下消化道出血(培训课件.pptVIP

定义(Definition);病因;肠道原发疾病;Partiallyulceratedcolorectalcancerwithcompletecircumferentialinfiltration.;Asmallwhitishhyperplasticpolypwithwell-depictedandregularlydistributedcryptopeningsisseenbesideofavillousadenoma.;炎症性病变;TwocasesofCrohnsdiseasewithlargenodulesandnarrowingofthelumen.;IschemicColitis，Longitudinalinvolvementofthedescendingcolonwithaswollenmucosaaccompaniedbyhemorrhageandexudates.;RadiationColitis，Alargeulceraccompaniedbyformationoffistulasinapatientpreviouslytreatedwithsurgeryandadjuvantradiationtherapyforrectalcarcinoma.;血管病变;Bleedingcecalangiodysplasiacausingacutemassivebleeding.Afterrinsingthoroughlythelesionisclearlyidentified.Identifythelesionontherightimagebyusingthemousepointer.;肠壁结构性病变;Sigmoideumdiverticulosiswithmultipleoutpouchings.Observefecalimpactioninoneofthediverticula(upperleft).;Smallanalfissurewithoozebleeding.;全身疾病累及肠道;下消化道出血的最常见原因;诊断;除外上消化道出血;下消化道出血的定位及病因诊断;出血前病史

结核病、血吸虫病、腹部放疗史可引起相应的肠道疾病

动脉硬化、口服避孕药可引起缺血性肠炎

在血液病、风湿性疾病病程中发生的出血应考虑原发病引起的肠道出血;粪便颜色和性状

血色鮮红，附于粪表面多为肛门、直肠、乙状结肠病变，便后滴血或喷血常为痔或肛裂

右侧结肠出血为暗红色或猪肝色，停留时间长可呈柏油样便

小肠出血与右侧结肠出血相似，但更易呈柏油样便

粘液脓血便多见于菌痢、溃疡性结肠炎，大肠癌特别是直肠、乙状结肠癌有时亦可出现粘液脓血便

;伴随症状

伴有发热见于肠道炎症性病变，由全身性疾病如白血病、淋巴瘤、恶性组织细胞病及风湿性疾病引起的肠出血亦多伴发热

伴不完全性肠梗阻症状常见于克罗恩病、肠结核、肠套叠、大肠癌,往往伴有不同程度腹痛

不伴有明显腹痛的多见于息肉、未引起肠梗阻的肿瘤、无合并感染的憩室和血管病变

;体格检查;实验室检查;影像学检查;结肠镜检查;X线钡剂造影;小肠X线钡剂造影;放射性核素扫描;选择性腹部血管造影;小肠镜检查;胶囊内镜检查;吞棉线试验;手术探查;下消化道出血的诊断歩骤;下??化道出血的诊断歩骤;治疗原则;一般治疗;补充血容量;补液量是否充分的判断指标;治疗;内镜下止血;Smallangiodysplasiatreatedwiththehotbiopsyforcepsintwosteps.Aftergraspingandliftingthelesioncoagulationisapplied..;OozebleedingfromatinyDieulafoys-likelesionintheascendingcolonthatwassubsequentlytreatedwiththeheaterprobe.;动脉栓塞治疗;谢谢大家！