gastrointestinalhemorrhage消化道出血武汉大学人民医院消化内科

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1、GastrointestinalHemorrhage消化道出血武汉大学人民医院消化内科于红刚副教授消化道以屈氏韧带(theligamentofTreitz)为界，其上的消化道出血称上消化道出血，其下的消化道出血称为下消化道出血SupperGastrointestinalHemorrhage上消化道出血EtiologyUppergastrointestinalbleedingismostcommonlycausedbypepticulceration,gastroesophagealvarices,acute

2、erosiveandhemorrhagicgastritis,andgastriccancer病因消化性溃疡食管胃底静脉曲张破裂急性糜烂出血性胃炎胃癌最常见EtiologyEsophagealDiseasesDuodenalandGastricDiseasesPortalHypertension-RelatedCausesHemobiliaHemosuccusPancreaticusSystemicDiseasesEsophagealDiseasesEsophagitisEsophagealulcerati

3、onTumoroftheesophagusEsophagusdiverticulitisEsophagusinjury:physical(Mallory-WeissTear);chemical(strongacidoralkali);radioactiveDuodenalandGastricDiseasesGastricUlcer;Acuteerosiveandhemorrhagicgastritis;Gastriccancer;Gastricpolyp;Zollinger-EllisonSyndrome;

4、MALToma;Neurofibromatosis;Gastricvascularabnormity(VascularEctasia,ArteriovenousMalformations,Dieulafoy'sLesion);Prolapseofgastricmucosa;Gastritisafteroperation;stomaulcerDuodenalUlcers;Duodenaldiverticulitis;Acuteerosiveduodenitis;Crohn’sdisease;Duodenalt

5、uberculosisPortalHypertension-RelatedCausesEsophagealvaricesGastricvaricesPortalhypertensivegastropathyHemobiliaIncludingtrauma,gallstones,cholecysticcarcinoma,cholangiocarcinoma,ascariasisofbiliarytract,livercancer,liverabscess,hepatichemangiomaHemosuccus

6、PancreaticusPancreaticcancerErosionofapseudocystintothesplenicorperipancreaticarteryorformationofanarterialaneurysminthecourseofchronicpancreatitisSystemicDiseasesVascularDiseases:hypersusceptiblepurpurahereditaryhemorrhagictelangiectasiaHematicDiseases:ha

7、emophilia;thrombocytopenicpurpuraUremiaConnectiveTissueDiseases:polyarteritisnodosa;systemiclupuserythematosusStress-relatedgastricmucosalinjury（一）上消化道疾病1．食管疾病2．胃十二指肠溃疡疾病（二）门静脉高压引起的食管胃底静脉曲张破裂或门脉高压性胃病（三）上消化道邻近器官或组织的疾病（1）胆道出血（2）胰腺疾病累及十二指肠（3）主动脉瘤破入食管、胃或十二指肠（4

8、）纵隔肿瘤或脓肿破入食管（四）全身性疾病1．血管性疾病2．血液病3．尿毒症4．结缔组织病5．急性感染6．应激相关胃粘膜损伤ClinicalPresentationHematemesisMelenaHematocheziaSymptomsofbloodlossAnemiaandChangeofhemogramElevationintheBUNlevel临床表现1．呕血与黑粪2．失血性周围循环衰竭3．贫血和血象变化4