课件：hematochezia(便血英文版).ppt

Hematochezia,caiqiao yin Department of Gastroenterology, Affiliated Minda Hospital Medical College, Hubei University for Nationalities,The Gastrointestinal System,Digestive and absorptive process take place in the GI tract,The mother river of the human body,Gastrointestinal Problems,upper gastrointestinal tract disorder hematemesis hematochezia melena Indigestion Belching Nausea Vomiting Anorexia lower GI tract hematochezia Diarrhea Constipation,jejunum,duodenum,suspensory ligament of duodenum,duodenojejunal flexure,upper gastrointestinal tract,lower gastrointestinal tract,definition of hematochezia,Hematochezia-passage of stools containing blood- usually represents lower GI ( colonic origin )source of bleeding(but can be UGI origin if brisk pace/large volume) colour: bright red blood, dark red, tarry 1.Bleeding that happens higher up in the digestive tract may make stool appear black and tarry. 2.a black, tarry stool is likely an ulcer or other problem in the upper part of the digestive tract. 3. Bright red blood or maroon-colored stools usually indicate a problem in the lower part of the digestive tract such as hemorrhoids or diverticulitis. amount very small(5-10ML)/(hidden blood in the stool) -only can be detected by occult blood test (OB) big amount-it may visible on toilet tissue or in the toilet after a bowel movement as bright red blood,Diverticulosis Colitis IBD (UCCD) Ischemia Infection Vascular anomalies Angiodysplasia Neoplasia Polyps or cancer Anorectal Hemorrhoids Anal fissure,Dieulafoys lesion Varices Vascular ectasia-liver cirrhosis -Small bowel, Rectal Aortoenteric fistula主动脉肠瘘 Kaposis sarcoma特发性出血性肉瘤 UPPER GI BLEED Peptic ulcers Esophageal Vascular ectasia,Causes of hematochezia,Causes of acute lower gastrointestinal bleeding,dysentery,Etiology classification according to the pathogenesis,Polyps Malignancy Kaposis sarcoma,Causes of Lower GI bleeding,Classification according to the location of the disease,Hemorrhoids,Anal Lesions,Hemorrhoids are extremely uncommon in the child and adolescent Fleshy rather than vascular lesions should raise the suspicion of Crohns disease,External hemorrhoids,Diverticulosis,Diverticular Bleeding,Diverticul- wall outwards.,Radiation Proctitis,IBD-inflammatory bowel disease,Colonic Polyps,“polyp,“ a nonspecific term to describe a growth on the inner surface of the colon,Malignancy(cancer),Colon Carcinoma,Vascular ectasia (Angiodysplasia),Radionuclide scanning A procedure that involves injecting small amounts of radioactive material into a vein and then using a special camera to see images of blood flow in the digestive tract to detect where bleeding is happening.,Recommended test for patients with brisk bleeding who cannot be stabilized or prepped for colonoscopy (or have had colonoscopy with failure to localize/treat bleeding site),Angiography Detects bleeding rates of 0.5-1 ml/min Therapeutic capability embolization with microcoils, polyvinyl alcohol, gelfoam Complications: bowel infarction, renal failure, hematomas, thromboses, dissection,Ischemic Colitis,Associated Symptoms,A person with blood in the stool may be unaware of bleeding and might have reported no symptoms. On the other hand, they may also have: abdominal pain, vomiting, weakness, difficulty breathing, diarrhea, palpitations, fainting, and weight loss depending on the cause, location, length, and severity of the bleeding.,differential diagnosis,Hematochezia-passage of stools containing blood- usually represents lower GI ( colonic origin )source of bleeding(but can be UGI origin if brisk pace/large volume) stool colour may be bright red blood, dark red, tarry hematemesis- is vomiting of blood.which can be fresh and red,or degraded by gastric pepsin,when it is dark brown in colour and resembles coffee grounds-Usually suggestive of UGI origin (but can be small intestinal, proximal colon origin if slow pace) melaena-is the passage of tarry,shiny black stools with a characteristic odour and results from upper gastrointestinal bleeding . hemoptysis - is spitting or coughing of blood,the bleeding lesions may be anywhere from nose to lung.,Glascow-Blatchford Bleeding Score,包含了临床数据和实验室检查信息，用于判定需要干预的方式（输血、内镜或外科手术治疗）及死亡风险。当Blatchford评分为0时，患者不需要入院行输血、内镜或手术治疗。积分6分为中高危，6分为低危。,clinical occurance,symptoms-history taking depend on the amount and speed of bleeding chief complaints:hematemesis / melena/ Hematochezia accompany complaints:abodominal pain/dizzy/sweat / conscious/short of breath/ past history: Is there a previous history of PU or liver disease? Is there a history of alcohol,NSAID or corticosteroid ingestion? Did the vomitus comprise fresh blood or coffeeground-stained fluid? Was the hnatemesis preceded by intense retching? Was blood stainning of the vomitus apparent in the first vomit?,clinical occurance,physical examination (signs) Vitals : T, P,R,Bp (Tachycardia, hypotension) Skin examination jaundice/ spider naevi/caput medusae/palmar erythema/mucotutaneous hemorrhage pallor/hydration/edma,palmar erythema,distended veins,clinical occurance,physical examination (signs) Abdominal examination inspection:scars/swellings/distended veins/varices of abdominal wall palpation:tnderness/hepatomegaly/splenomegaly percussion:ascites ausculation:bowel sounds/bruits,clinical occurance,Laboratory examination data blood routine examination (RBC/hemoglobin/Hct/WBC /PLT count) coagulation function: PT/APTT liver function: TBil(total bilirubin) : direct bilirubin (DBIL), indirect bilirubin(IBIL) albumin enzymology (AST/ALT/GGT/ALP) renal function: BUN and creatinine ,clinical occurance,endoscopy examination,clinical occurance,diagnosis history taking -complaints physical exaimation-signs Laboratory examination endoscopy examination,Clinical Scenario,67 yo M with history of HTN and osteoarthritis who presents to the ED with 3 episodes of coffee ground emesis today. No abdominal pain, melena or hematochezia. No history of liver disease or coagulopathy, +occasional ETOH use. Medications include HCTZ, Lisinopril, and Ibuprofen PRN for joint pain VS on arrival: T 37, HR 102, BP 108/72, similar BP standing , Pox 99% RA Examination: AOx3. No scleral icteru