消化道出血小讲课 PPT课件.pptx

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1、徐徐言言 Diagnosis of gastrointestinal bleeding:A practical guide forclinicians2008年执业医师资格考试试题：年执业医师资格考试试题：关于上消化道出血的定义，正确的是：关于上消化道出血的定义，正确的是：A.贲门以上部位出血贲门以上部位出血B.幽门以上部位出现幽门以上部位出现C.空肠以上部位出血空肠以上部位出血D.屈氏韧带以上部位出血屈氏韧带以上部位出血E.十二指肠乳头以上部位出血十二指肠乳头以上部位出血Gastrointestinalhemorrhage？Gastrointestinal bleed(GI bleed),a

2、lsoknownasgastrointestinal hemorrhage,isallformsofbloodlossfromthegastrointestinaltract,fromthemouthtotherectum.AnnualhospitaladmissionsforGIbleedingintheUnitedStatesandUnitedKingdomhavebeenestimatedatupto150patientsper100000populationwithamortalityrateof5%-10%2-5.EpidemiologyUpper GI bleedinglower

3、GI bleedingincidence40-150/10000020-27/100000mortality6%-10%4%10%Acute GI bleeding is a major cause of hospital admissions in the United States,which is estimated at 300000 patients annually15.Upper GI bleeding has an annual incidence that ranges from 40-150 episodes per 100000persons and a morality

4、 rate of 6%-10%16-18;compared with lower GI bleeding which has an annual incidence ranging from 20-27 episodes per 100000 persons and a mortality rate of 4%-10%19,20.Acute GI bleeding is morecommon in men than women and its prevalence increase with age13,21.DEFINITIONSOvert(acute)vs occult(chronic)v

5、s obscureDependingontherateofbloodloss,GIbleedingcanmanifestinseveralformsandcanbeclassifiedasovert,occultorobscure.DEFINITIONSUpper vs lowerIn recent years upper GI bleeding has beenredefied as bleeding above the ampulla of Vater within reach of an upper endoscopy;lower GI bleeding has been further

6、 subdivided into mid GI bleeding coming from the small bowel between the ampulla of Vater to the terminal ileum,and lower GI bleeding coming fromthe colon.Etiology and pathophysiologyUpper GI Bleedingulcerativetraumaticportalhypertensionvascular tumorsEtiology and pathophysiologylower GI bleedinginf

7、lammatorytraumaticiatrogenicvascular neoplasticInitial evaluationCT angiographyaccessory examinationUpper endoscopyColonoscopyRadionuclide imagingAs investigations are being planned,infusions of proton pump inhibitor or octreotide should be initiated for suspected bleeding peptic ulcer and varices r

8、espectivelyFigure1Upperendoscopicfindingsinpatientswithsuspecteduppergastrointestinalbleeding.Esophagealvarices(A),Dieulafoyslesioninthestomach(B),gastricantralvascularectasia(watermelonstomach)intheantrumofthestomachpreandpostargonplasmacoagulationtherapy(C,D).Upper endoscopyColonoscopyGIbleedingca

9、nbecausedbyawiderangeofpathologiesandtheydifferinonset,location,riskandclinicalpresentation.InpatientswithactiveGIbleedingwhoareunstable,acuteresuscitationshouldprecedeanyinvestigations.Accurateclinicaldiagnosisiscrucialindeterminingtheinvestigationofchoiceandspecifictreatmentinterventions.Thecorrec

10、tdiagnosticalgorithmreliesonagoodunderstandingofthetypeofGIbleeding,riskevaluationandclinicalpresentationwhichmayindicatethenatureandsourceofbleeding.Upperendoscopyandcolonoscopyarethemainstayofinitialinvestigations.AngiographyandradionuclideimagingarebestsuitedforacuteovertGIbleeding.Capsuleendosco

11、pyanddeepenteroscopyplaysignificantrolesinthediagnosisofobscureGIbleeding,usuallyfromthesmallbowel.CONCLUSION本文章深入浅出的对消化道出血的诊断思路做出了简略的介绍，有着对以前书本知识的巩固，也有着新知识的融入。希望本次文献阅读能够给大家一个更崭新的诊疗方向，使大家对于疾病有更深更细致的分类和理解，也能够由此展开更为针对性的治疗，并改善患者的预后。疾病不分难易，但生命有长短。哪怕是知识的一点点更新，也是对自身的提高，更为生命的救治打下了基础。读书育人，空气养人，希望这份简单的PTT是温故知新，也能够启发大家去探索、查找更多的知识。