西安交通大学医学院消化系统疾病课件 Massive Upper Gastrointestinal Hemorrhage.pptVIP

Massive Upper  Gastrointestinal  Hemorrhage Qiao Wen 1. Upper gastrointestional tract  *the digestive tract above the treitz ligament.  *includes esophagus, stomach, duodenal, pancreas, and biliary tract, jejunum after gastrojejunostomy is also in this range. 2. Massive upper gastrointestinal hemorrhage *rapid loss of sufficient blood (1000ml) within several hours,or more than 20% of blood volume to cause hypovolemic shock (hypotension, tachycardia). *manifestations: hematemesis, melena, etc. *The mortality is 10%，misdiagnosis rate of etiology is 20%.  The most common diseases The etiologies can be classified as  1.Upper gastrointestinal diseases1.1 esophageal diseases esophagitis (reflux esophagitis) 1.2 gastroduodenal diseases peptic ulcer; acute erosive-hemorrhagic gastropathy; gastric cancer; abnormal blood vessel of stomach; 2. The rupture of varices of esophagus and gastric fundus portal hypertensive gastropathy 3.The disease of organ or tissue near the upper gastrointestinal tract3.1 biliary hemorrhage3.2 pancreatic diseases3.3 arterial tumor 3.4 mediasdinal tumor or abscess 4. Systemic diseases4.1 disease of blood vessel 4.2 hematopathy leukemia, hemophilia 4.3 uremia 4.4 diseases of connective tissue4.5 stress-related gastric mucosal injury4.6 acute infection Manifestation  1.Hematemesis and melena *All patients after the massive gastrointestinal hemorrhage have melena, but not everyone has hematemesis. *The site of hemorrhage below the pylorus, there is only melena, but above the pylorus, the melana can be with hematemesis.  however, if the lesion below pylorus, the hemorrhage is very large and fast, the blood can reflux to stomach, th