gastrointestinal bleeding in the

gastrointestinal bleeding in the

Recommended Doctor gastrointestinal bleeding Sort:Director, Department of Gastroenterology, 301 Hospital Dr
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What are the performance and gastrointestinal bleeding diagnosed?
(A) of massive upper gastrointestinal bleeding of upper gastrointestinal bleeding, if early identification of acute peripheral circulatory failure due to emergence of signs of hematemesis and melena before, it must be with toxic shock, anaphylactic shock, cardiogenic shock or acute bleeding necrotizing pancreatitis, ectopic pregnancy and uterine rupture, spontaneous or traumatic rupture, aneurysm rupture, and other causes of hemorrhagic shock caused by the phase identification, a fashion must for upper gastrointestinal endoscopy and rectal examination, in order to find not vomit or be out of the blood, leaving the diagnosis was established early.
Upper gastrointestinal bleeding due to hematemesis and melena at first, and as epistaxis, dental extraction or tonsillectomy and swallow the blood due to a distinction between persons, but also to be associated with tuberculosis, bronchiectasis, lung cancer, caused by mitral stenosis distinguish hemoptysis, in addition to, oral livestock blood, bone charcoal, bismuth and some traditional Chinese medicine may also cause black stool, and upper gastrointestinal bleeding sometimes be caused by melena identification.
(B) the estimated amount of bleeding upper gastrointestinal bleeding to about 20ml, the stool hide blood (guaiac) test may be positive reactions, when the blood volume of 50 ~ 70ml or more, can be manifested as melena, bleeding severity 3 hours of domestic demand that can correct its output grate 1500ml shock, severity of bleeding can be divided into the nature of heavy bleeding (massive bleeding) refers to 300ml per hour, blood transfusion to stabilize their blood pressure by; the maximum amount of bleeding (major hemorrhage) transfusion refers 1000ml hemoglobin dropped to 10g/dl still less, persistent bleeding that within 24 hours seen in the 2nd endoscopy were active bleeding, bleeding continued in 60 hours or more, required to stabilize the loop transmission grate 3000ml who means of recurrent bleeding from the bleeding time 2 1 ~ 7 days at least, if the bleeding does not exceed 400ml, as mild hypovolemia can quickly be organized 500ml, blood loss and faster, the patient may have a head faint, fatigue, tachycardia and low blood pressure, such as performance, with the increase in the amount of bleeding, the symptoms more pronounced, and even lead to hemorrhagic shock.
For estimates of upper gastrointestinal bleeding, hypovolemia due mainly based on clinical manifestations of peripheral circulatory failure, especially for blood pressure and pulse dynamic observation, based on the patient''s red blood cell count, hemoglobin and hematocrit determination, it can be estimated the degree of blood loss.1. A history of peptic ulcer patients with the signs of 80% to 90% of them have a long history of regular abdominal pain, and improper diet, mental fatigue and other incentives under the concurrent bleeding, bleeding after the pain relief, emergency or early gastric endoscopy that can be found in ulcer hemorrhage, vomit bright red blood, while a large number of chronic hepatitis, schistosomiasis and other medical history, associated with liver palms, spider angioma, abdominal varices, splenomegaly, ascites and other signs of when to portal hypertension and esophageal varices Bleeding is the maximum possible, 45 years old hiding chronic persistent fecal blood test was positive, iron deficiency anemia associated with gastric or esophageal hiatal hernia should be considered, or are taking anti-inflammatory pain medication history of adrenal cortex hormones or severe trauma, surgery, sepsis , its stress ulcer bleeding in acute gastric mucosal lesions and the possibility of more than 50 years of age of unknown cause intestinal obstruction and blood in the stool, you should consider colon cancer, more than 60 years of age have coronary artery, atrial fibrillation, history of abdominal pain and blood in the stool who lack bloody bowel disease may be large, sudden abdominal pain, shock, blood in the stool who immediately thought of aneurysm rupture, jaundice, fever and abdominal pain with gastrointestinal bleeding, biliary tract bleeding can not be derived except for common bile duct stones or bile duct ascariasis.
2. Special diagnostic methods in recent years, clinical study of bleeding has been much progress, in addition to the traditional method of one-X-ray barium meal examination or for a long time outside irrigation, endoscopy has been widely used in the diagnosis of blood were developed on the basis of treatment.
(1) X-ray barium enema: only for bleeding has stopped and the patients in stable condition, the etiological diagnosis of acute gastrointestinal bleeding, the positive rate is not high.(3) angiography
(4) radionuclide imaging: radionuclide imaging examination in recent years, application of law to found the site of active bleeding, which is made after intravenous injection of 99m Tc colloidal abdominal scan to detect markers of vascular spillover from the evidence, Until the role of the initial orientation.
The clinical manifestations of gastrointestinal bleeding depends on the nature of bleeding lesions, location, blood loss and speed, with the patient''s age, general condition such as heart and kidney function is also related.
(A) way of acute massive bleeding bleeding manifested as hematemesis majority; chronic small amount of bleeding Zeyi performance of fecal occult blood positive; bleeding in the jejunum, the Department of Music''s ligaments are more, the clinical manifestations of vomiting, such as bleeding in the stomach after the blood retention time than long, become acidic due to the role of hemoglobin by the acid and was brown, such as blood bleeding out fast and great, the color is bright red hematemesis, melena or tarry stool that only the gastrointestinal tract in the bleeding area, but if second refers to the rate of intestinal bleeding lesion site too fast, short residence time in the intestine and feces the color will turn purple, right colon bleeding, stool color is bright red, in the space ileum and right colon disease caused by a small amount of seepage blood, manure can also be black.
(B) peripheral circulatory failure in hemorrhagic massive upper gastrointestinal hemorrhage cause of acute peripheral circulatory failure, blood loss amounted to a large, bleeding or not treated early can cause the body to reduce tissue blood perfusion and hypoxia and thus may be due to hypoxia, metabolic acidosis and the accumulation of metabolites, resulting in peripheral vasodilation, capillary extensive damage, resulting in a lot of dirty fluid stasis in the abdominal cavity and surrounding bone tissue, so that effective blood volume dropped, seriously affected the heart, brain and kidney blood supply , and finally the formation of irreversible shock, leading to death.
Peripheral circulatory failure in the development of bleeding, the clinic can be dizziness, heart palpitations, nausea, thirst, amaurosis, or syncope; skin vasoconstriction, and due to lack of blood perfusion was gray, cold and wet; press showing a bed, pale, and durable but not recovery, poor venous filling, surface veins are often deflated depression, the patient felt very weak, and further to mental wilt Mi, irritability, or even slow, confusion, poor old organ functional reserve, coupled with the elderly often have brain arteriosclerosis, hypertension, coronary heart disease, underlying diseases of aging such as chronic bronchitis, although small amount of bleeding, but also lead to multiple organ failure, increased mortality risk factors.
(C) can be divided into enterogenous azotemia, renal and prerenal azotemia, 3 species of intestinal azotemia refers to a large number of upper gastrointestinal bleeding, the blood protein decomposition products of the intestinal Road is absorbed, resulting in elevated blood nitrogen quality, prerenal azotemia is due to peripheral circulatory failure in hemorrhagic renal blood flow caused by a temporary decrease in glomerular filtration rate and renal excretory function decreased, resulting in mass storage of nitrogen stay in the correct hypotension, shock, blood urea nitrogen can be rapidly returned to normal, renal azotemia is due to the shock caused by serious and persistent tubular necrosis (acute renal failure), or blood loss is more important in the original have kidney renal damage can occur in clinical oliguria or anuria, bleeding stopped in the case, azotemia often lasted more than 4 days, after the make up blood volume, blood urea nitrogen shock can not be corrected to normal.
(D) After heating heavy bleeding, most often within 24 hours the patient had low fever, fever may be due to the hypovolemia, anemia, peripheral circulatory failure, blood decomposition of proteins and other factors led to the absorption central dysfunction body temperature regulation, analysis of heat looking for reasons to pay attention to other factors, such as pneumonia and complications.
(E) compensatory function after hemorrhage when blood volume gastrointestinal bleeding more than 1 / 4, cardiac output and diastolic blood pressure decreased significantly, then the appropriate body to release a large number of several tea phenol amines, increased peripheral vascular resistance and the systolic rate, in order to maintain blood perfusion of various organs, in addition to cardiovascular responses, hormone secretion, a corresponding compensatory hematopoietic system, aldosterone and vasopressin secretion and minimize the loss of interstitial water, to restore and maintain blood volume, such as the compensation will still not stimulate the hematopoietic system, active proliferation of blood cells, red blood cells and reticular cells increased.