上消化道出血(双语)-精品医学课件

Ligament of Treitz
Papilla of Vater
Ileocecal Valve
Upper GI (UGI)：proximal to the ligament of Treitz.
Mid-GI (MGI) ：From the ligament of Treitz to the ileocecal Valve
Dieulafoy’s lesion (杜氏病)
hookworms
Allergic Purpura
Duodenal mucosal purpura
2. Etiology
What are the causes of UGIB ? What are the most common causes ?
Esophageal varices Gastric varices
Etiology
The etiologies can be classified as
3. The diseases of organ or tissue near the upper gastrointestinal tract
• Disease of blood vessel • Hematopathy, leukemia, hemophilia • Uremia • Diseases of connective tissue • Stress-related gastric mucosal injury
(烧伤Curling ulcer, 脑血管意外Cushing ulcer) • Acute infection (Ebola virus, Dengue virus), etc.
➢ to cause hypovolemic shock ( hypotension, tachycardia)
➢ Manifestations: hematemesis, melena, etc
➢ The mortality is 10%, misdiagnosis rate of etiology is 20%
Q: Are there any special in UGI ? Special environment: gastric acid, pepsin Standard gastroscopy
Interaction
Do they belong to Upper Gastro-intestinal Bleeding?
2. Etiology
What are the causes of UGIB ? What are the most common causes ?
2. Etiology
What are the causes of UGIB ? What are the most common causes ?
• Biliary hemorrhage • Pancreatic diseases • Arterial tumor • Mediastinal tumor or abscess, etc.
Etiology
The etiologies can be classified as
4. Systemic diseases 全身性疾病
1. Definition
Where is upper gastrointestinal (UGI) tract ? What is acute upper GI bleeding ? What is massive UGIB ?
1. Definition
Where is upper gastrointestinal (UGI) tract ? What is acute upper GI bleeding ? What is massive UGIB ?
syndrome); chemical (strong acid or alkali); radioactive, etc.
Mallory – Weiss tear
Etiology
The etiologies can be classified as
1. Upper gastrointestinal diseases 1.2 gastroduodenal diseases: • peptic ulcer, stoma ulcer • acute erosive-hemorrhagic gastropathy • gastric cancer • Vascular abnormity ( Vascular Ectasia,
Summary
Definition
Upper Gastro-intestinal Tract
anatomic landmark The digestive tract above the Treitz ligament or papilla of Vater
includes esophagus, stomach, duodenum.
duodenal-jejunal junction
Q: Where is the papilla of Vater ? an important landmark, halfway
along the second part of the duodenum
Dct ?
Upper Gastrointestinal Bleeding
( UGIB )
Upper Gastrointestinal Bleeding
abbreviation ( UGIB )
Zheng Jianwei
Department of Gastroenterology The First Affiliated Hospital of Xiamen University
Etiology
The etiologies can be classified as
1. Upper gastrointestinal diseases 1.1 Esophageal disorders 1.2 gastroduodenal diseases
2. Portal hypertension-related causes
1. Definition
Where is upper gastrointestinal (UGI) tract ? What is acute upper GI bleeding ? What is massive UGIB ?
Upper GI massive bleeding
➢ rapid loss of blood ( >1000ml) or more than 20% of blood volume within several hours
Q：Bleeding from bile duct, pancrease？ from jejunum near gastrointestinal anastomasis？ from mouth, pharynx and larynx？ from ruptured aortic aneurysm into esophagus？
3. The diseases of organ or tissue near the upper gastrointestinal tract
4. Systemic diseases 全身性疾病
Etiology
The etiologies can be classified as
1. Upper gastrointestinal diseases 1.1 Esophageal disorders: • esophagitis( reflux esophagitis) • esophageal carcinoma • esophageal ulcer • esophageal injury: physical ( Mallory-Weiss
Definition
Q: Why do they have different anatomic landmark of UGI, the ligament of Treitz or the papilla of Vater ?
As the lower bend of the duodenum is not always reached with standard gastroscopy, to set the boundary to the papilla of Vater, all bleeding sites can be reached and treated endoscopically.
Definition
What is acute upper GI bleeding?
Upper GI bleeding is from a source proximal to the ligament of Treitz ( or the papilla of Vater)
Acute bleeding is defined as the the development of sudden blood loss.
（8th edition）
Lower GI (LGI)：Distal to the ligament of Treitz
（Old Edition）.
Distal to the ileocecal valve
（New Edition）
Where is UGI tract ?
Q: What is the ligament of Treitz? is an anatomic landmark for the
Arteriovenous Malformations, Dieulafoy’s Lesion) • Zollinger-Ellison syndrome • Prolapse of gastric mucosa • acute erosive duodenitis • gastric lesions after gastrectomy, etc.
3. Clinical Presentation
Hematemesis & Melena ( or hematochezia) Signs and symptoms of blood loss Anemia & hemogram Occult blood in the stool fever Elevation in the BUN level
Pancreas, biliary tract & jejunum after gastrojejunostomy are also in this range
1. Definition
Where is upper gastrointestinal (UGI) tract ? What is acute upper GI bleeding ? What is massive UGIB ?
Peptic ulcer
Acute erosive hemorrhagic gastritis
Gastric Cancer
Etiology
The etiologies can be classified as
2. Portal hypertension-related causes
portal hypertensive gastropathy (PHG)
Etiology
The most common diseases ?
➢ Peptic ulcer 50%
➢ Varices of esophagus &
fundus of stomach 25%
➢ Acute erosive hemorrhagic
lesion 15~30%
➢ Gastric cancer 5%
Where is UGI tract ?
Definition
Q: How many parts of the GI ( gastrointestinal ) tract are divided into ?
Q: What are the anatomical demarcation (landmark)s ?