，尤其面积较大者多有上腹部痛。其痛多在劳累、紧张或饱餐后突然发作，呈持续性绞痛，并向左肩或双臂内侧部位放射。常伴恶心，可有休克。体征检查时上腹部或有轻度压痛、无肌紧张和反跳痛，但心脏听诊多有心律紊乱。作心电图检查可以确诊本病。 10.铅中毒 见于长期接触铅粉尘或烟尘的人，偶尔亦见由误服大量铅化合物起者。铅中毒有急性与慢性之分。但无论急性、慢性，阵发性腹绞痛则为其特征。其发作突然，多在脐周部。常伴腹胀、便秘及食欲不振等。检查时腹部体征有不明显，无固定压痛点，肠鸣音多减弱。此外，齿龈边缘可见铅线，为铅中毒特征性体征。周围血中可见嗜碱性点彩红细胞，血铅和尿铅的增高可以确立诊断。 * * 1.??????? Quality and severity: perforation with severe dull pain over upper abdomen. It is steady and aching in character. Moreover, the intensity of the pain is dependent on the type and amount of foreign substance to which the peritoneal surfaces are exposed in a given period of time. For example, sterile acid gastric juice causes much more pain than the same amount of grossly contaminated neutral fecal material. Renal colic with severe pain over back radiating to lower abdomen. The pain of obstruction of hollow abdominal viscera is classically described as intermittent, or colicky. The colicky pain of obstruction of the small intestine is usually periumbilical or supraumbilical and is poorly localized. Sudden distention of the biliary tree produces a steady rather than colicky type; hence the term biliary colic is misleading. Pain associated with intraabdominal vascular disturbances is sudden and catastrophic in nature. Pain arising from the abdominal wall is usually constant and aching. * 1.??????? Quality and severity: perforation with severe dull pain over upper abdomen. It is steady and aching in character. Moreover, the intensity of the pain is dependent on the type and amount of foreign substance to which the peritoneal surfaces are exposed in a given period of time. For example, sterile acid gastric juice causes much more pain than the same amount of grossly contaminated neutral fecal material. Renal colic with severe pain over back radiating to lower abdomen. The pain of obstruction of hollow abdominal viscera is classically described as intermittent, or colicky. The colicky pain of obstruction of the small intestine is usuall