太久沒有超音波文,今天要來說的是有經典超音波特徵的十二指腸閉鎖,還有胎兒腸阻塞相關問題~
🔎全文參見
https://drjessicakang.blogspot.com/2021/06/blog-post.html
#十二指腸閉鎖 Duodenal atresia
#超音波主要特徵
1. Double bubble sign
2. 羊水過多
✏️但是這兩個超音波特徵,通常在"高層次"的週數是不會發現的! 很多都是超過24週才出現。所以高層次沒有異常發現,不代表之後一定沒問題的喔!
✏️Duodenal atresia超音波診斷並不會太難,但是一旦發現了,後續染色體檢查是需要安排的切勿忘記!
#強烈建議染色體檢查 (karyotyping):
約25~30%的十二指腸閉鎖病患也是唐氏症患者;反之,約有5-15%唐氏症患者會有十二指腸閉鎖。
#其他合併異常:
1. 50-70%十二指腸閉鎖的案例會有其他心臟或腸胃道異常。
2. 以單一器官來說,先天性心臟病最常見(大約有20%會合併)。
3. VACTERL: 腎臟、脊椎也要特別注意。
4. 其他腸胃道異常,環形胰臟等。
---
🔎Double bubble sign就一定是十二指腸閉鎖嗎?
不一定,也會出現假的也就是Pseudo-double-bubble sign。
假的Double bubble鑑別診斷有很多,文章有詳細說明。
---
🔎產前腸子脹,還有哪些鑑別診斷呢?
空回腸閉鎖 (Jejunoileal atresia)
腸道轉位異常/腸扭轉 (Malrotation with volvulus)
胎糞性腸阻塞(Meconium ileus)
---
但是回顧了一些研究文獻,產前診斷有沒有界定 #腸子要多寬? #是不是一定會有羊水過多? 這都還沒有一定的標準。
🔎哪些超音波特徵來診斷腸阻塞最準?
超音波診斷率很差。
有研究發現,超過32週,腸子寬度>1.7公分 + 羊水過多 -> 腸阻塞的偵測率較高
🔎如果胎兒沒有出現超音波異常,是不是就不會有腸阻塞?
錯。
有部分胎兒是產前羊水量正常,而且腸子或胃也沒有特別脹。
🔎如果產前沒有診斷出來,會不會影響寶寶出生後的預後?
研究發現,產前沒有出現超音波異常的案例,出生後開刀住院天數、ICU天數、死亡率等和有出現超音波異常的案例比較,是差不多的。
閉鎖的種類,還有診斷的時間(產前、出生後),也對預後沒有太大影響。
以上供大家參考囉
#十二指腸閉鎖
#十二指腸狹窄
#DoubleBubbleSign
#腸阻塞
#產前超音波
同時也有10000部Youtube影片,追蹤數超過2,910的網紅コバにゃんチャンネル,也在其Youtube影片中提到,...
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跟時間賽跑的腸道急症
一位剛出生寶寶被轉診到本院。
這位寶寶在OOOO醫院出生,因爲一出生狀況不好,於是就被轉診到本院。
轉診到本院後,發現寶寶的確出現肚子脹、嘔吐的情形,於是緊急安排影像學檢查後,兒科醫護團隊在寶寶出生後的第一張腹部X光片上,發現有「雙重氣泡的影像」(double bubble sign)。(圖)
有雙重氣泡的影像!!!
這是一個腸道急症喔!!!
於是兒科醫護團隊在確定寶寶是腸道急症,緊急安排手術治療,術後確診為先天性腸道旋轉不良併中腸扭轉(Malrotaion with midgut volvulus)。
而中腸扭轉就是跟時間賽跑的腸道急症
「那甚麼是雙重氣泡的影像呢?」
雙重氣泡的影像是新生兒或嬰兒十二指腸有阻塞的影像表現。
這在腹部X光片和超音波檢查中都可以看到。
在嬰兒中見到雙重氣泡的影像,表示寶寶十二指腸近端和胃有擴張的情形,但寶寶遠端的十二指腸管內無氣體且不擴張。
這就是告訴我們:
「寶寶有先天性十二指腸阻塞的問題」
先天性十二指腸阻塞的病因包括內源性和外源性。
內源性的病因最常見的是十二指腸閉鎖,其他還包括十二指腸狹窄、十二指腸蹼。
外源性阻塞的病因有環狀胰腺、中腸扭轉(midgut volvulus)或 Ladd 束帶壓迫所致。
所以寶寶一出生就面臨這麼嚴峻的挑戰,寶寶要加油喔!
中腸扭轉就是跟時間賽跑的腸道急症!
double bubble sign 在 Tata Young Fanclub - ทาทา ยัง แฟนคลับ Facebook 的最佳解答
#TataYoung #ladeezpop
จำได้หรือไม่ ทาทา ยัง คือคนไทยคนแรกที่ได้ขึ้นปก Time Magazine ฉบับเดือนเมษายน ปี 2001 เนื้อหาเกี่ยวกับประเด็น Eurasian Invasion รวมลูกครึ่งเอเชียที่มาแรง ร่วมกับนักแสดงชาว Hong Kong Maggie Q สมัยสาวๆ และ Indian VJ Asha Gill
เนื้อหาประกอบ บางส่วน :
Tata Young certainly knows how to let loose. Back in 1995, when she broke into Thailand's entertainment industry at the age of 15, the pert half-Thai, half-American singer was on the forefront of the Eurasian trend. Today, the majority of top Thai entertainers are luk kreung. Now 20, Young is the first Thai to sign a contract with a major U.S. label, Warner Brothers Records (owned by AOL Time Warner, parent company of Time), which she hopes will elevate her into the Britney Spears/Christina Aguilera pantheon. Back at home, Young has to contend with a gaggle of luk kreung clones who mimic her brand of bubble-gum pop. The hottest act now is a septet called, less-than-imaginatively, Seven, and three out of seven are of mixed race.
The luk kreung crowd tend to hang tight, dining, drinking and dating together. "We understand each other," says Nicole Terio, one of the group. "It comes from knowing what it means to grow up between two cultures." But the luk kreung's close-knit community and Western-stoked confidence sometimes elicits grumbles from other Thais, who also resent their stranglehold on the entertainment industry. The ultimate blow came a few years back when Thailand sent a blue-eyed woman to the Miss World competition. Sirinya Winsiri, also known as Cynthia Carmen Burbridge, beat out another half-Thai, half-American for the coveted Miss Thailand spot. "Luk kreung have made it very difficult for normal Thais to compete," gripes a Bangkok music mogul. "We should put more emphasis on developing real Thai talent." The Eurasians consider this unfair. "I was born in Bangkok," says Young. "I speak fluent Thai and I sing in Thai. When I meet Westerners, they say I'm more Thai than American." Channel V's Asha Gill senses the frustration: "A lot of Asians despise us because we get all the jobs, but if I've bothered to learn several languages and understand several cultures, why shouldn't I be employed for those skills?"
The jealous sniping angers many who suffered years of discrimination because of their mixed blood. Eurasian heritage once spoke not of a proud melding of two cultures but of a shameful confluence of colonizer and colonized, of marauding Western man and subjugated Eastern woman. Such was the case particularly in countries like the Philippines, Thailand and Vietnam, where American G.I.s left thousands of unwelcome offspring. In Vietnam, these children were dubbed bui doi, or the dust of life. "Being a bui doi means you are the child of a Vietnamese bar girl and an American soldier," says Henry Phan, an Amerasian tour guide in Ho Chi Minh City. "Here, in Vietnam, it is not a glamorous thing to be mixed." As a child in Bangkok during the early 1990s, Nicole Terio fended off rumors that her mother was a prostitute, even though her parents had met at a university in California. "I constantly have to defend them," she says, "and explain exactly where I come from."
Ever since Europe sailed to Asia in the 16th century, Eurasians have populated entrepots like Malacca, Macau and Goa. The white men who came in search of souls and spices left a generation of mixed-race offspring that, at the high point of empire building, was more than one-million strong. Today, in Malaysia's Strait of Malacca, 1,000 Eurasian fishermen, descendants of intrepid Portuguese traders, still speak an archaic dialect of Portuguese, practice the Catholic faith and carry surnames like De Silva and Da Costa. In Macau, 10,000 mixed-race Macanese serve as the backbone of the former colony's civil service and are known for their spicy fusion cuisine.
Despite their long traditions, though, Eurasians did not make the transition into the modern age easily. As colonies became nations, mixed-race children were inconvenient reminders of a Western-dominated past. So too were the next generation of Eurasians, the offspring of American soldiers in Southeast Asia. In Thailand, luk kreung were not allowed to become citizens until the early 1990s. In Hong Kong, many Eurasians have two names and shift their personalities to fit the color of the crowd in which they're mixing. Singer and actress Karen Mok, for example, grew up Karen Morris but used her Chinese name when she broke into the Canto-pop scene. "My Eurasian ancestors carried a lot of shame because they weren't one or the other," says Chinese-English performance artist Veronica Needa, whose play Face explores interracial issues. "Much of my legacy is that shame." Still, there's no question that Eurasians enjoy a higher profile today. "Every time I turn on the TV or look at an advertisement, there's a Eurasian," says Needa. "It's a validating experience to see people like me being celebrated."
But behind the billboards and the leading movie roles lurks a disturbing subtext. For Eurasians, acceptance is certainly welcome and long overdue. But what does it mean if Asia's role models actually look more Western than Eastern? How can the Orient emerge confident if what it glorifies is, in part, the Occident? "If you only looked at the media you would think we all looked indo except for the drivers, maids and comedians," says Dede Oetomo, an Indonesian sociologist at Airlangga University in Surabaya. "The media has created a new beauty standard."
Conforming to this new paradigm takes a lot of work. Lek, a pure Thai bar girl, charms the men at the Rainbow Bar in the sleaze quarters of Bangkok. Since arriving in the big city, she has methodically eradicated all connections to her rural Asian past. The first to go was her flat, northeastern nose. For $240, a doctor raised the bridge to give her a Western profile. Then, Lek laid out $1,200 for plumper, silicone-filled breasts. Now, the 22-year-old is saving to have her eyes made rounder. By the time she has finished her plastic surgery, Lek will have lost all traces of the classical Thai beauty that propelled her from a poor village to the brothels of Bangkok. But she is confident her new appearance will attract more customers. "I look more like a luk kreung, and that's more beautiful," she says.
A few blocks away from Rainbow Bar, a local pharmacy peddles eight brands of whitening cream, including Luk Kreung Snow White Skin. In Tokyo, where the Eurasian trend first kicked off more than three decades ago, loosening medical regulations have meant a proliferation of quick-fix surgery, like caucasian-style double eyelids and more pronounced noses. On Channel V and mtv, a whole host of veejays look ethnically mixed only because they've gone under the knife. "There's a real pressure here to look mixed," says one Asian veejay in Singapore. "Even though we're Asians broadcasting in Asia, we somehow still think that Western is better." That sentiment worries Asians and Eurasians. "More than anything, I'm proud to be Thai," says Willy McIntosh, a 30-year-old Thai-Scottish TV personality, who spent six months as a monk contemplating his role in society. "When I hear that people are dyeing their hair or putting in contacts to look like me, it scares me. The Thai tradition that I'm most proud of is disappearing."
In many Asian countries—Japan, Malaysia, Thailand—the Eurasian craze coincides with a resurgent nationalism. Those two seemingly contradictory trends are getting along just fine. "Face it, the West is never going to stop influencing Asia," says performance artist Needa. "But at the same time, the East will never cease to influence the West, either." In the 2000 U.S. census, nearly 7 million people identified themselves as multiracial, and 15% of births in California are of mixed heritage. Crouching Tiger, Hidden Dragon, the Oscar-winning kung fu flick, was more popular in Middle America than it was in the Middle Kingdom. In Hollywood, where Eurasian actors once were relegated to buck-toothed Oriental roles, the likes of Keanu Reeves, Dean Cain and Phoebe Cates play leading men and women, not just the token Asian. East and West have met, and the simple boxes we use for human compartmentalization are overflowing, mixing, blending. Not all of us can win four consecutive major golf titles, but we are, indeed, more like Tiger Woods with every passing generation.
cr. TIME / HANNAH BEECH
#SentiSaturday
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