诊断性呕吐和粪便中的血液.pptVIP

Hematemesis Melena Hematochezia More proximal lesions produce hematemesis or melena, whereas more distal lesions are more likely to produce hematochezia. If hematochezia is from an upper GI source, it usually reflects a massive bleed (i. e. , greater than 1000 ml). What is the causes of bleeding? 90% upper GI bleeding is due to four lesions: 1) peptic ulcer (消化性溃疡) 2) hemorrhagic gastritis (胃炎) 3) esophageal or gastric varices (　静脉曲张) 4) gastric cancer peptic ulcer hemorrhagic gastritis esophageal varices gastric cancer Causes of gastrointestinal bleeding Mallory-Weiss tear 食道 - 贲门撕裂伤 Causes of gastrointestinal bleeding Portal-hypertensive gastropathy 门脉高压胃病 Ancylostomiasis 钩虫病 Post-sphincterotomy 括约肌切开术后 Causes of gastrointestinal bleeding Colorectal cancer Colitis Large hemorrhoid 大痔 Rectum tear 肛裂 Vascular anomalies Hematologic diseases Diagnostic approach to gastrointestinal bleeding 1 History and physical examination 2 Endoscopy 3 Barium radiography 4 Angiography 5 Nuclear scintigraphy History and physical examination A history of previously docu-mented GI tract disease determined by radiography, endoscopy, or surgical procedures is very useful. Diagnostic approach to GI bleeding Diagnostic approach to GI bleeding Patients with hepatitis B or chronic active liver disease may present with painless hematemesis from esophageal varices. Diagnostic approach to GI bleeding Patients with forceful, retching (干呕) or multiple episodes of vomiting of food prior to the onset of hematemesismay be bleeding from Mallory－Weisstears of the gastroesophageal junction. Diagnostic approach to GI bleeding A history of epigastric (上腹部) burning pain promptly relieved by foodor antacids (抗酸剂) or nocturnal (夜间) pain suggests peptic ulcer disease,particularly duodenal (十二 指肠) ulcer. Diagnostic approach to GI bleeding