食管胃底静脉曲张出血

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.
常见病因
消化性溃疡 (十二指肠和胃) 食管和胃静脉曲张 Mallory-Weiss 综合征 胃或十二指肠糜烂 血管瘤 肿瘤
33-51% 23-33% 3-10% 1-19% 0-7% 1-5%
With the inverted gastroscope a spurting hemorrhage from a fundal varice is discerbnable. Hemostasis is achieved with several low volume injections of Histoacryl - glue. The right picture shows the therapeutic success.
再次升高
➢出血后48小时以上未再继续出血,再出血可能性小; ➢既往有大出血史、本次出血量大、24小时内反复大量
出血、食管胃底静脉曲张出血、有明显的高血压或动 脉硬化者,再出血可能性大
•粪便隐血试验阳性 •黑粪 •呕血 •出现全身症状 •周围循环衰竭
每日消化道出血＞5~10ml 50~100ml 250~300ml 400~500ml ＞1000ml
❖最有价值的标准:周围循环衰竭的临床表现 ❖动态观察血压和心率
出血是否停止
继续出血或再出血的表现: •反复呕血或黑粪 •周围循环衰竭经治疗后无改善或波动 •Hb\RBC继续下降,Ret持续升高 •补液与尿量足够的情况下,血尿素氮持续或
There are blood covered errosions throughout the whole stomach. This has led to a upper GI hemorrhage compromising the patient hemodynamically. The sole reason was a single ingestion of 400 mg of ibuprofen
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.
上消化道出血
中山大学附属第一医院
高翔
简介
上消化道出血: Treitz 韧带以上的消化道 引起的出血:食管,胃,十二指肠,胰,胆,胃空 肠吻合术后的空肠病变
下消化道出血: Treitz 韧带以下的消化道 引起的出血
上消化道出血引起的大量出血较下消化 道更为常见
大量出血:短期内失血超过1000ml或循环 血量20%
Esophageal varices grade II (right) und grade III (left). Cherry red spots are signs of imminent hemorrhage (right). They correspond to areas of especially thin and altered variceal wall.
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.
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
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?
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
Fra Baidu bibliotek
出血量的估计