Gastrointestinal hemorrhage(中国医大7年制《内科学》课件).ppt

Gastrointestinal hemorrhage Case ：患者男,45岁。近5年常出现乏力、食后腹胀、食欲不振,大便不成形,日2次。8h前突然剧烈恶心,呕吐暗红色血约1500毫升,吐后自觉头晕、心悸、晕倒在厕所,面色苍白,周身大汗淋漓,半小时后神志转清,而急来我院,来院途中又呕血一次量约500ml。既往无肝炎、心脏病及溃疡病史。体格检查：体温37.5℃，108次/分，血压90/45mmHg。神志清楚，面色灰暗，睑结膜苍白，巩膜黄染，面部及颈部各见一个蜘蛛痣,心肺正常。腹部平软，肝肋下未触及，脾肋下3厘米，移动性浊音可疑，肠鸣音12次／分,无气过水音。 Question：1、What is the initial diagnosis? 2、How to manage? Definitions Acute upper gastrointestinal bleeding is defined as the development of sudden blood loss from the upper gastrointestinal tract(i.e.esophagus,stomach,dudenum or bladder and pancreas) leading to melena or hematemesis. 上消化道出血：指Treitz韧带以上的消化道，包括食管、胃、十二指肠或胆胰等病变引起的出血；胃空肠吻合术后的空肠出血亦属此范围。 上消化道大量出血：指短期内的失血量超出1000毫升或循环血容量的20%。 The overall approach to the patient with GI hemorrhage Recognition of hemorrhage and assessment of severity ↓ Resuscitation ↓ Differentiation of upper from lower GI hemorrhage ↓ Empiric therapy for upper GI hemorrhage ↓ Diagnosis ↓ Treatment How to recognize? Recognition of GI hemorrhage 一、clinical manifestation: 呕血Hematemesis is the vomiting of blood.this may be fresh and red with clots when bleeding is profuse, or black (coffee grounds) when less severe. 黑便Melaena is the passage of black, tarry ,sticky, odoriferous stools due to the presence of altered blood and 95% of cases originate from the upper GI tract. 二、signs and symptoms of hypovolemia patient often complains of faintness,sweating,palpitation,fatigue,thi-rst,and syncope.Main physical signs are pallor,sweating, Restlessness,tachycardia hypotension. pulse and blood pressure： 三、anemia :either symptomatic or detected only by routine laborator