诊断学 呕血与便血 英文版

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1、DiagnosisofGastrointestinalBleedingHematemesisandHematochezia呕血与便血Theapproachtogastro-intestinal(GI)bleedingistailoredtothemannerofappearance.Isbleedingacuteorchronic?IntensivecareWhereisthesourceofbleeding?EmpirictherapyDiagnosisTreatment(经验治疗)Whatisthecausesofbleeding?R

2、ecognitionofhemorrhageIntensivecareWhereisthesourceofbleeding?EmpirictherapyDiagnosisTreatment(经验治疗)Whatisthecausesofbleeding?Isbleedingacuteorchronic?RecognitionofhemorrhageClinicalManifestations1Mannerofbleedingpresentation2Hypovolemia(低血容量)orshock3Anemia(贫血)Recognitiono

3、fhemorrhagePatientsmanifestbloodloss1)Hematemesis呕血Bloodyvomitus,eitherfreshandbrightredorolderand“coffee-ground”(hematin酸化正铁血红素)incharacterHemoptysis?Nosebleeding?MannerofbleedingpresentationfromtheGItractinfiveways:2)Melena黑便Shiny,black,sticky,foul-smellingstooldegradati

4、onofbloodexogenousstooldarkenersironbismuth(铋剂)MannerofbleedingpresentationMannerofbleedingpresentation3)Hematochezia便血brightredormaroonbloodfromtherectumpurebloodbloodintermixedwithformedstoolbloodydiarrheaMannerofbleedingpresentation4)Occult隐血detectedonlybytestingthestoo

5、lwithamonoclonalantibodyforhumanhemoglobinEstimateamountofbleedingfromupperGItract5~10ml/dOB+50~70ml/dMelena250~300mlinshorttimeHematemesisMannerofbleedingpresentationwithoutanyobjectivesignofbleedingwithsymptomsofbloodlossdizziness,dyspnea,anginacordis(心绞痛),orevenshockdig

6、italexamination(指检)oftherectumHypovolemiaorshockSpeedandvolumeofbloodlossWeakness,giddiness(眩晕),oliguria,(少尿)coldextremity,sweatingVitalsigns:tachycardia,(心动过速)hypotention(低血压)AnemiapaledizzinesspalpitationeasyfatigabilitydyspneaanginacordisIsbleedingacuteorchronic?1)Bleed

7、ingspeedHematemesisoffreshbloodgenerallyindicatesamoreseverebleedingepisodethanmelena,whichoccurswhenbleedingisslowenoughtoallowtimefordegradationofbloodIsbleedingacuteorchronic?2)Hematocritbleedingslowlyhypochromic(血红蛋白过少)microcytic(小细胞)redbloodcellsmeancorpuscularvolume(

8、MCV，平均血球压积)ofthecellsmaybelowIsbleedingacuteorchronic?Ifbloodlossisacute,thehematocritdos