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小儿肠胃道出血
学习目标PGY1PGY21.认识小儿肠胃道出血2.小儿肠胃道出血处置1.小儿肠胃道出血的分类2.能诊断小儿肠胃道出血3.小儿肠胃道出血处理
INTRODUCTIONUppergastrointestinal(UGI)bleeding(arisingproximaltotheligamentofTreitzinthedistalduodenum)commonlypresentswithhematemesis(vomitingofredbloodorcoffeeground-likematerial)?and/or?melena(black,tarrystools).Hematochezia(brightredormaroon-coloredbloodorfreshclotsperrectum)isusuallyasignofalowergastrointestinal(LGI)source(definedasdistaltotheligamentofTreitz).
ETIOLOGYThemostcommoncausesofUGIbleedinginchildrenvarydependinguponageandthegeographicsetting.InWesterncountries,themostcommoncausesaregastricandduodenalulcers,esophagitis,gastritis,andvaricesThemostcommoncausesofrectalbleedingininfantsareanalfissureorcowsmilkorsoyprotein-inducedcolitis.Inchildren12monthsandolder,themostcommoncausesofrectalbleedingareinfectiousgastroenteritisandanalfissures.?
UGIbleeding
Neonates?—?UGIbleedingTrueUGIbleedinginaneonatemustbedistinguishedfromswallowedmaternalbloodVitaminKdeficientbleeding(hemorrhagicdiseaseofthenewborn)shouldbeconsideredinneonateswhowerenotgivenvitaminKprophylaxisatbirthStressgastritisorulcersareassociatedwithcriticalillnessbutalsomayoccurspontaneouslyeveninthefirstfewdaysoflifeCongenitalanomaliesincludingintestinalduplicationsorvascularanomaliesmaypresentwithgastrointestinal(GI)hemorrhageCoagulopathyinaneonatemayalsobecausedbyinfection,liverfailure,oracongenitalcoagulationfactordeficiency.SeveraltypesofcoagulopathiescanpresentduringthenewbornperiodMilkproteinintolerancemaypresentwithUGIbleeding,althoughlowergastrointestinal(LGI)bleedingismuchmorecommon.
Infants,childrenandadolescents—?UGIbleedingMallory-Weisssyndrome–Mallory-Weisssyndromeischaracterizedbylongitudinalmucosallacerationsinthedistalesophagus,usuallydevelopin
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