抗生素英文课件精品Gastrointestinal.pptVIP

Gastrointestinal Bleeding Jarrett Lefberg South Pointe Hospital Incidence Upper GI bleed 100/100,000 Above the ligament of Treitz Lower GI Bleed 20/100,000 Below the ligament of Treitz Both are more common in males and elderly. Causes of Upper GI Bleed 1) Peptic ulcer disease - most common cause A) duodenal ulcers 29% will rebleed in 10% of cases within 24-48h B) gastric ulcers 16% more likely to rebleed C) stomal ulcers 5% Causes of Upper GI Bleed 2) Erosive gastritis, esophagitis, duodenitis some causes are ETOH, ASA, NSAID’s 3) Esophageal and gastric varices causes by portal hypertension 4) Mallory-Weiss syndrome – longitudinal mucosal tear in the cardioesophageal region caused by repeated retching Causes of Upper GI Bleed 5) stress ulcers 6) arteriovenous malformation 7) malignancy 8) aortoenteric fistula Causes of Lower GI Bleeding 1) Hemorrhoids - most common cause 2) Diverticulosis – common, painless, and can be massive Caused from an erosion into a penetrating artery from the diverticulum. 3) Arteriovenous malformations – common and seen in people with hypertension and aortic stenosis Causes of Lower GI Bleeding 4) CA/polyps 5) inflammatory bowel disease 6) infectious gastroenteritis 7) Meckel diverticulum Diagnosis Questions to ask in history Any hematemesis, coffee-ground emesis, melena, or hematochezia. Any weight loss or changes in bowel habits. Any vomiting and retching. Any history aortic graft. Any history of ASA, NSAID’s, steroids. Any ETOH abuse. Any history of iron or bismuth which can simulate melena and beets which can simulate hematochezia. Note stool guaiac testing will be negative. Diagnosis Physical exam Vital signs may show hypotension and tachycardia. Cool, clammy skin then in shock. Spider angiomata, palmer erythema, jaundice, and gynecomastia seen in liv