G.I._Bleeding上消化道出血.ppt

G.I. Bleeding Presented by: Ahmed T. Al-Suwaidi Mohamed S. Al-Hoqani G.I. Bleeding Case 50 yrs, Pakistani, male C/O: Bleeding/rectum Abd. pain Painless bleeding, 1 yr – excess bleeding, 1 month Black, 4-5 times/day, little quant. Abd. pain Vomiting, 1 week G.I. Bleeding Case M.H: * no peptic ulcer disease * no medications (NSAIDs) * no urinary symptoms * not known DM, HPTN, IHD ** weight loss G.I. Bleeding Case O/E: * Afebrile * no pallor * not dyspneaic * no lymphoadenopathies * no S.C.L.N G.I. Bleeding Case Vital Signs: * Pulse: 78 bts/min * BP: 130/80 * RR: 18 br/min Heart: NAD Lung: NAD G.I. Bleeding Case Abd.: * not distended * no epigast. tenderness * tender, firm, partly mobile mass at Rt lumbar region. * spleen not palpable * Lt lobe liver palpable, mildly tender * bowel sounds present G.I. Bleeding Case PR: * no enlarged piles * no active bleeding * no palpable mass * no blood on finger ECG, CBC, Sr Amylase, Bleeding profile, Abd X-ray, fecal loading ascending colon G.I. Bleeding Case Lab Results: * Hb: 14.1 g/dl * Plt: 252 * 103 * Hypochromic, microcytic * PT: 17.3 sec * aPTT: 35.4 sec * Sr Amy: 129 U/l ? 106 U/l * Na+: 140 mmol/l * K+: 4.1 mmol/l * BUN: 17 mg/dl G.I. Bleeding Acute Vs Chronic Acute Upper G.I.Bleeding: Acute Lower G.I.Bleeding: Acute Upper G.I. Bleeding Haematemesis Melaena Site Time Acute U.G.I. Bleeding ·?Aetiology: 1. Drugs (Aspirin NSAIDs) 2. Alcohol 3.Chronic peptic ulceration (50% of GI hemorrhage) 4.Others: reflux esophagitis, varices, gastric carcinoma, acute gastric ulcers erosions. Acute U.G.I. Bleeding ·??Clinical approach: 1. recent (24 hrs), then hospitalized. 2. if small amount, no immediate Tx, because CVS can compensate 3. 85% stop bleeding during 48 hrs 4. history helps in diagnosing the cause of the hemorrhage, eg: long history of indigestion, or previous hem. from ulcers. Acute U.G.I. Bleeding ? ·??Clinical approach: 5. factors incl