マインドマップギャラリー 肝内胆管結石
『外科学』第 9 版教科書: 原因を含む胆道疾患のマインドマップ 病理、 臨床症状、 治療方針など
2024-04-05 19:57:14 に編集されましたThis template, created with EdrawMind, provides a structured workflow for weekly coordination meetings focused on MEP (Mechanical, Electrical, Plumbing) pipeline layout. It follows a four-stage cycle: starting with Issue Identification (Clash Detection) to detect pipeline conflicts, moving to Meeting Agenda preparation to define discussion topics, then On-site Discussion to review and resolve issues on the construction site, and finally Resolution & Update to document solutions and track progress. This template can be reused to standardize MEP coordination processes, ensuring clear communication, efficient problem-solving, and smooth construction progress.
This template, created with EdrawMind, outlines a quarterly checklist for preparing materials for green building certification. It is divided into four sequential quarters: Q1 focuses on Basic Material Preparation, including collecting project approval documents and compiling self-assessment reports; Q2 covers Technical Data Improvement, such as organizing energy consumption calculation books and preparing green construction proof materials; Q3 involves On-site Inspection Preparation, including organizing construction process materials and verifying certification standards; and Q4 is for Formal Application, which includes completing online reporting and cooperating with expert on-site reviews. This template can be reused to systematically prepare for green building certification, ensuring all requirements are met and the process is efficient.
This template, created with EdrawMind, provides a comprehensive framework for daily monitoring of deep foundation pit construction. It covers six key monitoring areas: Retaining Wall Top Displacement, Settlement of Surrounding Buildings, Groundwater Level, Pit Bottom Heave, Support Axial Force, and Data Summary & Analysis. Each section specifies monitoring points, frequency, and warning values to ensure safety. The template can be reused to standardize monitoring practices, track structural stability, and trigger immediate alarms if warning thresholds are exceeded, thus mitigating risks during foundation pit construction.
This template, created with EdrawMind, provides a structured workflow for weekly coordination meetings focused on MEP (Mechanical, Electrical, Plumbing) pipeline layout. It follows a four-stage cycle: starting with Issue Identification (Clash Detection) to detect pipeline conflicts, moving to Meeting Agenda preparation to define discussion topics, then On-site Discussion to review and resolve issues on the construction site, and finally Resolution & Update to document solutions and track progress. This template can be reused to standardize MEP coordination processes, ensuring clear communication, efficient problem-solving, and smooth construction progress.
This template, created with EdrawMind, outlines a quarterly checklist for preparing materials for green building certification. It is divided into four sequential quarters: Q1 focuses on Basic Material Preparation, including collecting project approval documents and compiling self-assessment reports; Q2 covers Technical Data Improvement, such as organizing energy consumption calculation books and preparing green construction proof materials; Q3 involves On-site Inspection Preparation, including organizing construction process materials and verifying certification standards; and Q4 is for Formal Application, which includes completing online reporting and cooperating with expert on-site reviews. This template can be reused to systematically prepare for green building certification, ensuring all requirements are met and the process is efficient.
This template, created with EdrawMind, provides a comprehensive framework for daily monitoring of deep foundation pit construction. It covers six key monitoring areas: Retaining Wall Top Displacement, Settlement of Surrounding Buildings, Groundwater Level, Pit Bottom Heave, Support Axial Force, and Data Summary & Analysis. Each section specifies monitoring points, frequency, and warning values to ensure safety. The template can be reused to standardize monitoring practices, track structural stability, and trigger immediate alarms if warning thresholds are exceeded, thus mitigating risks during foundation pit construction.
肝内胆管結石
1. 原因
胆道感染症、胆道寄生虫(回虫、クロストリジウム・シネンシス)、胆汁うっ滞
2. 病理
ほとんどは細菌を含む胆汁色素結石です。
それは主に肝臓の左外葉と右後葉で発生します。
二次病変:
①肝胆道閉塞。
②急性肝内胆管炎、肝線維化と萎縮を引き起こす慢性炎症。
③肝胆道がん。
④肝硬変による門脈圧亢進症
3. 臨床症状
1.
慢性期:
上腹部、胸、背中の痛みと不快感
急性期:
急性胆管炎
主な症状は悪寒、高熱、腹痛ですが、黄疸ではない場合もあります(閉塞範囲が狭いため)。
2. 身体的な兆候
肥大した肝臓または非対称な肝臓のみが触知され、肝臓領域に圧痛と打診痛が生じます。
3. 補助検査
肝機能酵素検査の異常
糖鎖抗原 (CA19-9) または CEA が著しく上昇している場合は、がんが強く疑われるはずです。
映画学位試験
1. B-超音波検査
2. PTC
3. ERCP
4. MRCP
5. CT
4. 治療原則
原則として:
無症状
治療は必要ありませんが、定期的な経過観察と観察のみが必要です。
症状を繰り返す方
外科的治療
技術:
胆管切開と結石除去、
肝管空腸Roux-en-Y吻合、
肝臓切除
1. 再発性結石感染症
肝萎縮や線維化を引き起こすもの
2. 胆管出血とがんの合併
左葉に多い