上海交大外科学上血pbl.pptVIP

For Reference Peptic ulcer消化性溃疡 Stress gastritis应激性胃炎 Stomach neoplasms胃肿瘤 Portal hypertension门脉高压 Hemobilia胆道出血 Miscellaneous其他少见原因 Peptic Ulcer history of chronic ulcer epigastric pain (nocturnal symptoms) 上腹痛（夜间痛） dyspepsia消化不良 satiety饱胀 history of mucosa damage diet smoking NSAIDs 非甾体类抗炎药物 Adrenal cortical hormone肾上腺皮质激素 usually melena, sometimes hematemesis Stress Gastritis history of stress应激病史 burn injuries head injuries predisposing clinical conditions可导致应激的临床情况 shock休克 multiple trauma多发伤 ARDS (acute respiratory distress syndrome)急性呼吸窘迫综合征 SIRS (systemic inflammatory response syndrome)全身炎症反应综合征 MODS (multiple organ dysfunction syndrome)多脏器功能障碍综合征 sepsis脓毒症 Stomach Neoplasms middle age中年 weight loss体重减轻 anorexia厌食 irregular epigastric pain不规则腹痛 abdominal mass腹部包块 Portal Hypertension predisposing history of cirrhosis肝硬化基础疾病 hepatitis肝炎 Schistosomiasis血吸虫病 alcohol abuse酒瘾 special features特殊体征 jaundice黄疸 ascites腹水 dilated vein in the anterior abdominal wall腹壁静脉怒张 rectal hemorrhoids痔 Formation of Portal System 3 inflow vein collect blood from spleen, pancreas, stomach, intestine, colon, and rectum splenic vein superior mesenteric vein inferior mesenteric vein 2 branches into left right hepatic lobe through hepatic sinus to hepatic vein to IVC 75% blood supply, 50% oxygen supply of liver Collateral Vascular System侧支循环 esophageal-fundus submucosal venous plexus食管下段-胃底交通支 rectal hemorrhoidal system直肠下段肛管交通支 retroperitoneal system后腹膜交通支 anterior abdominal wall system前腹壁交通支 Definition of Portal Hypertension normal portal pressure: 13-24cmH2O normal hepatic vein pressure gradient (HVPG) : 5-9cmH2O portal hypertension: 30-50cmH2O HVPG 12mmHg leads to UGIB Cause of Hypertension cirrhosis hepatic sinus narrowness portal blood inflow blocked high pressure hepatic artery flow to low pressure portal vein Pathophysiology of Portal Hypertension splenemegaly hypersplenism脾肿大/脾功能亢进 peripheral total blood count decrease collateral vascular varix侧支静脉曲张 esophageal-fundus