文档介绍：Hemetamesis and Hemetochezia (Acute GI Hemorrhage)
Dr. Wu ShuMing
GI Dept. RenJi Hospital
SSMU
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 .*
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 e melena
Bleeding lesion distal to T be either hematochezia, but never manifests hematemesis
Common cause of up GI bleeding
Peptic ulcer ;
Gastropathy (alcohol, aspirin, NSAIDs, stress);
GE varices;
Gastric cancer
mon 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 monest on the lesser curve away from acid-secreting epithelium.
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.
Duodenum Ulcer
The lesion monly affecting the duodenum is ulceration, and it is now known that both ant