消化道出血med126com材料.ppt

消化道出血;消化道出血-----呕血;呕血;; 对出血的诊断、治疗及预防之前，病人的血液动力学必须稳定。 Despite the increasing armamentarium of the therapeutic endoscopist and angiographer（血管造影）, the cornerstone of management for GI hemorrhage remains rapid assessment of the patient with appropriate resuscitation. The patient must be hemodynamically stabilized before diagnosis, therapy, and prevention of rebleeding can begin. ;病因;病 因;病因;病因;病因;一．消化性溃疡（Peptic Ulcers ）;二. 门脉高压症　（Portal Hypertension） ;;三．食管喷门粘膜撕裂综合征Mallory-weiss syndrome;食管喷门粘膜撕裂综合征Mallory-weiss syndrome;五．胃肿瘤;胃黏膜损伤;应激性病变;食管损伤;四．The Dieulafoys ;;;呕血的原因以消化性溃疡引起最为多见. 其次为胃底或食道静脉曲张破裂 再次为急性胃粘膜病变. ;临床表现;临床表现;临床表现;临床表现;出血量的估计:;出血量的估计;临床表现;临床表现;伴随症状:;伴随症状;在诊断上消化道出血的诊断过程中,必须注意以下几个问题: ㈠排除消化道以外的出血因素 ⑴ 排除来自呼吸道出血: 大量咯血时, 可吞咽 入消化道,而引起呕血或黑便. ⑵ 排除口、鼻、咽喉部出血:注意病史询问和 局部检查. ⑶ 排除进食引起黑便:如动物血, 炭粉, 含铁剂 的药物或含铋剂的药物. ;问诊要点;便血(hematochezia);病 因;病因;病因;The most common causes of chronic lower GI bleeding are hemorrhoids （痔）and colonic neoplasia（结肠新生物）. As is the case with upper GI bleeding, 80% of bleeding episodes resolve spontaneously. Among the patients in whom bleeding ceases, 25% have recurrent bleeding. Unlike upper GI bleeding, most lower GI bleeding is slow and intermittent and does not require hospitalization. ; Final Diagnoses of acute lower GI bleeding of Major Lower Gastrointestinal Bleeding DIAGNOSIS PERCENT OF TOTAL DIAGNOSIS Diverticulosis（憩室） 43 Angiodysplasia（血管发育不良） 20 Undetermined（不明原因） 12 Neoplasia（肿瘤） 9 Colitis（结肠炎） 9 Radiation 6 Ischemic缺血性 2 Ulcerative 1 Other（其它） 7 ;Diverticular Bleeding ;Diverticular Bleeding ;Diverticular Bleeding ;Angiodysplasia ;Angiodysplasia ;;Neoplasms ;Perianal Disease 肛周疾病;Meckels Diverticulum shows gastric mucosa;Meckels