マインドマップギャラリー 急性閉塞性化膿性胆管炎
『外科学』第9版教科書:胆道疾患の原因を紹介するマインドマップ、 病理、 臨床症状、 補助検査、 治療方針など
2024-04-05 19:59:24 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.
急性閉塞性化膿性胆管炎
1. 原因
総胆管結石、良性および悪性の狭窄。
2. 病理
1. 胆管の完全閉塞と胆管内の化膿性感染症
2. 胆管圧が15cmH2Oを超えると、胆汁血が逆流し、胆汁逆流を介して細菌(主にグラム陰性菌、大腸菌、クレブシエラ属が多く、嫌気性細菌感染症と合併することが多い)が侵入し、全身性の炎症反応や肝細胞の損傷を引き起こします。
3. 臨床症状
1.
発症は突然で、症状は急速に進行し、死に至る場合も少なくありません。
シャルコーのトライアド:
悪寒、高熱(39~40℃以上)、黄疸、激しい腹痛
レイノルズペンタッド:
トライアド:精神的変化、低血圧
2. 身体的な兆候
高熱、速くて弱い脈拍、低血圧、剣状突起の下または右上腹部の圧痛、腹膜刺激、しばしば圧痛と打診痛を伴う肝臓肥大
4. 補助検査
1. 白血球と好中球が大幅に増加します (>20*109/L になる可能性があります)
2. 尿ビリルビン陽性、血中ビリルビン上昇、肝機能異常、血液培養における細菌増殖
3. 超音波、CT、MRCP、PTC
5. 治療原則
原則として:
閉塞を取り除くための緊急手術。十分な抗生物質と組み合わせて容量を拡張してショックに耐え、胆道を排水します。
緊急外科的胆管減圧術:
総胆管切開減圧Tチューブドレナージ、ENBD、PTCD