UGIB上消化道出血.pptVIP

CASE1 徐义忠，男，52岁，因“呕血黑便2天”入院，患者2天前（大量？）饮酒后呕吐，次日清晨解柏油样便一次，量约 ml，中午开始出现呕血，初为深紫色液体含少量食物残渣，后逐渐转为鲜红色，总量约1500ml，无明显腹痛、腹胀。遂转入我院急诊，查血常规：WBC 21.84*10^9/L，RBC 2.17*10^12/L，Hb 70g/L；立即予以禁食、补液、止血、抑酸、护胃治疗后转入我科。既往体健。查体： 结膜苍白，心肺（-），腹（-） 9-12日胃镜：1、贲门粘膜撕裂 2、慢性胃炎伴胆汁反流 Upper gastrointestinal bleeding Definition： upper gastrointestinal hemorrhage: bleeding in gastrointestinal which above the ligament of Treitz: including the esophagus, stomach, duodenum, pancreas and biliary tract Pathogeny upper gastrointestinal disease Portal hypertension adjacent organs or tissues of gastrointestinal Systemic diseases Upper gastrointestinal disease Esophageal: esophagitis, esophageal cancer, esophageal ulcers Gastroduodenal: peptic ulcer, acute gastric mucosa damage, gastric carcinoma Jejunum: Jejunal ulcer, Jejunal crohns disease Portal hypertension Gastroesophageal varices haemorrhage Hepatic cirrhosis Portal vein obstruction: blood clots Adjacent organs or tissues Biliary tract bleeding:biliary ascariasis, cholelithiasis Pancreatic disease: Pancreatic cancer, Acute pancreatitis others: Aneurysm Systemic diseases hematological disease: ITP, DIC , haemophilia uremia vascular disease: Atherosclerosis, allergic purpura connective tissue diseases(CTD): SLE(Systemic lupus erythematosus ), Polyarteritis nodosa, stress ulcer acute infection Four most common diseases: Peptic ulcer (duodenal, gastric ) Varices Acute erosive stomach bleeding Tumours (benign and malignant) Clinical manifestation Hematemesis and melena (characteristic) Peripheral circulatory failure (1000ml, fast): palpitations, sweating, thirsty, syncope Fever (in 24h, 38.5℃, 3-5 days) Anemia (after 3-4h, Reticulocyte↑ 24h) Azotemia Laboratory examination Blood routine examination: RBC, WBC, PLT, HB, PCV Coagulation function : PT, APTT Liver function Renal function To estimate blood loss and presence of active bleeding Special examination Endoscopy