Hematochezia [hemətə‘ki:zɪə]便血
Etiology
The most common 4 causes Peptic Ulcer> Varices bleeding > Acut hemorrhagic gastritis> Gastric cancer>
Etiology
1.Upper gastroitation
1. Hematemaesis , Melena, Hematochezia 2. Hemodynamical failure • larg and rapid loss of circulatory volume.
palpitation心悸 lightheadedness头昏, syncope晕厥, Inertia 乏力postural hypotention 体位性低血压 • shock： Dysphoria烦躁不安，confused state of mind, Pale， dyspnea呼吸困难, extremities Coldness， lips cyanosis口唇发绀，BP<90/60mmHg, tachycardia心动过 速，urea volume decrease.
• Esophageal disease :Mallory-Weiss
• Gastroduodenal disease: PU,AGML,Cancer,
Vascular malformation, Dieulafoy’s disease （caliber-persistent-
artery malformations恒径动脉畸形）
1. Hematemaesis: bloody vomits, bright/older red and coffee-ground
Melena: black, tarry, foul-smelling stool, Hematochezia: Maroon blood or bright
red blood
Diagnosis
1. Establishment of the diagnosis： • Direct manifestation: Hemetamesis; Melena; Hemetochezia:
Occult of stool; • Indirect manifestation: Circulating failure; Laboratory evidence.
Diagnosis
1. Establishment of the diagnosis： • Direct manifestation: • Indirect manifestation: • Differentiation
Chapter 21 Gastrointestinal Hemorrhage
Upper gastrointestinal hemorrhage
Bleeding occurred in proximal intestinal tract / Treitz ligament Massive bleeding: large amount(1000ml) and rapidly Hematemaesis [ˌhi:mə‘teməsɪs] 吐血 Melena, 黑便
• allergic purpura过敏性紫癜 • hematopathy • uremia • connective tissue disease, • acute infection • Stress-related gastric mucosal injury
Clinical manifestation
– bile duct – pancreas
– aneurysm – mediastinum 纵膈 disease
Etiology
1.Upper gastrointestinal tact 2. Portal Hypertension 3. Nearby organs 4. Systemic disease
（intestinal or prerenal ）３～４days drop to normal
RBC :
3-4h 24-72h
• RC
24h 4-7d
• WBC
5h
2-3d 2-5h
• BUN
3-6h 24-48h 3-4d
Clinical manifestation
1. Hematemaesis , Melena, Hematochezia 2. Hemodynamical failure 3. Laboratory test 4. Fever : Central regulator
Clinical manifestation
1. Hematemaesis , Melena, Hematochezia 2. Hemodynamical failure 3. Laboratory test • Hemoglobin, Hematocrit decrease 3~4hr after bleeding
hemangioma血管瘤 aneurysm [ˈænjərɪzəm] 动脉瘤
Etiology
1.Upper gastrointestinal tact 2. Portal Hypertension
varices congestiv gastropathy
Etiology
1.Upper gastrointestinal tact 2. Portal Hypertension 3. Neighbor organs
(which normal or even raised in initial time). • White cell raised, drope to normal in 2~3days • Reticulocyte(RC) raised in 24hr, peak in 4~7days • Blood Urea Nitrogen(BUN): hours after bleeding.