消化道出血武汉大学人民医院消化内科.ppt

消化道以屈氏韧带(the ligament of Treitz)为界，其上的消化道出血称上消化道出血，其下的消化道出血称为下消化道出血 Supper Gastrointestinal Hemorrhage 上消化道出血 Etiology Upper gastrointestinal bleeding is most commonly caused by peptic ulceration, gastroesophageal varices, acute erosive and hemorrhagic gastritis, and gastric cancer 病因 消化性溃疡 食管胃底静脉曲张破裂 急性糜烂出血性胃炎 胃癌 Etiology Esophageal Diseases Esophagitis Esophageal ulceration Tumor of the esophagus Esophagus diverticulitis Esophagus injury: physical (Mallory-Weiss Tear); chemical (strong acid or alkali); radioactive Duodenal and Gastric Diseases Gastric Ulcer; Acute erosive and hemorrhagic gastritis; Gastric cancer; Gastric polyp; Zollinger-Ellison Syndrome; MALToma; Neurofibromatosis; Gastric vascular abnormity (Vascular Ectasia, Arteriovenous Malformations, Dieulafoys Lesion); Prolapse of gastric mucosa; Gastritis after operation; stoma ulcer Duodenal Ulcers; Duodenal diverticulitis; Acute erosive duodenitis; Crohn’s disease; Duodenal tuberculosis Portal Hypertension-Related Causes Esophageal varices Gastric varices Portal hypertensive gastropathy Hemobilia Including trauma, gallstones, cholecystic carcinoma, cholangiocarcinoma, ascariasis of biliary tract, liver cancer, liver abscess, hepatic hemangioma Hemosuccus Pancreaticus Pancreatic cancer Erosion of a pseudocyst into the splenic or peripancreatic artery or formation of an arterial aneurysm in the course of chronic pancreatitis Systemic Diseases Vascular Diseases: hypersusceptible purpura hereditary hemorrhagic telangiectasia Hematic Diseases: haemophilia; thrombocytopenic purpura Uremia Connective Tissue Diseases: polyarteritis nodosa; systemic lupus erythematosus Stress-related gastric mucosal injury （一）上消化道疾病 1．食管疾病 2．胃十二指肠溃疡疾病 （二）门静脉高压引起的食管胃底静脉曲张破裂或门脉高压性胃病 （三）上消化道邻近器官或组织的疾病 （1）胆道出血 （2）胰腺疾病累及十二指肠 （3）主动脉瘤破入食管、胃或十二指肠 （4）纵隔肿瘤或脓肿破入食管 （四）全身性疾病 1．血管性疾病 2．血液病 3．尿毒症 4．结缔