Hematemesis(呕血).ppt

Hemetamesis and Hemetochezia(Acute GI Hemorrhage) Five Ways of GI Bleeding Hematemesis：vomitting of blood of altered blood（coffee grounds） indicates bleeding proximal to ligament of Treitz Melena：Tarry stool. Altered （black） blood per rectum （60ml） Hematochezia： Bright red or maroon rectal ,bleeding implies bleeding beyond Lig.T.* FOB+ and Iron deficiency anemia Factors affect the way to manifest Site of bleeding Speed of bleeding Amount of blood loss Flora of enterocolon . Differentiating Upper from Low GI Bleeding Hematochezia usually represents a lower GI source bleeding Upper GI lesion may bleed so briskly that blood doesn`t remain in bowl long enough to become melena Bleeding lesion distal to T Lig.may be either M.or hematochezia, but never manifests hematemesis Common cause of up GI bleeding Peptic ulcer ； Gastropathy （alcohol， aspirin， NSAIDs， stress）； GE varices； Gastric cancer Less common cause of up GI bleeding Esophageal or intestinal neoplam Esophagitis； Malloy-weiss tear， Hemoptysis: Swallowed blood Anticoagulant fibrinoloytic therapy: Telangiectases； aneurysm ；vasculitis；Dieulafoy ulcer； AV malformation Connective tissue disease； Hemabilia（biliary origin；Crohn`s disease；amyloidosis , hematological diseases BENIGN GASTRIC ULCER The classical presentation of gastric ulcer : with weight loss and indigestion made worse by eating, patients more often describe symptoms that would fit equally well for duodenal ulcer - investigation with barium meal or (preferably) endoscopy is, of course, appropriate for either. Benign ulcers may occur at any site in the stomach, but are commonest on the lesser curve away from acid-secreting epithelium. Duodenum Ulcer The lesion most commonly affecting the duodenum is ulceration, and it is now known that both antral infection with Helicobacter pylori and the presence of gastric acid are virtual prerequisites for it.. GE Varices A number of cutaneous features (stigmata) may develop in a patient with cirrhosis,