上海交通大学：《诊断学》课程PPT教学课件（英语版）Chapter 15 Five Ways of GI Bleeding

Hemetamesis and hematochezia (Acute GI Hemorrhage) Dr Wu ShuMing GI Dept. RenJi Hospital SSMU

Hemetamesis and Hemetochezia (Acute GI Hemorrhage) Dr. Wu ShuMing GI Dept. RenJi Hospital SSMU

Five Ways of GI Bleeding Hematemesis: vomitting of blood of altered blood (coffee grounds indicates bleeding proximal to ligament of Treitz Melena: Tarry stool. Altered (black blood per rectum (>60ml) Hematochezia: Bright red or maroon rectal bleeding implies bleeding beyond Lig. T. FOBt and iron deficiency anemia

Five Ways of GI Bleeding Hematemesis：vomitting of blood of altered blood（coffee grounds） indicates bleeding proximal to ligament of Treitz Melena：Tarry stool. Altered （black） blood per rectum （>60ml） Hematochezia： Bright red or maroon rectal bleeding implies bleeding beyond Lig.T.* FOB+ and Iron deficiency anemia

Factors affect the way to manifest Site of bleeding Speed of bleeding Amount of blood loss Flora of enterocolon

Factors affect the way to manifest Site of bleeding Speed of bleeding Amount of blood loss Flora of enterocolon

Differentiating Upper from Low GI Bleeding 1g Hematochezia usually represents a lower GI source bleeding pper gi lesion may bleed so briskly that blood doesn t remain in bowl long enough to become melena Bleeding lesion distal to T Lig. may be either m. or hematochezia, but never manifests hematemesis

Differentiating Upper from Low GI Bleeding Hematochezia usually represents a lower GI source bleeding Upper GI lesion may bleed so briskly that blood doesn`t remain in bowl long enough to become melena Bleeding lesion distal to T Lig.may be either M.or hematochezia, but never manifests hematemesis

Common cause of up gi bleeding Peptic ulcer Gastropathy (alcohol, aspirin, NSAIDs stress GE varices Gastric cancer

Common cause of up GI bleeding Peptic ulcer ； Gastropathy （alcohol， aspirin， NSAIDs， stress）； GE varices； Gastric cancer

Less common cause of up GI bleeding Esophageal or intestinal neoplam Esophagitis; Malloy-weiss tear Hemoptysis: Swallowed blood Anticoagulant fibrinolytic therapy Telangiectases; aneurysm vasculitis; Dieulafoy ulcer: AV malformation Connective tissue disease Hemabilia biliary origin; Crohns disease amyloidosis, hematological diseases

Less common cause of up GI bleeding Esophageal or intestinal neoplam Esophagitis； Malloy-weiss tear， Hemoptysis: Swallowed blood Anticoagulant fibrinoloytic therapy: Telangiectases； aneurysm ；vasculitis；Dieulafoy ulcer； AV malformation Connective tissue disease； Hemabilia（biliary origin；Crohn`s disease； amyloidosis , hematological diseases

BENIGN GASTRIC ULCER The classical presentation of gastric ulcer with weight loss and indigestion made worse by eating patients more often describe symptoms that would fit equally well for duodenal ulcer-investigation with barium meal or(preferably) endoscopy is, of course, appropriate for either. Benign ulcers may occur at any site in the stomach, but are commonest on the lesser curve away from acid secreting epithelium

BENIGN GASTRIC ULCER The classical presentation of gastric ulcer : with weight loss and indigestion made worse by eating, patients more often describe symptoms that would fit equally well for duodenal ulcer - investigation with barium meal or (preferably) endoscopy is, of course, appropriate for either. Benign ulcers may occur at any site in the stomach, but are commonest on the lesser curve away from acid￾secreting epithelium

Location of benign gastric ulcers in relationship to the distance from the pylorus. The majority of benign ulcers will be found on the lesser curvature within 3 cm of the angulus MSPHINC TER 20.0 i5.0 r2.5 28.4 INCISURA 7.5 31寓 22.4 3.5 SPHINCTER

Location of benign gastric ulcers in relationship to the distance from the pylorus. The majority of benign ulcers will be found on the lesser curvature within 3 cm of the angulus

Duodenum ulcer The lesion most commonly affecting the duodenum is ulceration and it is now known that both antral infection with Helicobacter pylori and the presence of gastric acid are virtual prerequisites for it

Duodenum Ulcer The lesion most commonly affecting the duodenum is ulceration, and it is now known that both antral infection with Helicobacter pylori and the presence of gastric acid are virtual prerequisites for it

A number of cutaneous features(stigmata may develop in a patient with cirrhosis, and these are important as they aid clinical recognition of chronic liver disease

A number of cutaneous features (stigmata) may develop in a patient with cirrhosis, and these are important as they aid clinical recognition of chronic liver disease