警惕:莫将急腹症误诊为阑尾炎!

2017-11-09 Ryder 基层医师公社

急腹症的突出表现是急性腹痛,在疾病分布及症状上与阑尾炎极为相似。而阑尾炎是外科最常做的手术,占基层医院急诊手术首位。一般成年人急性阑尾炎诊断多无困难,但遇到婴幼儿、老年人及妊娠妇女患急性阑尾炎时,诊断和治疗均应引起高度重视。

急腹症的突出表现是急性腹痛,在疾病分布及症状上与阑尾炎极为相似。而阑尾炎是外科最常做的手术,占基层医院急诊手术首位。一般成年人急性阑尾炎诊断多无困难,但遇到婴幼儿、老年人及妊娠妇女患急性阑尾炎时,诊断和治疗均应引起高度重视。

小编将急腹症和阑尾炎临床诊断上要注意的要点做一些整理和归纳,分享给大家。

询问病史

病史对急腹症与阑尾炎的诊断和鉴别诊断非常重要,在询问病人病情的时候须着重了解以下情况:

一问  腹痛发作情况

包括诱发腹痛的原因、缓急、症状出现的先后次序和演变过程。

二问  腹痛性质

持续性钝痛或隐痛,一般为腹腔炎症或腹腔出血刺激腹膜所致;阵发性绞痛一般是腔道阻塞后痉挛收缩的结果;持续性疼痛、阵发性加剧的腹痛,多为炎症和梗阻并存。

三问  腹痛程度

疼痛较轻微、可以忍受的情况多为急性炎症性病变引起的腹痛,如部分急性阑尾炎患者;疼痛剧烈的情况可见于伴发腔道梗阻的患者,如梗阻性阑尾炎、胆管结石梗阻等。

四问  腹痛部位

这对病变的定位有一定参考意义,如病变性质肯定的情况下结合病变部位,一般不难确定是哪个器官的病变。

五问  伴发症状

胃肠道症状如恶心、呕吐、肛门停止排气排便是外科急腹症常有的伴发症状。

六问  既往病史

有慢性溃疡病史者突发上腹部剧痛,应考虑溃疡穿孔的可能;有右上腹反复疼痛者,应考虑胆囊炎的可能;有腹部外伤手术炎症病史者,应考虑黏连性肠梗阻的可能;女性月经情况和阴道流血情况,有助妇科疾病的诊断。

体格检查

只因有右下腹部压痛、反跳痛就断定为急性阑尾炎是不严谨的,必须认真进行全面的体格检查再得出结论。

首先观察病人一般情况

关注病人姿态、表情。一般急性炎症情况多不严重,穿孔性腹膜炎情况紧急。腹膜炎患者常表现为屈膝、弯腰、不动;肠根阻患者表现为辗转不安、大汗淋漓;腹腔内出血病人则会出现面色苍白、表情淡漠,往往伴休克。

其次须辅助腹部检查

观察腹式呼吸有无受限,有无腹胀、肠型、蠕动波或逆蠕动;扪诊时注意腹部有无压痛、反跳痛等腹膜刺激征,同时注意疼痛部位、范围、程度;叩诊时重点注意有无肝浊音界消失和移动性浊音;听诊时注意肠鸣音是否亢进、减弱甚至消失,有无特殊的气过水声或叮铃声。所有的外科急腹症患者都应常规做直肠指检,疑似妇科疾病患者,有时须做腹壁阴道双合诊。

辅助检查

化验检查

常规检查对诊断有帮助。如感染性急腹症患者,白细胞和中性粒细胞都会增加,腹腔内出血患者连续复查红细胞和血红蛋白会出现进行性下降;尿路损伤或结石患者,尿检有红细胞;疑似胰腺炎患者,检查血、尿淀粉酶会出现明显升高。

X线检查

疑似穿孔时,胸片检查出现膈下有游离气体可确诊,但不见游离气体亦不能排除。

腹腔穿刺和灌洗

诊断性腹腔穿刺和灌洗对腹部外伤和急腹症都有特殊诊断价值,尤其在基层医院更有实际意义,阳性率92%-98%。

分析鉴别

通常情况下经过全面的病史询问和体格检查,都不难明确诊断。外科急腹症的病因都在腹部,而内科范围内的疾病即使出现急性腹痛的症状,一般不是最早或最突出的表现,或存在其他同样突出的症状。

外科急腹症出现的腹痛程度重、部位明确,有压痛且拒按,同时腹式呼吸受限或消失,有明显的腹壁压痛、反跳痛、腹肌强直、腹膜刺激征;内科腹痛程度轻、不固定、不拒按,不会有腹式呼吸消失或腹膜刺激征。

上述鉴别诊断在临床上有普遍意义,但须排除例外情况:如老年人反应迟钝,腹部压痛、反跳痛不明显,或白细胞、体温都可能正常或不升高;幼儿神经系统发育不健全,往往不严重的病变即可引起明显的全身症状,出现高热、白细胞明显升高。因此须全面看问题,首先确定患者是否为外科急腹症。

鉴别疾病性质



确定病变脏器

根据腹痛、阳性体征确定

急性炎症痛在右下腹为阑尾炎,在右上腹为胆囊炎;穿孔性腹膜炎疼痛先在上腹部开始则为胃十二指肠穿孔,在下腹部为肠穿孔;外伤性出血患者左上腹疼痛为脾破裂,右上腹疼痛为肝破裂。

根据病变特征确定

定性为腔道梗阻的患者伴肠蠕动亢进为肠根阻,伴有黄疸的病人为胆道梗阻,伴泌尿道症状和血尿者为尿道梗阻;阑尾炎有腹痛转移史,回盲部肠套叠有黏液血便史,钡剂灌肠见杯状充盈缺损可确诊。

通过以上方法尽可能多地掌握一些临床资料,进行分析对比,避免主观片面,可以极大避免急腹症的误诊和误治!

原始出处:

[1] 魏保生.外科主治医生[M].中国人口出版社,2007:83

[2] 刘杰,钟华,刘勇燕.超声在急性阑尾炎诊断中的应用价值[J].疾病监测与控制杂志,2009,3(9):559

[3] 陈洪杰.急腹症误诊为急性阑尾炎14例临床分析[J].河北医药,2011,33(1):101

[4] 王颖瑛.外科急腹症的鉴别及护理[J].中外医疗,2010.29(29):187

[5] 傅绍祥,姚万健,陈梅昆,等.妇科急腹症误诊急性阑尾炎20例分析[J].中国煤炭工业医学杂志,2010,13(2):280

[6] 汪洪林.易误诊为急性阑尾炎的妇科急腹症的诊治[J].中国医药指南,2009,7(14):87-88

[7] 李家胜.76例急腹症误诊为阑尾炎的情况分析及鉴别要点[J].深圳中西医结合杂志,2014,7(6):81-82

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (6)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1428559, encodeId=166b1428559fc, content=<a href='/topic/show?id=8d2b525354a' target=_blank style='color:#2F92EE;'>#急腹症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52535, encryptionId=8d2b525354a, topicName=急腹症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=07ae4095227, createdName=qblt, createdTime=Sat Nov 11 13:44:00 CST 2017, time=2017-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260207, encodeId=168026020e5c, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Fri Nov 10 07:59:01 CST 2017, time=2017-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260175, encodeId=d4ee2601e5f2, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo5nmIH5IQqCKjJgSCuicPWUWOUcdqt1ROPnEiaOYN4pSHibDv8la3OxNLalvuvUXn8clpJlrpuyTpckgt9OPkeSSdT/0, createdBy=8fd71930726, createdName=半夏微凉, createdTime=Fri Nov 10 06:58:32 CST 2017, time=2017-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260140, encodeId=2542260140ae, content=学习了很有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3IzoRn621JdKCFUI4XvNELcibocrAVU6aUzEVDSaf3rYH08PUYUiagGqxAEhj8g9WqqNvD1CupIpCrmnR2OrqHZh/0, createdBy=7f181365728, createdName=飛歌, createdTime=Fri Nov 10 00:44:54 CST 2017, time=2017-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260114, encodeId=d852260114c1, content=很好的文章.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Nov 09 23:59:25 CST 2017, time=2017-11-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260100, encodeId=653d2601005a, content=^_^^_^^_^^_^, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Swp2ehfHpiciczeTntUyQOlIGMzQ705ic67sdMTVMbwTv7KbmlUvxrGvRSvQZjPkz7ib5tEDfIaORgczPtmHDpwojg/0, createdBy=c54b2163125, createdName=wqkm, createdTime=Thu Nov 09 23:01:05 CST 2017, time=2017-11-09, status=1, ipAttribution=)]
    2017-11-11 qblt
  2. [GetPortalCommentsPageByObjectIdResponse(id=1428559, encodeId=166b1428559fc, content=<a href='/topic/show?id=8d2b525354a' target=_blank style='color:#2F92EE;'>#急腹症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52535, encryptionId=8d2b525354a, topicName=急腹症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=07ae4095227, createdName=qblt, createdTime=Sat Nov 11 13:44:00 CST 2017, time=2017-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260207, encodeId=168026020e5c, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Fri Nov 10 07:59:01 CST 2017, time=2017-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260175, encodeId=d4ee2601e5f2, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo5nmIH5IQqCKjJgSCuicPWUWOUcdqt1ROPnEiaOYN4pSHibDv8la3OxNLalvuvUXn8clpJlrpuyTpckgt9OPkeSSdT/0, createdBy=8fd71930726, createdName=半夏微凉, createdTime=Fri Nov 10 06:58:32 CST 2017, time=2017-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260140, encodeId=2542260140ae, content=学习了很有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3IzoRn621JdKCFUI4XvNELcibocrAVU6aUzEVDSaf3rYH08PUYUiagGqxAEhj8g9WqqNvD1CupIpCrmnR2OrqHZh/0, createdBy=7f181365728, createdName=飛歌, createdTime=Fri Nov 10 00:44:54 CST 2017, time=2017-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260114, encodeId=d852260114c1, content=很好的文章.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Nov 09 23:59:25 CST 2017, time=2017-11-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260100, encodeId=653d2601005a, content=^_^^_^^_^^_^, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Swp2ehfHpiciczeTntUyQOlIGMzQ705ic67sdMTVMbwTv7KbmlUvxrGvRSvQZjPkz7ib5tEDfIaORgczPtmHDpwojg/0, createdBy=c54b2163125, createdName=wqkm, createdTime=Thu Nov 09 23:01:05 CST 2017, time=2017-11-09, status=1, ipAttribution=)]
    2017-11-10 明月清辉

    谢谢分享.学习了

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1428559, encodeId=166b1428559fc, content=<a href='/topic/show?id=8d2b525354a' target=_blank style='color:#2F92EE;'>#急腹症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52535, encryptionId=8d2b525354a, topicName=急腹症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=07ae4095227, createdName=qblt, createdTime=Sat Nov 11 13:44:00 CST 2017, time=2017-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260207, encodeId=168026020e5c, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Fri Nov 10 07:59:01 CST 2017, time=2017-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260175, encodeId=d4ee2601e5f2, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo5nmIH5IQqCKjJgSCuicPWUWOUcdqt1ROPnEiaOYN4pSHibDv8la3OxNLalvuvUXn8clpJlrpuyTpckgt9OPkeSSdT/0, createdBy=8fd71930726, createdName=半夏微凉, createdTime=Fri Nov 10 06:58:32 CST 2017, time=2017-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260140, encodeId=2542260140ae, content=学习了很有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3IzoRn621JdKCFUI4XvNELcibocrAVU6aUzEVDSaf3rYH08PUYUiagGqxAEhj8g9WqqNvD1CupIpCrmnR2OrqHZh/0, createdBy=7f181365728, createdName=飛歌, createdTime=Fri Nov 10 00:44:54 CST 2017, time=2017-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260114, encodeId=d852260114c1, content=很好的文章.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Nov 09 23:59:25 CST 2017, time=2017-11-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260100, encodeId=653d2601005a, content=^_^^_^^_^^_^, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Swp2ehfHpiciczeTntUyQOlIGMzQ705ic67sdMTVMbwTv7KbmlUvxrGvRSvQZjPkz7ib5tEDfIaORgczPtmHDpwojg/0, createdBy=c54b2163125, createdName=wqkm, createdTime=Thu Nov 09 23:01:05 CST 2017, time=2017-11-09, status=1, ipAttribution=)]
    2017-11-10 半夏微凉

    学习了谢谢分享

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1428559, encodeId=166b1428559fc, content=<a href='/topic/show?id=8d2b525354a' target=_blank style='color:#2F92EE;'>#急腹症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52535, encryptionId=8d2b525354a, topicName=急腹症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=07ae4095227, createdName=qblt, createdTime=Sat Nov 11 13:44:00 CST 2017, time=2017-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260207, encodeId=168026020e5c, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Fri Nov 10 07:59:01 CST 2017, time=2017-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260175, encodeId=d4ee2601e5f2, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo5nmIH5IQqCKjJgSCuicPWUWOUcdqt1ROPnEiaOYN4pSHibDv8la3OxNLalvuvUXn8clpJlrpuyTpckgt9OPkeSSdT/0, createdBy=8fd71930726, createdName=半夏微凉, createdTime=Fri Nov 10 06:58:32 CST 2017, time=2017-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260140, encodeId=2542260140ae, content=学习了很有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3IzoRn621JdKCFUI4XvNELcibocrAVU6aUzEVDSaf3rYH08PUYUiagGqxAEhj8g9WqqNvD1CupIpCrmnR2OrqHZh/0, createdBy=7f181365728, createdName=飛歌, createdTime=Fri Nov 10 00:44:54 CST 2017, time=2017-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260114, encodeId=d852260114c1, content=很好的文章.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Nov 09 23:59:25 CST 2017, time=2017-11-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260100, encodeId=653d2601005a, content=^_^^_^^_^^_^, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Swp2ehfHpiciczeTntUyQOlIGMzQ705ic67sdMTVMbwTv7KbmlUvxrGvRSvQZjPkz7ib5tEDfIaORgczPtmHDpwojg/0, createdBy=c54b2163125, createdName=wqkm, createdTime=Thu Nov 09 23:01:05 CST 2017, time=2017-11-09, status=1, ipAttribution=)]
    2017-11-10 飛歌

    学习了很有用

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1428559, encodeId=166b1428559fc, content=<a href='/topic/show?id=8d2b525354a' target=_blank style='color:#2F92EE;'>#急腹症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52535, encryptionId=8d2b525354a, topicName=急腹症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=07ae4095227, createdName=qblt, createdTime=Sat Nov 11 13:44:00 CST 2017, time=2017-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260207, encodeId=168026020e5c, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Fri Nov 10 07:59:01 CST 2017, time=2017-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260175, encodeId=d4ee2601e5f2, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo5nmIH5IQqCKjJgSCuicPWUWOUcdqt1ROPnEiaOYN4pSHibDv8la3OxNLalvuvUXn8clpJlrpuyTpckgt9OPkeSSdT/0, createdBy=8fd71930726, createdName=半夏微凉, createdTime=Fri Nov 10 06:58:32 CST 2017, time=2017-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260140, encodeId=2542260140ae, content=学习了很有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3IzoRn621JdKCFUI4XvNELcibocrAVU6aUzEVDSaf3rYH08PUYUiagGqxAEhj8g9WqqNvD1CupIpCrmnR2OrqHZh/0, createdBy=7f181365728, createdName=飛歌, createdTime=Fri Nov 10 00:44:54 CST 2017, time=2017-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260114, encodeId=d852260114c1, content=很好的文章.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Nov 09 23:59:25 CST 2017, time=2017-11-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260100, encodeId=653d2601005a, content=^_^^_^^_^^_^, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Swp2ehfHpiciczeTntUyQOlIGMzQ705ic67sdMTVMbwTv7KbmlUvxrGvRSvQZjPkz7ib5tEDfIaORgczPtmHDpwojg/0, createdBy=c54b2163125, createdName=wqkm, createdTime=Thu Nov 09 23:01:05 CST 2017, time=2017-11-09, status=1, ipAttribution=)]
    2017-11-09 清风拂面

    很好的文章.谢谢分享

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1428559, encodeId=166b1428559fc, content=<a href='/topic/show?id=8d2b525354a' target=_blank style='color:#2F92EE;'>#急腹症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52535, encryptionId=8d2b525354a, topicName=急腹症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=07ae4095227, createdName=qblt, createdTime=Sat Nov 11 13:44:00 CST 2017, time=2017-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260207, encodeId=168026020e5c, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Fri Nov 10 07:59:01 CST 2017, time=2017-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260175, encodeId=d4ee2601e5f2, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo5nmIH5IQqCKjJgSCuicPWUWOUcdqt1ROPnEiaOYN4pSHibDv8la3OxNLalvuvUXn8clpJlrpuyTpckgt9OPkeSSdT/0, createdBy=8fd71930726, createdName=半夏微凉, createdTime=Fri Nov 10 06:58:32 CST 2017, time=2017-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260140, encodeId=2542260140ae, content=学习了很有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3IzoRn621JdKCFUI4XvNELcibocrAVU6aUzEVDSaf3rYH08PUYUiagGqxAEhj8g9WqqNvD1CupIpCrmnR2OrqHZh/0, createdBy=7f181365728, createdName=飛歌, createdTime=Fri Nov 10 00:44:54 CST 2017, time=2017-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260114, encodeId=d852260114c1, content=很好的文章.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Nov 09 23:59:25 CST 2017, time=2017-11-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260100, encodeId=653d2601005a, content=^_^^_^^_^^_^, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Swp2ehfHpiciczeTntUyQOlIGMzQ705ic67sdMTVMbwTv7KbmlUvxrGvRSvQZjPkz7ib5tEDfIaORgczPtmHDpwojg/0, createdBy=c54b2163125, createdName=wqkm, createdTime=Thu Nov 09 23:01:05 CST 2017, time=2017-11-09, status=1, ipAttribution=)]
    2017-11-09 wqkm

    ^_^^_^^_^^_^

    0

相关资讯

腹痛、血尿、干咳,捣乱的竟都是你……

主动脉夹层可谓灾难性疾病,一周内死亡率60% - 70%,3个月内死亡率可达90%,所以早期诊断及时治疗尤为重要。

NEJM:缺血性肠病静脉充血-病例报道

肠系膜动脉缺血可由急性动脉血栓栓塞或静脉血栓栓塞引起,或内脏血管血流量降低所致,也可能是由于动脉硬化引起的低血压导致的。如果病人出现急性腹膜炎的症状,则需要紧急的剖腹探查以评估梗死的肠道。

腹痛+面色苍白,这个真不是输液反应!

疼痛不太剧烈,隐痛,基本上呈持续性,程度稍有波动,前天呕吐一次,为胃内容物,无胸闷,无心悸,无发热,胃纳同前,二便无殊。

Lancet Gastroen Hepatol:小儿功能性胃肠疾病相关腹痛的治疗

经皮神经电刺激是有效的青少年功能性胃肠疾病相关腹痛非药物治疗手段

Lancet Gastroen Hepatol:粪便菌群移植用于中重度肠易激综合征

研究认为,对于中重度肠易激综合征患者,接受粪便菌群移植可改善患者疾病症状

患者急腹痛来,最后竟是……

凌晨六点的急诊,显出难有的宁静与清闲,离交班下班还有2小时,此时身体与心情都处于松懈状态。事实证明,此时间段亦是问题最多的时刻。说来就来,一名25岁的青年小伙子捂着上腹、满头大汗、脸色苍白踏进诊室,一进门就看看抱怨:“医生, 可能吃错东西了,肚子痛。”我马上予病史采集、体格检查、生命征评估。体温 38度,血压 150/100 mmHg,面色苍白,肺部闻少许湿罗音,心率110 次/分,律齐无杂音。全