便血病理ppt课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Hemetamesis and Hemetochezia(Acute GI Hemorrhage),Hemetamesis and Hemetochezia(,1,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,Five Ways of GI BleedingHemate,2,Factors affect the way to manifest,Site of bleeding,Speed of bleeding,Amount of blood loss,Flora of enterocolon,.,Factors affect the way to mani,3,Differentiating Upper from Low GI Bleeding,Hematochezia usually represents a lower GI source bleeding,Upper GI lesion may bleed so briskly that blood doesnt remain in bowl long enough to become melena,Bleeding lesion distal to T Lig.may be either M.or hematochezia,but never manifests hematemesis,Differentiating Upper from Low,4,Common cause of up GI bleeding,Peptic ulcer；,Gastropathy（alcohol，aspirin，NSAIDs，stress）；,GE varices；,Gastric cancer,Common cause of up GI bleeding,5,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；Crohns disease；amyloidosis,hematological diseases,Less common cause of up GI ble,6,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.,BENIGN GASTRIC ULCERThe class,7,Location of benign gastric ulcers,in relationship to the distance from the pylorus.The majority of benign ulcers will be found on the lesser curvature within 3 cm of the angulus.,Location of benign gastric ul,8,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.,Duodenum UlcerThe lesion most,9,Bleeding From EV,A number of cutaneous features(stigmata)may develop in a patient with cirrhosis,and these are important as they aid clinical recognition of chronic liver disease.,Bleeding From EVA number of cu,10,便血病理ppt课件,11,便血病理ppt课件,12,便血病理ppt课件,13,Bleeding Survey:Endoscopic Findings in 214 Patients With Clear Nasogastric Aspirates,FINDING NUMBER OF PATIENTS INCIDENCE(%),Duodenaal ulcer 64 29.8,Gastric erosions 57 6.5,Gastric ulcer 47 21.9,Esophagitis 23 10.7,Duodenitis 21 9.8,Varices 11 5.1,Mallory-Weiss tear 10 4.7,Neoplasm 8 3.7,Stomal ulcer 7 3.3,Esophageal ulcer 2 0.9,Telangiectasia 0,Other 18 8.4,Bleeding Survey:Endoscopic Fi,14,Clinical manifestation of GI Bleeding,Abdominal disconfort,Nausea,Hemadynamic change:reduction in blood volume(syncope,light-headedness,sweating,therst)or shock,Laboratory changes:HCT,BUN,Clinical manifestation of GI B,15,Hematemesis with other symptoms,Hematemesis with upper abdominal pain,Hematemesis with hepatomegly and spleenomegly,Hematemesis with jaundice,Hematemesis with Skin&mucosa hemorrhage,Hematemesis with upper abdominal mass,Others:NSAIDs,Stress,Burning,Brain operation,Trauma,Vomiting,Hematemesis with other sympto,16,Lab.Examination in Localization&Diagnosis of GI Bleeding,Endoscopy,Barium Radiographs,Angiography,Radionuclide imaging,Lab.Examination in Localizatio,17,Approach to the patient with acute upper gastrintesttinal hemorrhage,Acute upper Gastrointestinal Hemorrhage,Rapid assessment Monitor hemodynamic status,Fluid resuscitation Gastric lavage(?),self-limited(80%)bleeding(10-20%),Empiric medical therapy,Urgent endoscopy,recurrent hemorrhage,endoscopy Site not localized Localized,further assessment,enteroscopy,radioisotope s scan,angiography,exploratory surgery,Definitive therapy,Definitive therapy,Approach to the patient with a,18,便血病理ppt课件,19,Endoscopic view of a Mallory-Weiss tear with active bleeding(gastric lumen is at top left).B,Endoscopic view of an organized clot adherent to a Mallory-Weiss tear(gastric lumen is at bottom left).,Endoscopic view of a Mallory-W,20,Endoscopic view of a Dieulafoy lesion on the lesser curvature of the stomach,Endoscopic view of a Dieulafoy,21,Endoscopic view of a vascular ectasia(angiodysplasia)in the duodenum.,Endoscopic view of a vascular,22,Endoscopic view of the gastric antrum with watermelon stomach.The pylorus is at top center.Note the linear distribution pattern of the vascular lesions arranged radially around the pylorus.,Endoscopic view of the gastric,23,Endoscopic views of ulcers with stigmata of recent hemorrhage.A,Duodenal ulcer with a visible vessel.B,Gastric ulcer with a red