1、300,000 hospitalizations yearly (USA). upper gastrointestinal tract 5x more common than LGIB. upper gastrointestinal tract more common in men than woman. GI more common in the elderly.almost always above the ligament of TreitzCecil textbook of medicine, 21 edition, p654esophageal varices bleedingA g
2、astroscopy for gastrointestinal hemorrhage revealed a superficial, longitudinal and bleeding . Longlasting reflux disease could as well be prooved by the tortuous distal esophagus as by the relative stenosis.There are blood covered errosions throughout the whole stomach. This has led to a upper GI h
3、emorrhage compromising the patient hemodynamically. The sole reason was a single ingestion of 400 mg of ibuprofen. Esophageal varices. They correspond to areas of especially thin and altered variceal wall. The main causes of upper gastrointestinal Tract bleeding急性非静脉曲张性上消化道出血诊治指南(草案)Hematemesis or e
4、mesis with red bloodMelenemesis or “coffee grounds” vomitingHematocheziaMelena occult blood?AzotemiaBlood routine test changedazotemia with the intestinal originPrerenal azotemiarenal azotemiaBlood routinediagnosis of UGIBHematemesis, melena, origin of food, drugs or lower gastrointestinal tract ble
5、eding should be excluded.呕血与咯血鉴别呕血与咯血鉴别_ 咯血 呕血_病史 肺结核、支扩、心脏病 溃疡病、肝硬化出血方式 咳出 呕出出血前症状 常有喉痒、咳嗽、胸闷 恶心、呕吐、上腹不适或痛血内混有物 气泡及痰 食物及胃液颜色 鲜红 暗红或咖啡色血液反应 碱性 酸性黑便 无(咽下后有) 有上、下消化道出血鉴别上、下消化道出血鉴别_ 上消化道出血 下消化道出血_既往史 多有溃疡病、肝胆疾病 曾有下腹疼痛、包块及排便 或呕血史 异常(腹泻、便秘)史或便血史出血先兆 上腹胀、疼痛或绞痛 中下腹不适或下坠、欲排大便 恶心、反胃 出血方式 呕血伴柏油便 便血、无呕血便血特点 柏油
6、样便、稠或成形 暗红或鲜红、稀多不成形 无血块 量大时可有血块_How to differentiate upper gastrointestinal bleeding from lower gastrointestinal bleeding?evaluationthe source of bleeding: where?the volume of bleeding: how much?是上消化道出血吗是上消化道出血吗?出了多少血出了多少血?出血停止了吗出血停止了吗?什么原因引起的出血什么原因引起的出血?Diagnosis of UGIBHow to diagnose active bleed
7、ing and recurrence?ulcer bleeding4)Barium radiography5)Nuclear scintigraphyAngiographygeneral treatmentFastingFluid replacement and Transfuse with bloodNoradrenalin, thrombin pH6Urgent endoscopy therapy:Noradrenalin, thrombin, etc. Injection of drugs, clip, etc. This duodenal ulcer at the left edge
8、of the figure, shows an oozing, active bleeding. 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. At 6 weeks the ulcer has healed completely with only residual scarrin
9、g. The hemoclip is not to be found anymore and has probably fallen off. Inversion of the endoscope shows a subcardial ulcer. The vessel of this hemorrhage (Forrest Ib), is not amenable to sufficient clipping. Thus an additional fibrin injection is performed.A Sengstaken-Blackmore tube has three chan
10、nels One to inflate the gastric balloon One to inflate the oesophageal balloon One to aspirate the stomach Therapeutic angiography:operation：prognosis急性非静脉曲张性上消化道出血诊治指南(草案)score 2, recurrence 4%，mortality 5, recurrence 24%，mortality 11%这位这位39岁的女患者几分？岁的女患者几分？急性非静脉曲张性上消化道出血诊治指南(草案)急性非静脉曲张性上消化道出血诊治指南(草
11、案)Hp阳性的下列疾病必须支持消化性溃疡早期胃癌术后胃MALT淋巴瘤慢性胃炎伴胃黏膜萎缩、糜烂或消化不良症状计划长期使用NSAID胃癌家族史个人强烈要求治疗者 1. What are the main causes of upper gastrointestinal tract bleeding?2. How to differentiate upper gastrointestinal tract bleeding from lower gastrointestinal tract bleeding?3. Can the barium radiography be used under the condition of active upper gastrointestinal tract bleeding?谢谢大家谢谢大家
