上消化道出血内镜表现和治疗.pptxVIP

上消化道出血内镜表现和治疗第1页/共19页第2页/共19页With the inverted gastroscope a spurting hemorrhage from a fundal varice is discerbnable. Hemostasis is achieved with several low volume injections ofHistoacryl - glue. The right picture shows the therapeutic success.第3页/共19页This massive vessel with active bleeding was diagnosed in a 58 year- old patient, who presented with tary stools. The first picture shows the lesion after injection of fibrin glue. The right picture shows additionally applied hemoclips. Bleeding stopped at the end of the procedure, but reccurred twice before the patient had to be treated surgically. In dieu-la-foy ulcers an arterial vessel of abnormal size reaches the mucosa causing a tiny ulzeration by permanent compression of the mucosal layer. 第4页/共19页Esophageal varices grade II (right) und grade III (left). Cherry red spots are signs of imminenthemorrhage (right). They correspond to areas of especially thin and altered variceal wall. 第5页/共19页This duodenal ulcer at the left edge of the figure, shows an oozing, active bleeding. According to the Forrest classification of gastrointestinal hemorrhage of the upper GI- tract, this bleeding is graded as Forrest Ib. The visible vessel is treated by primary application of a hemoclip. At the 3 week follow- up (fig )the Clip is still in the original position. The ulcer shows a progressive healing. 第6页/共19页Inoperable choledochal cancer. A wall stent had been inserted 3 months earlier. The patient was admitted for severe hemorrhage, which was endoscopically proved to originate from the biliary duct. The hemorrhage was not amenable to endoscopy and surgery. Huge blood clots prolapse from the biliary duct. 第7页/共19页临床表现呕血与黑粪失血性周围循环衰竭血象变化发热氮质血症第8页/共19页诊 断 思 路是上消化道出血吗?出了多少血?出血停止了吗?什么原因引起的出血?第9页/共19页上消化道出血的确立呕血和黑粪,失血性周围循环衰竭,血和粪便 的检查早期识别:直肠指诊排除消化道以外的病因:咯血、口鼻咽出血、 事物或药物第10页/共19页出血量的估计粪便隐血试验阳性 每日消化道出血＞5~10ml黑粪 50~100ml 呕血