上消化道出血(1)PPT课件.ppt

1,G.I.Bleeding,Presentedby:AhmedT.Al-SuwaidiMohamedS.Al-Hoqani,2,G.I.BleedingCase,50yrs,Pakistani,maleC/O:Bleeding/rectum&Abd.painPainlessbleeding,1yrexcessbleeding,1monthBlack,4-5times/day,littlequant.Abd.painVomiting,1week,3,G.I.BleedingCase,M.H:*nopepticulcerdisease*nomedications(NSAIDs)*nourinarysymptoms*notknownDM,HPTN,IHD*weightloss,4,G.I.BleedingCase,O/E:*Afebrile*nopallor*notdyspneaic*nolymphoadenopathies*noS.C.L.N,5,G.I.BleedingCase,VitalSigns:*Pulse:78bts/min*BP:130/80*RR:18br/minHeart:NADLung:NAD,6,G.I.BleedingCase,Abd.:*notdistended*noepigast.tenderness*tender,firm,partlymobilemassatRtlumbarregion.*spleennotpalpable*Ltlobeliverpalpable,mildlytender*bowelsoundspresent,7,G.I.BleedingCase,PR:*noenlargedpiles*noactivebleeding*nopalpablemass*nobloodonfingerECG,CBC,SrAmylase,Bleedingprofile,AbdX-ray,fecalloadingascendingcolon,8,G.I.BleedingCase,LabResults:*Hb:14.1g/dl*Plt:252*103*Hypochromic,microcytic*PT:17.3sec*aPTT:35.4sec*SrAmy:129U/l106U/l*Na+:140mmol/l*K+:4.1mmol/l*BUN:17mg/dl,9,G.I.Bleeding,AcuteVsChronicAcuteUpperG.I.Bleeding:AcuteLowerG.I.Bleeding:,10,AcuteUpperG.I.Bleeding,HaematemesisMelaenaSite&Time,11,AcuteU.G.I.Bleeding,Aetiology:1.Drugs(Aspirin&NSAIDs)2.Alcohol3.Chronicpepticulceration(50%ofGIhemorrhage)4.Others:refluxesophagitis,varices,gastriccarcinoma,acutegastriculcers&erosions.,12,AcuteU.G.I.Bleeding,Clinicalapproach:1.recent(24hrs),thenhospitalized.2.ifsmallamount,noimmediateTx,becauseCVScancompensate3.85%stopbleedingduring48hrs4.historyhelpsindiagnosingthecauseofthehemorrhage,eg:longhistoryofindigestion,orprevioushem.fromulcers.,13,AcuteU.G.I.Bleeding,Clinicalapproach:5.factorsinclude:age(60+)amountofbldlostcontinuingvisiblebldloss.signsofchronicliverdiseaseclassicalclinicalfeaturesofshock,14,AcuteU.G.I.Bleeding,Clinicalapproach:6.liverdiseasesevere,recurrentbleeding(iffromvarices)7.splenomegalyportalhypertension,15,AcuteU.G.I.Bleeding,Immediatemanagement:*Emergencymanagement:History+exam.Monitor:pulse&BP/30minBldsample:haemoglobin,urea,electrolytes,grouping&cross-matchingI.v.access,16,AcuteU.G.I.Bleeding,*Emergencymanagement(cntd):Bldtransfusionincaseof1)shock2)haemoglobin1ml/minute,24,RadionuclidescanningUsestechnetium-99mlabeledredbloodcells,25,Management,Ifsourceofcolonicbleedingunclearperformasubtotalcolectomyandend-ileostomy,Acutebleedingtendstobeselflimiting,Considerselectivemesentericembolisationiflifethreateninghaemorrhage,IfbleedingpersistsperformendoscopytoexcludeupperGIcause,Proceedtolaparotomyandconsideron-tab