上消化道出血乐亭县医院洪素妹简介上消化道出血上消化道出血::TreitzTreitz韧带以上的消化道引起的韧带以上的消化道引起的出血出血::食管食管,,胃胃,,十二指肠十二指肠,,胰胰,,胆胆,,胃空肠吻合胃空肠吻合术后的空肠病变术后的空肠病变下消化道出血下消化道出血::TreitzTreitz韧带以下的消化道引起的韧带以下的消化道引起的出血出血上消化道出血引起的大量出血较下消化道更为常上消化道出血引起的大量出血较下消化道更为常见见大量出血大量出血::短期内失血超过短期内失血超过10001000mlml或循环血量或循环血量220%0%常见病因消化性溃疡消化性溃疡((十二指肠和胃十二指肠和胃)33-51%)33-51%食管和胃静脉曲张食管和胃静脉曲张23-33%23-33%Mallory-WeissMallory-Weiss综合征综合征3-3-10%10%胃或十二指肠糜烂胃或十二指肠糜烂1-1-19%19%血管瘤血管瘤0-0-7%7%肿瘤肿瘤1-5%1-5%Withtheinvertedgastroscopeaspurtinghemorrhagefromafundalvariceisdiscerbnable.HemostasisisachievedwithseverallowvolumeinjectionsofHistoacryl-glue.Therightpictureshowsthetherapeuticsuccess.Therearebloodcoverederrosionsthroughoutthewholestomach.ThishasledtoaupperGIhemorrhagecompromisingthepatienthemodynamically.Thesolereasonwasasingleingestionof400mgofibuprofenThismassivevesselwithactivebleedingwasdiagnosedina58year-oldpatient,whopresentedwithtarystools.Thefirstpictureshowsthelesionafterinjectionoffibringlue.Therightpictureshowsadditionallyappliedhemoclips.Bleedingstoppedattheendoftheprocedure,butreccurredtwicebeforethepatienthadtobetreatedsurgically.Indieu-la-foyulcersanarterialvesselofabnormalsizereachesthemucosacausingatinyulzerationbypermanentcompressionofthemucosallayer.EsophagealvaricesgradeII(right)undgradeIII(left).Cherryredspotsaresignsofimminenthemorrhage(right).Theycorrespondtoareasofespeciallythinandalteredvaricealwall.Thisduodenalulcerattheleftedgeofthefigure,showsanoozing,activebleeding.AccordingtotheForrestclassificationofgastrointestinalhemorrhageoftheupperGI-tract,thisbleedingisgradedasForrestIb.Thevisiblevesselistreatedbyprimaryapplicationofahemoclip.Atthe3weekfollow-up(fig)theClipisstillintheoriginalposition.Theulcershowsap...
