消化道出血小讲课

徐言,Diagnosis of gastrointestinal bleeding: A practical guide forclinicians,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,Gastrointestinal hemorrhage？Gastrointestinal bleed(GI bleed), also known asgastrointestinal hemorrhage, is all forms ofbloodloss from thegastrointestinal tract, from themouthto therectum.,Annual hospital admissions for GI bleeding in the United States andUnited Kingdom have been estimated at up to 150 patients per 100000 population with a mortality rate of 5%-10%2-5.,Epidemiology,Acute GI bleeding is a major cause of hospital admissions in the United States, which is estimated at 300000 patients annually15. Upper GI bleeding has an annual incidence that ranges from 40-150 episodes per 100000persons 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 morecommon in men than women and its prevalence increase with age13,21.,DEFINITIONS,Overt (acute) vs occult (chronic) vs obscureDepending on the rate of blood loss, GI bleedingcan manifest in several forms and can be classified asovert, occult or obscure.,DEFINITIONS,Upper vs lower,In recent years upper GI bleeding has beenredefied 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 fromthe colon.,Etiology and pathophysiology,Upper GI Bleeding,Etiology and pathophysiology,lower GI bleeding,Initial evaluation,As investigations are being planned, infusions of proton pump inhibitor or octreotide should be initiated for suspected bleeding peptic ulcer and varices respectively,Figure 1 Upper endoscopic findings in patients with suspected upper gastrointestinal bleeding. Esophageal varices(A), Dieulafoys 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 endoscopy,Colonoscopy,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 theinvestigation 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 indicatethe 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.,CONCLUSION,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