消化道出血 小讲课

Gastrointestinal hemorrhage？ Gastrointestinal bleed (GI bleed), also known as gastrointestinal hemorrhage, is all forms of blood loss from the gastrointestinal tract, from the mouth to the rectum.
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。
lower GI bleeding
iatrogenic
vascular
Initial evaluation
Radionuclide imaging
CT angiography
accessory examination
As investigations are being planned, infusions of proton pump inhibitor or octreotide should be initiated for suspected bleeding peptic ulcer and varices respectively
DEFINITIONS
Overt (acute) vs occult (chronic) vs obscure Depending on the rate of blood loss, GI bleeding can manifest in several forms and can be classified as overt, occult or obscure.
Epidemiology
Annual hospital admissions for GI bleeding in the United States and United Kingdom have been estimated at up to 150 patients per 100000 population with a mortality rate of 5%10%[2-5].
Upper endoscopy Colonoscopy
Upper endoscopy
Figure 1 Upper endoscopic findings in patients with suspected upper gastrointestinal bleeding. Esophageal varices(A), Dieulafoy’s lesion in the stomach (B), gastric antral vascularectasia (watermelon stomach) in the antrum of the stomach pre and post argon plasma coagulation therapy (C, D).
Upper GI bleeding
lower GI bleeding
incidence mortality
40-150/100000 6% - 10%
20-27/100000 4%～10%
Acute GI bleeding is a major cause of hospital admissions in the United States, which is estimated at 300000 patients annually[15]. Upper GI bleeding has an annual incidence that ranges from 40-150 episodes per 100000 persons and a morality 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 more common in men than women and its prevalence increase with age[13,21].
Diagnosis of gastrointestinal bleeding: A practical guide for clinicians
徐言
2008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： A.贲门以上部位出血 B.幽门以上部位出现 C.空肠以上部位出血 D.屈氏韧带以上部位出血 E.十二指肠乳头以上部位出血
Etiology and pathophysiology
trauma tic
tumors
ulcerative
Upper GI Bleeding
portaHale Waihona Puke Baidu hypertension
vascular
Etiology and pathophysiology
trauma tic
neoplastic
inflammatory
DEFINITIONS
Upper vs lower
In recent years upper GI bleeding has been redefied as bleeding above the ampulla of Vater within reach of an upper endoscopy; lower GI bleeding has been further subdivided into mid GI bleeding coming from the small bowel between the ampulla of Vater to the terminal ileum, and lower GI bleeding coming from the colon.
Colonoscopy
CONCLUSION
GI bleeding can be caused by a wide range of pathologies and they differ in onset, location, risk and clinical presentation. In patients with active GI bleeding who are unstable, acute resuscitation should precede any investigations. Accurate clinical diagnosis is crucial in determining the investigation of choice and specific treatment interventions. The correct diagnostic algorithm relies on a good understanding of the type of GI bleeding, risk evaluation and clinical presentation which may indicate the nature and source of bleeding. Upper endoscopy and colonoscopy are the mainstay of initial investigations. Angiography and radionuclide imaging are best suited for acute overt GI bleeding. Capsule endoscopy and deep enteroscopy play significant roles in the diagnosis of obscure GI bleeding, usually from the small bowel.