1、1便血病理便血病理第1页/共52页第2页/共52页第3页/共52页第4页/共52页第5页/共52页第6页/共52页第7页/共52页第8页/共52页第9页/共52页第10页/共52页第11页/共52页第12页/共52页第13页/共52页Bleeding Survey:Endoscopic Findings in 214 Patients With Clear Nasogastric AspiratesFINDING NUMBER OF PATIENTS INCIDENCE(%)Telangiectasia 0第14页/共52页第15页/共52页第16页/共52页第17页/共52页Laborato
2、ry changes:HCT,BUNGastric cancerSevere acute ulcerative colitis.Hematemesis：vomitting of blood of altered blood（coffee grounds）indicates bleeding proximal to ligament of TreitzHematochezia with other symptomspatients more often describe symptoms that would fit equally well for duodenal ulcer-investi
3、gation with barium meal or(preferably)endoscopy is,of course,appropriate for either.Upper GI lesion may bleed so briskly that blood doesnt remain in bowl long enough to become melenaCauses of Low GI BleedingAltered（black）blood per rectum（60ml）Diffuse erythema,spontaneous bleeding,and loss of the vas
4、cular pattern with formation of telangiectasis are present.第18页/共52页第19页/共52页Endoscopic view of a Mallory-Weiss tear with active bleeding(gastric lumen is at top left).B,Endoscopic view of an organized clot adherent to a Mallory-Weiss tear(gastric lumen is at bottom left).第20页/共52页Endoscopic view of
5、 a Dieulafoy lesion on the lesser curvature of the stomach第21页/共52页Endoscopic view of a vascular ectasia(angiodysplasia)in the duodenum.第22页/共52页Endoscopic view of the gastric antrum with watermelon stomach.The pylorus is at top center.Note the linear distribution pattern of the vascular lesions arr
6、anged radially around the pylorus.第23页/共52页Endoscopic views of ulcers with stigmata of recent hemorrhage.A,Duodenal ulcer with a visible vessel.B,Gastric ulcer with a red spot in the center of the crater.C,Duodenal ulcer with a red spot in the center of the crater.D,Purplish clot adherent to a gastr
7、ic ulcer.第24页/共52页第25页/共52页第26页/共52页Site of bleedingEndoscopic views of ulcers with stigmata of recent hemorrhage.Five Ways of GI Bleedingfurther assessmentRadionuclide scanningLinear ulceration runs circumferentially along the interhaustral septum with tiny satellite ulcerations.Advantage colon car
8、cinomaRadionuclide imagingCauses of Low GI BleedingHematemesis with other symptomsB,Gastric ulcer with a red spot in the center of the crater.self-limited(80%)bleeding(10-20%)Diffuse erythema,spontaneous bleeding,and loss of the vascular pattern with formation of telangiectasis are present.B,Mucosa
9、surrounding the ulcers is nodular(cobblestoning).amyloidosis,hematological diseasesBENIGN GASTRIC ULCERrecurrent hemorrhage第27页/共52页ESOPHAGUS STOMACHDUODENUMJEJUNUM ILEUMCOLORECTUMEsophageal varicesAV malformationsAngiodysplasiaEsophagitisAngiodysplasiaAV malformationsGastritisUlcersUlcerative colit
10、isGastric varices AnastomoticDiverticulosisMallory-Weiss tears SimpleCancerPeptic ulcerDiverticulaPolypsAV malformationsMeckelsHemorrhoidsCancerAcquiredAnal fissurePolypsCrohns diseaseStomal varicesLeiomyomaVaricesPostoperativeSarcomaIschemic ulcerPostpolypectomyBrunners adenomaTuberculosisAnastomot
11、icAngiodysplasiaArteritisTraumaPancreatic restBlind loopUlcersTraumaAngiomaSimplePostoperativeLeiomyomaStercoralRetained ulcerCancerTyphoidResidual gastritisSarcomaAmebicAnastomotic ulcerPolyps Uremic ulcer Stomal varices Lymphoid hyperplasia Trauma第28页/共52页第29页/共52页第30页/共52页第31页/共52页第32页/共52页第33页/共
12、52页第34页/共52页第35页/共52页第36页/共52页第37页/共52页第38页/共52页第39页/共52页第40页/共52页第41页/共52页第42页/共52页第43页/共52页第44页/共52页第45页/共52页第46页/共52页第47页/共52页ESOPHAGUS STOMACHDUODENUMJEJUNUM ILEUMCOLORECTUMEsophageal varicesAV malformationsAngiodysplasiaEsophagitisAngiodysplasiaAV malformationsGastritisUlcersUlcerative colitisG
13、astric varices AnastomoticDiverticulosisMallory-Weiss tears SimpleCancerPeptic ulcerDiverticulaPolypsAV malformationsMeckelsHemorrhoidsCancerAcquiredAnal fissurePolypsCrohns diseaseStomal varicesLeiomyomaVaricesPostoperativeSarcomaIschemic ulcerPostpolypectomyBrunners adenomaTuberculosisAnastomoticAngiodysplasiaArteritisTraumaPancreatic restBlind loopUlcersTraumaAngiomaSimplePostoperativeLeiomyomaStercoralRetained ulcerCancerTyphoidResidual gastritisSarcomaAmebicAnastomotic ulcerPolyps Uremic ulcer Stomal varices Lymphoid hyperplasia Trauma第48页/共52页第49页/共52页第50页/共52页第51页/共52页第52页/共52页
