问题
问答题 案例分析题
病历摘要男性，24岁。腹部外伤后腹痛、腹胀4小时。患者4小时前因车祸，中腹部被木柱撞击，伤后腹部剧痛，休息后似乎缓解。不到2小时，腹部剧痛再次出现，并呈持续钝痛，伴有腹胀，逐渐加重，再不缓解，急诊来院。查体：T37.6℃，P100次／分，R24次／分，BP118/78mmHg。神清，查体合作，头颈、心肺未见异常，腹稍胀，腹式呼吸减弱，脐周可见挫伤痕迹，全腹均有压痛，而以腹中部最重，腹肌稍紧张，反跳痛较明显，肝浊音界存在，移动性浊音（±），肠鸣音甚弱，听不清。辅助检查：血常规：Hb120×109／L，WBC11×109／L；腹部X线平片：膈下未见明显游离气体：B超显示肠间隙增宽。腹腔穿刺有少量淡黄色浑浊液体。要求：根据以上病历摘要，请写出初步诊断及诊断依据、鉴别诊断、进一步检查与治疗原则。
答案
参考答案：
初步诊断及诊断依据
初步诊断：1.腹部闭合性损伤2.弥漫性腹膜炎3.空腔脏器破裂（肠管破裂）
诊断依据：1.病史：（1）腹中部直接受力的外伤史。（2）典型的临床表现：外伤初期疼痛缓解后2小时，腹痛、腹胀再次逐渐加重（为肠内容物溢出导致腹膜炎的表现）。2.查体：全腹有腹膜炎的腹膜刺激体征。3.腹腔穿刺抽出液，外观类似小肠液。
鉴别诊断：1.其他腹内空腔脏器破裂2.单纯腹壁损伤3.腹内实质性脏器损伤
进一步检查：1.重复诊断性腹腔穿刺，并做穿刺液常规检查和镜检。2.必要时可行腹部CT检查。
治疗原则：1.开腹探查，以明确诊断及时处理。2.视肠管损伤情况，行破裂肠管壁缝合或肠段切除吻合术。
My mother moved a lot when she was growing up on account of Grandpa being in the army. She hated having to adjust to new schools and make new friends. That’s why I thought she was joking when she put forward the idea of moving. But she was completely serious. “For just the two of us,” my mother said, “an apartment in the city will suit our needs much better.” Personally, I think she’s lost her mind. I guess I can understand why she would want to move, but what about me and what this house means to me?
ooked at my house, you might think it was just another country house. But to me it is anything but standard. I moved into this house with my parents ten years ago. I can still remember that first day like it was yesterday. The first thing I noticed was the big front yard. To me it seemed like an ocean of grass—I couldn’t wait to dive in. The backyard was full of gnarled (扭曲的, 粗糙的) and scary trees that talk on windy nights. But I grew to like them and the shadows they cast in my room. My father and I even built a small tree house, where I often go to remember all the wonderful times we had before Father’s death. 
was growing up because of ________.