消化道出血小講課

1、徐言,Diagnosis of gastrointestinal bleeding: A practical guide forclinicians,2008年執(zhí)業(yè)醫(yī)師資格考試試題：→關于上消化道出血的定義，正確的是：A.賁門以上部位出血B.幽門以上部位出現(xiàn)C.空腸以上部位出血D.屈氏韌帶以上部位出血E.十二指腸乳頭以上部位出血,Gastrointestinal hemorrhage？Gastrointestina

2、l bleed (GI bleed), also known as gastrointestinal hemorrhage, is all forms of blood loss from the gastrointestinal tract, from the mouth to the rectum.,Annual hospital admissions

3、for GI bleeding in the United States andUnited Kingdom have been estimated at up to 150 patients per 100000 population with a mortality rate of 5%-10%[2-5].,Epidemiology,Acute GI bleeding is a major cause of hospital ad

4、missions in the United States, which is estimated at 300000 patients annually[15]. Upper GI bleeding has an annual incidence that ranges from 40-150 episodes per 100000persons and a morality rate of 6%-10%[16-18]; compa

5、red with lower GI bleeding which has an annual incidence ranging from 20-27 episodes per 100000 persons and a mortality rate of 4%-10%[19,20]. Acute GI bleeding is morecommon in men than women and its prevalence increas

6、e with age[13,21].,DEFINITIONS,Overt (acute) vs occult (chronic) vs obscureDepending on the rate of blood loss, GI bleedingcan manifest in several forms and can be classified asovert, occult or obscure.,DEFINITIONS,U

7、pper vs lower,In recent years upper GI bleeding has beenredefied as bleeding above the ampulla of Vater within reach of an upper endoscopy; lower GI bleeding has been further subdivided into mid GI bleeding coming from

8、the small bowel between the ampulla of Vater to the terminal ileum, and lower GI bleeding coming fromthe colon.,,,Etiology and pathophysiology,Upper GI Bleeding,,Etiology and pathophysiology,lower GI bleeding,,,,Initial

9、 evaluation,,,,,As investigations are being planned, infusions of proton pump inhibitor or octreotide should be initiated for suspected bleeding peptic ulcer and varices respectively,Figure 1 Upper endoscopic findings in

10、 patients with suspected upper gastrointestinal bleeding. Esophageal varices(A), Dieulafoy’s lesion in the stomach (B), gastric antral vascularectasia (watermelon stomach) in the antrum of the stomach pre and post argon

11、plasma coagulation therapy (C, D).,Upper endoscopy,Colonoscopy,GI bleeding can be caused by a wide range of pathologies and they differ in onset, location, risk and clinical presentation. In patients with active GI bleed

12、ing who are unstable, acute resuscitation should precede any investigations. Accurate clinical diagnosis is crucial in determining theinvestigation of choice and specific treatment interventions. The correct diagnostic

13、algorithm relies on a good understanding of the type of GI bleeding, risk evaluation and clinical presentation which may indicatethe nature and source of bleeding. Upper endoscopy and colonoscopy are the mainstay of ini

14、tial investigations. Angiography and radionuclide imaging are best suited for acute overt GI bleeding. Capsule endoscopy and deep enteroscopy play significant roles in the diagnosis of obscure GI bleeding, usually from t

15、he small bowel.,CONCLUSION,本文章深入淺出的對消化道出血的診斷思路做出了簡略的介紹，有著對以前書本知識的鞏固，也有著新知識的融入。 希望本次文獻閱讀能夠給大家一個更嶄新的診療方向，使大家對于疾病有更深更細致的分類和理解，也能夠由此展開更為針對性的治療，并改善患者的預后。疾病不分難易，但生命有長短。哪怕是知識的一點點更新，也是對自身的提高，更為生命的救治打下了基礎。讀書育人，空氣養(yǎng)人，希望這份簡單的PTT