临床诊断学呕血便血幻灯片.pptVIP

colon carcinoma hemorrhoid familial polyposis diverticulum Vascular ectasia, polyp 临床表现 血便的颜色 血与便 鉴别 影响因素： 出血部位 出血量 血液在肠腔内停留时间 血与便 混合均匀：上消化道、小肠 混合不均匀：下消化道 鉴别： 1.食用动物血、肝等 2.口腔、鼻、咽、支气管、肺等部位出血咽下 3.口服某些中草药、铁剂、铋剂、炭粉等 伴随症状 伴腹痛 伴里急后重 伴腹部肿块 伴发热 伴皮肤粘膜出血 1.便血的病因和诱因 饮食、服药史或集体发病 2.便血的量 估计失血量（结合全身反应更准确） 3.伴随的症状 4.患者一般情况变化 5.既往史 过去有否腹泻、腹痛、腹鸣、痔、肛裂 病史，有否用过抗凝药物、有否胃肠手术史等。 问诊要点 小结 常见病因 临床表现 呕血与便血的联系 Hematemesis Melena Hematochezia 思考题 1. 呕血最常见的病因是什么？ 2. 不同低血容量状态的临床表现是什么? 谢谢 * Let us see the concept .What is hematemesis. Who can tell me. In fact hematemesis is a medical term ,the meaning in similar to the simple phrase “volmeting of blood ” according to anatomic point, hematemesis. Often Indicates an upper gastro-intestinal site of bleeding, always proximal to the ligament of Treitz. In clinic practice it is a rule. * the image is reflecting Esophageal Varices, the shape is like a continous nodules or a string of beads. it’s a result from portal hypertension. And portal hypertension is the typical clinic menisfatation of decompensated liver cirrhosis The varices are dilated veins that are under high pressure with thin walls, Bleeding from esophageal or gastric varices is often aggressive and frequently accompanied by hemodynamic instablity. The mortality rate is relatively high . * Mallory-Weiss tear also called esophagogastric mucosal lacertionIt is the third common cause of hematemesis. ,the lacertion is longitudinal lesion at the cadia,most are superficial, it is caused by violent retching ,usualy after alcoholic binge. The clinic present is vomiting blood after vomiting food and clear fluid .majority are selflimited. 呕血 Hematemesis 蔡玲 定义 呕血(hematemesis):是由上消化道疾病或全身性疾病所致的急性上消化道出血. 上消化道指屈氏韧带以上的消化器官,