便血病理课件

ulcer； AV malformation Connective tissue disease； Hemabilia（biliary origin；Crohn`s disease；
amyloidosis , hematological diseases
BENIGN GASTRIC ULCER
The classical presentation of gastric ulcer :
Esophageal or intestinal neoplam Esophagitis； Malloy-weiss tear， Hemoptysis: Swallowed blood Anticoagulant fibrinoloytic therapy: Telangiectases； aneurysm ；vasculitis；Dieulafoy
57
6.5
Gastric ulcer
47
21.9
Esophagitis
23
10.7
Duodenitis
21
9.8
Varices
11
5.1
Mallory-Weiss tear 10
4.7
Neoplasm
8
3.7
Stomal ulcer
7ห้องสมุดไป่ตู้
3.3
Esophageal ulcer
2
0.9
Telangiectasia
0
Other
18
8.4
Clinical manifestation of GI Bleeding
Abdominal disconfort Nausea,
Hemadynamic change: reduction in blood volume (syncope,light-headedness, sweating,therst) or shock Laboratory changes: HCT, BUN
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.
Bleeding Survey: Endoscopic Findings in 214 Patients With
Clear Nasogastric Aspirates
FINDING NUMBER OF PATIENTS INCIDENCE (%)
Duodenaal ulcer
64
29.8
Gastric erosions
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..
Hematemesis with other symptoms
Hematemesis with upper abdominal pain Hematemesis with hepatomegly and spleenomegly Hematemesis with jaundice Hematemesis with Skin & mucosa hemorrhage Hematemesis with upper abdominal mass Others: NSAIDs, Stress, Burning, Brain operation, Trauma, Vomiting
便血病理课件
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
Bleeding From EV
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.
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 acidsecreting epithelium.
Common cause of up GI bleeding
Peptic ulcer ； Gastropathy （alcohol， aspirin， NSAIDs，
stress）； GE varices； Gastric cancer
Less common cause of up GI bleeding