 Wysłany: Pią 18:02, 25 Mar 2011 Temat postu: 46 cases of acute appendicitis in pregnancy diagno |
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| 46 cases of acute appendicitis in pregnancy diagnosis and treatment of
6 cases of early pregnancy, 13%; trimester in 24 cases, 52; 16 down in late pregnancy, accounting for an average of 35 a history of 26h (12 ~ 4Oh). The main symptoms; 28 patients with metastatic right lower abdominal pain, right lower back pain 2o commission, right upper quadrant pain with the right dig down 2 Department of diffuse pain, nausea, vomiting, 29 cases; chills, fever and 19 cases of the main signs: 38 cases of the right abdominal tenderness, rebound and 39 cases of muscular tension. 4O psoas muscle test positive cases, 20 cases of right flank pain knocked laboratory; WBC 11.8 ~ 21.9 × lo9 few tips acute appendicitis abdominal B-32 Yong conservative treatment after hospitalization in 18 cases, 28 cases of surgical treatment , the pathological diagnosis of acute simple appendicitis 13 commission, acute suppurative appendicitis in 12 cases, 3 cases of perforated appendicitis were discharged 2 to discuss an etiology: In addition to the appendix tube dirty obstruction, gastrointestinal tract disease effects caused by bacterial invasion and other common disease factors, maternal physiological changes during pregnancy is also an important factor in disease caused by one of appendicitis. Major changes are: ① the increase of uterine volume during pregnancy resulted in the appendix lumen is susceptible to blood pressure ② hypercoagulable state during pregnancy. Easy to form the appendix mesentery vascular thrombosis, necrosis of the appendix caused by pregnancy hormones ③. Gastrointestinal tract, reduce muscle tension level precision, reduced bowel motility, intestinal contents stay too long, could easily lead to the appendix lumen, obstruction. ④ the uterine volume is increasing, the increase in external rotation of the appendix, omentum no protection, once the diagnosis of inflammation can easily spread should pay attention to the problem 2.2: ① metastatic recurrent right lower abdominal pain or not Obviously, this group of patients had no such symptoms 18 commission. Pregnant women because of thinning of the abdominal wall relaxation. Often without muscle tension and rebound tenderness. ② different because of pregnancy, appendectomy different positions, a tender point is different Jian especially during late pregnancy, the appendix is located in the uterus, even after the peritoneal adhesion, resulting in lower back pain often associated with the right ③ appendicitis during pregnancy low back pain and urine a small amount of red blood cells,keen shoes sale, do not be misdiagnosed as pregnant women prone to pyelonephritis or stone to the right. ④ For diffuse abdominal pain with right shoulder pain patients. Not likely to occur during pregnancy misdiagnosed as cholelithiasis ⑤ pregnant 7 weeks pregnant from the beginning, since the blood cell count increased. To 30 weeks of pregnancy reached a peak, the optional 15 × 109 / L white blood cell count and therefore can not be judged based on disease severity of appendicitis abdominal B-⑥ appendicitis diagnosis of pregnancy has an important role, especially for patients with atypical symptoms of appendicitis. 2.3 Treatment: ① conservative treatment: mainly used in a pregnancy early acute simple appendicitis, lesser symptoms. b trimester mild symptoms, family members do not agree to surgery c mild symptoms in late pregnancy can wait for delivery after the surgery to remove the appendix. However, the disease should be closely observed, if the symptoms get worse, immediately result l ~ iT-treatment ② surgery: Surgery is the most thorough method of treatment of appendicitis. Pregnancy is not a contraindication to surgery, surgery does not necessarily lead to miscarriage and premature delivery as the increase in the month of pregnancy, increase the chance of appendicitis more and more a threat to the fetus and pregnant women the greater the Early diagnosis is important, and early surgery is The most scientific and most secure method of surgical treatment of problems needing attention; a continuous epidural anesthesia should be applied, intraoperative oxygen. Should be closely observed while blood pressure, pulse and other vital indications. Special attention to prevent supine hypotension syndrome; b I = 1 surgical option should be based on the location of the appendix during pregnancy changes, often in the rectus abdominis incision in the side. c operative position by right booster 30 d of perforated appendicitis the higher number of intra-abdominal fluid. Best wet gauze to absorb mining dump and wipe the liquid. To wash as little as possible to avoid inflammatory proliferation and peritoneal washing fluid due to temperature difference between the uterus caused by stimulation of the uterus. e try to hold drainage strip. Drainage of the uterus due to a certain section of the stimulus, while a risk of retrograde infection Qi drainage is crucial for the inflammatory heavier strips, should be set aside early. Measures to deal with after surgery: a majority of intravenous penicillin for bacterial infections because of its good effect both on the fetus with no side ashamed, but the antibiotics have side effects on the fetus can not be used. b for the prevention of miscarriage and premature delivery should be pain after surgery, sedation and other symptomatic treatment of both conventional intramuscular injection of progesterone lo ~ 20mg, day 1, once every two weeks. C in pregnant women can not eat during the surgery does not exhaust should be given intravenously enough energy to supply the energy of the mother and children demand Yi |
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