上海交通大学医学院外科学各论（英文）课件第十五章 上消化道大出血.ppt

Etiology Peptic disorders Nonsteroidal anti-inflammatory drug–associated disorders Acute gastric mucosal lesions Portal hypertension–related causes Neoplasms of the esophagus, stomach, or duodenum Esophagitis due to infection Dieulafoy’s lesion Aortoduodenal fistula Angiodysplasias Crohn’s disease Hemobilia Hemorrhage from a pancreatic source Peptic disorders Duodenal ulcer Gastric ulcer Reflux esophagitis Gastritis Duodenitis Peptic ulcer Peptic ulcer Neoplasms of the stomach Acute gastric mucosal lesions stress gastritis acute mucosal ischemia erosive gastritis stress ulceration Portal hypertension–related causes Esophageal varices Gastric varices Portal hypertensive gastropathy “Watermelon” stomach Mallory-Weiss tear Mallory-Weiss tear Clinical presentations Hematemesis Melena Anemia Peripheral circulatory failure of bood loss Fever Azotemia Laboratory tests Blood test Fecal test Doppler ultrasonography X-ray CT Angiography Endoscopy Algorithm for the management of upper gastrointestinal bleeding Therapeutic Interventions First-aid measure Medical Management. Endoscopic Therapy. Surgical Therapy. First-aid measure Body position Keep air-way easy and smooth Abrosia Monitoring of vital sign Medical management antiulcer therapy :H2 –receptor antagonist or proton-pump inhibitor cessation of NSAIDs if applicable H. pylori eradication with antibiotics if H. pylori positive. Endoscopic therapy Transendoscopic bipolar electrocoagulation heater probe therapy LASER coagulation Injection therapy Ligation Ligation Injection therapy——Sclerosis Surgical therapy Indication: active hemorrhage not responsive to endoscopic measures significant recurrent hemorrhage after endoscopic treatment an ongoing transfusion requirement transfusion requirements exceeding 6 units of packed red blood cells in a 24-hour interval Choice of operation the goal of surgical intervention in bleeding peptic ulcer is to control hemorrhage. Choice of operation direct suture li