诊断学呕血与便血英文版课件.pptVIP

Diagnosis ofGastrointestinal Bleeding Hematemesis and Hematochezia 呕血与便血 Recognition of hemorrhage Recognition of hemorrhage Clinical Manifestations 1 Manner of bleeding presentation 2 Hypovolemia (低血容量) or shock 3 Anemia (贫血) Patients manifest blood loss 1) Hematemesis 呕 血 Bloody vomitus, either fresh and bright red or older and “coffee -ground” (hematin 酸化正铁血红素) in character Hemoptysis? Nosebleeding? Manner of bleeding presentation Manner of bleeding presentation Manner of bleeding presentation Estimate amount of bleeding from upper GI tract Manner of bleeding presentation Hypovolemia or shock Speed and volume of blood loss Weakness, giddiness (眩晕), oliguria, (少尿) cold extremity, sweating Vital signs: tachycardia, (心动过速) hypotention (低血压) Anemia pale dizziness palpitation Is bleeding acute or chronic? 1) Bleeding speed Hematemesis of fresh blood generally indicates a more severe bleeding episode than melena, which occurs when bleeding is slow enough to allow time for degradation of blood Is bleeding acute or chronic? 2) Hematocrit bleeding slowly hypochromic (血红蛋白过少) microcytic (小细胞) red blood cells mean corpuscular volume (MCV， 平均血球压积) of the cells may be low Is bleeding acute or chronic? If blood loss is acute, the hematocrit dose not change during the first few hours after hemorrhage About 24 to 72 hours later, plasma volume is larger than normal and the hematocrit is at its lowest point Is bleeding acute or chronic? Hematocrit changes A Before bleeding B Immediately after bleeding C 24~72 hours after bleeding Is bleeding acute or chronic? 3) Blood pressure and heart rate depend on amount of blood loss suddenness of blood loss extent of cardiac and vascular compensation Is bleeding acute or chr