甲狀腺疾病英文版課件.ppt

ThyroidDisorders WordList Thyroiddisorders甲狀腺病癥Isthmus峽部Thyroxine甲狀腺素Triiodothyronine三碘甲狀腺氨酸Parathyroidglands甲狀旁腺Calcitonin降鈣素 Recurrentlaryngealnerve喉返神經(jīng)Hyperthyroidism甲亢Hypothyroidism甲減Goitre甲狀腺腫Exophthalmos突眼癥Tremor震顫TSH促甲狀腺激素 Thyroidectomy甲狀腺切除術(shù)Thyroidcrisis甲狀腺危象Atracheostomyset氣管切開(kāi)包Tetamy手足抽搐 ThyroidGland Itisapartoftheendocrine 內(nèi)分泌 system playsamajorroleinregulatingthebody smetabolism Section1 Anatomy physiologyofthyroid PlaceBloodsupplyNervessupplyFunctions Anatomy physiologyofthyroid Locatedinthelowerneckanteriortothetrachea Twolaterallobesconnectedbyanisthmus 峽部 Butterfly shapedorgan5cmlong 3cmwide 30gTheparathyroidglands 甲狀旁腺 lyingonthedorsalside 背面 ofthethyroidgland Rich fromthesuperiorandinferiorthyroidartery Artery Thearterialbranchesprovidebloodsupplytootherstructuresinthearea Theinteriorthyroidarteryprovidesbranchestothepharynx tracheaandesophagus Vein 1 Thesuperiorthyroidvein2 Themiddlethyroidvein3 Theinferiorthyroidvein Thenervessupplyingthethyroidoriginatefromvagus 迷走神經(jīng) innervatetheepithelialcells 上皮細(xì)胞 ofthefollicles 濾泡 ofthethyroidgland Onemustbeawareofthebilateralexistenceofarecurrentlaryngealnerve 喉返神經(jīng) duringdissection Produces synthesizes stores andsecretesTwoHormonesCalledThyroxine T4 Thyronine T3 RegulatesMetabolismsoYourCellsFunctionProperlyAffectsEveryCellintheBody necessaryfornormalgrowthanddevelopment Commondisorder AdeficiencyofiodineOtherdisorder AutoimmunethyroiddiseaseClassification Hyperthyroidism 甲亢 hypothyroidism 甲減 tumours cancerorgoitre 甲狀腺腫 WhentheThyroidDoesn tWork HyperthyroidismTooMuchThyroidHormoneMetabolismSpeedsUp HypothyroidismTooLittleThyroidHormoneMetabolismSlowsDown Hyperthyroidism 甲狀腺功能亢進(jìn) Definition Hyperthyroidismisanimbalanceofmetabolismcausedbyoverproductionofthyroidhormone Cause Increasedsecretionofthyroidhormone Females males 4 1 ittendstoaffectmalesmoreseverely Incidence 20 40yearsoldgroup ClinicalManifestation GoiterExophthalmos 突眼征 IncreasedmetabolicrateIncreasedfunctionofsympatheticnerve 交感神經(jīng) Cardiovascularalteration Thethyroidcanbepalpatedforasymmetry 不對(duì)稱(chēng) andsize Itmayenlarge3 4timestoitsnormalsize Itiscalledgoitre Hyperthyroidism Asaresultofincreasedthyroidhormoneproduction theclienthasanincreasedmetabolicrate Weightlossdespiteincreasedappetite fatigue poortolerancetoheat andprofuseperspiration menstrualirregularities Nervous restlessness irritability difficultyconcentrating emotionalliability moodswings personalitychanges Finetremorsofthefingersandtongue shakyhandwriting clumsiness troubleinclimbingstairs ordyspneapossiblyatrest Theskiniswarmandmoist characteristicsalmoncolour 鮮肉色 Thehairisfineandsoftwithprematuregreyandincreasedhairloss Thenailsappearfragilewithdistalnailseparationfromthenailbed Tachycardia 160bpmanddownto80bpmduringsleep Pulsepressureiswidened Therecanbemuscularweaknessandatrophy 萎縮 paralysis 癱瘓 DiagnosticTests TSH 促甲狀腺激素 T3 T4Radioactiveiodineuptake 131 ThyroidscanMensurationofbasicmetabolismrate BMR TSH Thyroid StimulatingHormone normalTSHreflectaeuthyroid 甲狀腺機(jī)能正常的 state Hyperthyroidism TSHisloworabsent Inmildformsofhyperthyroidism slightlyabnormal ThyroidscanScanarehelpfulindetermininglocation size shape andanatomicfunctionofthethyroidgland MensurationofBasicMetabolismRate BMR Conditions Earlyinthemorning emptystomach atthetimeofrestBasicMetabolismRate Pulserate Pulsepressure 111 Grade Normal 10 Slightlyabnormal 20 30 Moderatelyabnormal 30 60 Seriouslyabnormal 60 Treatment Antithyroiddrugs radioactiveiodine orthyroidectomy 甲狀腺切除術(shù) Individualizedanddependsontheageandgeneralstateofhealth thesizeofthegoiterandtheabilitytoobtainfollow upcare Partialorcompletethyroidectomymaybecarriedoutasprimarytreatment Thetypeandextentofthesurgerydependonthediagnosis goalofsurgery andprognosis SurgicalIndications AverylargegoiteroramultinodulargoiterwithrelativelylowradioactiveiodineuptakeMalignantthyroidnodulePsychologicallyormentallyincompetentpatients 2020 1 29 33 可編輯 Surgery Aportionofthethyroidglandisremoved butatotalthyroidectomymaybeperformed expensive risks Indicationsforsubtotalthyroidectomy themainadvantagesarerapidcontrolofthediseaseandalowerincidenceofhypothyroidismthancanbeachievedwithradioiodinetreatment Surgery Ifapartialthyroidectomyisdone theremainingthyroidtissueshouldprovideadequateamountsofthyroidhormones Ifacompletethyroidectomyisdone theclientwillrequirethyroidhormonereplacementforalifetime Theneckisextendedandasymmetrical gentlycurvedincisionismade1to2cmabovetheclavicle 鎖骨 Closureofthewoundisaccomplishedbythestrapmusclesinthemidline Asmallsuctioncatheterisusuallyinsertedthroughastabwound Complicationsaftersurgery Dyspnea asphyxiaInjuryoflaryngealnerveSpasmsThyroidcrisis 甲狀腺危象 HaemorrhageHaematoma 血腫 formationTrachealcollapse 氣管塌陷 TrachealmucousaccumulationLaryngealorlocaltissueedema Cause Complicationsaftersurgery Respiratorydistressandhaemorrhage Difficultyinrespirationwhichistheoccurswithinafterthesurgery mostcriticalcomplication 48hours Management Surgicalevacuationisrequired ThefirstaidbythebedA cutoffthesutureB openedthewoundwideC removedthehematomaThetracheaiscut applyoxygenSendtotheoperationroomforfurthertreatment Preventiveinterventions Atracheostomyset 氣管切開(kāi)包 iskeptatthepatient sbedsideatalltimes andthesurgeonissummonedatthefirstindicationofrespiratorydistress Injuryoflaryngealnerve Anyvoicechangesarenotedbecausetheymightindicateinjurytotherecurrentlaryngealnerve 喉返神經(jīng) whichliesjustbehindthethyroidnexttothetrachea Talkaslittleaspossible Canbecuredspontaneously orbyphysicaltherapy Spasm Theparathyroidglandsmaybeinjuredorremoveddisturbanceofthecalciummetabolismofthebodybloodcalciumlevelfallsspasmsofthehandsandfeetandmusculartwitching tetany laryngospasm Management TemporaryLimittakingofmeat eggswhicharehighinphosphorus 磷 UseofthesedativetocontrolthepainIntravenousadministrationofcalciumgluconate葡萄糖酸鈣 Thyroidcrisis storm Reason insufficientpreoperativepreparation areleaseoflargeamountsofthyroidhormone rareOutcome canleadtocardiac hepaticorrenalfailure Stressfulfactors surgery infectionortrauma pregnancy Timeofoccurring thefirst12hourspostoperative Clinicalmanifestation Tachycardia 130bmp T 39 sometimes 41 ExaggeratedsymptomsofhyperthyroidismDisturbancesofamajorsystem Gastrointestinal diarrhea abdominalpain Neurologic psychosis somnolence coma Cardiovascular edema chestpain dyspnea palpitations Fatalness Theclientmaydevelopcongestiveheartfailureanddie Preventions Thekeyistodothepreoperativepreparationsufficiently andperformthesurgeryuntiltheBMRbecomenormal MedicalManagement Thephysicianmustbeinformedimmediately TransferthepatienttotheintensivecareforclosermonitoringIodineisadministeredtodecreasetheoutputofthyroidhormone TakeKIsolution3mlorally orput10 iodinesodium5mlintoin10 glucose andgiveivinjectiontothepatient 200 400mgHydrocortisone氫化可的松isprescribedtotreatshockoradrenalinsufficiency Theusageofsedative luminal魯米納Q6 8h Reducebodytemperatureandheartrateandtopreventvascularcollapse 37 Alargeamountofglucoseareneeded Oxygentherapy HumidifiedoxygenisadministeredtoimprovetissueoxygenationandmeetthehighmetabolicdemandsCardiacproblems arterialfibrillation andcongestiveheartfailure sympatholyticagentsmaybeadministered suchaspropranolol 心得安 Preoperativecare PerfectpreoperativecareBaselineinformationPharmacologictherapyMentalsupportNutritionInstruction Pharmacologictherapy Itisnecessaryforsurgicaltreatment butitcannotactasatherapueticmedication Encouragesthepatienttotakethemedicationsasprescribed Iodinepreparationsmayhavebeenprescribed10to14daysbeforesurgerytodecreasethyroidvascularityanddecreasebleeding 2to5dropsofpotassiumiodidesolution 復(fù)方碘化鉀 orLugol siodinesolution 盧戈氏液 aregiveninconjunctionwithpropylthiouracil 丙基硫尿嘧啶 todecreasethefriabilityandvascularityofthethyroid itshouldbeapplieduntilthetimeofoperationandthepatientbecameeuthyroid Requirement euthyroidPatient smoodissteady thesleeptakesafavorableturn gainweight pulserate 90times min BasicMetabolismRate 20 情緒穩(wěn)定 睡眠正常 體重增加 心跳正常 代謝恢復(fù) Nutrition Severalwell balancedmealsofsmallamount evenuptosixmealsaday Highlyseasonedfoodsandstimulants suchascoffee tea cola andalcoholarediscouraged High calorie high proteinfoodsareencouraged Preoperativeteaching Howtosupporttheneckwiththehandsaftersurgerytopreventstressontheincision Eyecareandprotectionmaybecomenecessary correctinstillationofeyedropsorointmentprescribedtosoothetheeyesandprotecttheexposedcornea Postoperativecare PositionObservationOxygenNutritionMedicationHealthinstruction Observation Cardiacandrespiratoryfun