1、Hematemesis and Hematochezia呕血和便血The professional staff room Rainny LinHematemesis 呕血呕血 Definition定义 Hematemesis is the vomiting of blood.血液从口腔呕出。血液从口腔呕出。Pathogeny病因病因1.Esophageal diseases食管疾病食管疾病Esophagitis食管炎食管炎、Esophageal cancer食管癌、食管癌、Esophageal varices食管静脉曲张破裂。食管静脉曲张破裂。2.Gastric and duodenal di
2、seases胃与十二指肠疾病胃与十二指肠疾病Peptic消化性溃疡、消化性溃疡、Gastric mucosal lesions胃黏膜病变、胃黏膜病变、Chronic gastritis慢性胃炎、慢性胃炎、Gastric cancer胃癌等。胃癌等。3、Hepatobiliary diseases肝胆疾病肝胆疾病Liver cirrhosis and portal hypertension肝硬化门脉高肝硬化门脉高压压、Liver cancer肝癌、肝癌、Liver abscess肝脓肿、肝脓肿、Gallbladder and bile duct stones胆囊与胆管结石胆囊与胆管结石 等。等。
3、4、Pancreatic diseases胰腺疾病胰腺疾病Pancreatic cancer胰腺癌、胰腺癌、Acute pancreatitiscomplicated with abscess 急性胰腺炎合并急性胰腺炎合并脓肿等。脓肿等。5、Acute infectious disease急性传染病急性传染病Severe hepatitis重症肝炎等。重症肝炎等。6、Blood disease血液病血液病白血病白血病Leukemia、血小板减少性紫癜、过敏性紫癜、血小板减少性紫癜、过敏性紫癜、血友病等血友病等7、Others：Uremia尿毒症尿毒症、Pulmonary heart disea
4、se肺源性心脏肺源性心脏病病 Clinical manifestation临床表现临床表现1、Hematemesis and melena呕血与黑便呕血与黑便 2、Hemorrhagic shock失血性休克失血性休克3、Fever发热发热4、Hematological changes血液学改变血液学改变5、Azotemia氮质血症氮质血症Accompanying symptoms伴随症状伴随症状1、with abdominalpain呕血伴上腹痛呕血伴上腹痛Peptic ulcer消化性溃疡；消化性溃疡；Gastric cancer胃癌。胃癌。2、with hepatosplenomegal
5、y呕血伴肝脾肿大呕血伴肝脾肿大Liver cancer肝癌；食管胃底静脉曲张破裂出血。肝癌；食管胃底静脉曲张破裂出血。3、with mucocutaneous bleeding呕血伴皮肤黏膜出血呕血伴皮肤黏膜出血血液病、败血症、血液病、败血症、Severe hepatitis重症肝炎等。重症肝炎等。4、with jaundice 呕血伴黄疸呕血伴黄疸5、with enlargement of left praclavicular lymph nodes 呕血伴左锁骨上淋巴结肿大呕血伴左锁骨上淋巴结肿大Gastric cancer胃癌、胰腺癌等胃癌、胰腺癌等Interrogation point
6、s问诊要点问诊要点1、Eliminate the oral cavity,nasopharyngeal bleeding and hemoptysis.2、The relationship between the cause of hematemesis and diet.Drinking,poison,special drug intake history?3、The amount and color of hematemesis.4、The general condition of the patient.Hematochezia便血 Definition hematochezia is
7、gastrointestinal(Gl)bleeding excreted from the body via anus.消化道出血经肛门排出体外。Pathogeny1.Rectum and Anal canal diseases直肠与肛管疾病 Rectal cancer直肠癌、Rectal polyps 直肠息肉、hemorrhoids痔疮、Anal fissure肛裂等。2.Colonic diseases结肠疾病 Colon cancer结肠癌、Colonic polyps结肠息肉。3.Small intestinal diseases小肠疾病 Intestinal tuberculos
8、is肠结核、Tumor肿瘤。Clinical manifestationThe bleeding site出血部位出血部位;The amount of bleeding出血量多少出血量多少;The length of blood stay in the intestinal cavity血液在血液在肠腔内停留时间长短肠腔内停留时间长短.1、Melena 黑 便 Shiny,black,sticky,foul-smelling stool有光泽，黑色，黏稠，恶臭的粪便 （1）degradation of blood 退化的血 （2）exogenous stool darkeners外源性黑便 I
9、ron铁剂 bismuth(铋剂)2.fresh bloody stool鲜血便 bright red or maroon blood from the rectum来在直肠的鲜红色或褐红色血 Pure blood 纯血 blood intermixed with formed stool血与粪便混合形成 bloody diarrhea 血性腹泻3、Occult 隐 血 detected only by testing the stool with a monoclonal antibody for human hemoglobin 只有与人的血红蛋白单克隆抗体检测粪便Estimate amo
10、unt of bleeding from upper GI tract 510 ml/d OB +5070 ml/d Melena 250300 ml in short time Hematemesis Accompanying symptoms 1、with abdominal pain便血伴腹痛 2、With tenesmus hematochezia便血伴里急后重 3、with abdominal mass 便血伴腹部肿块 4、with fever便血伴发热 5、with mucocutaneous bleeding便血伴皮肤黏膜出血Interrogation points 1.Is there unclean food,medication history and the collective disease?2.The amount and colour of hematochezia.And the relationship to stool.3.The general condition of the patient.4.Is there a history of diarrhea,abdominal pain,hemorrhoids,anal fissure history or abdominal operation?
