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1、CHAPTER48ACUTEGASTROINTESTINALHEMORRHAGEAliTavakkolizadehandStanleyW.Ashleyagingofthepopulation,withanincreaseincomorbidity.Today,approachtothepatientthepatientrequiringoperativeinterventionisbotholderandacuteuppergastrointestinalhemorrhagesickerthaninthepast.acutelowergastro
2、intestinalhemorrhageHemorrhagecanoriginatefromanyregionoftheGItractobscurecausesofacutegastrointestinalhemorrhageandistypicallyclassifiedbasedonitslocationrelativetotheligamentofTreitz.UpperGIhemorrhagefromproximaltotheligamentofTreitzaccountsformorethan80%ofcasesofacute1Acut
3、egastrointestinal(GI)hemorrhageisacommonclinicalbleeding.Pepticulcerdiseaseandvaricealhemorrhagearetheproblemwithdiversemanifestations.Thisbleedingmayrangemostcommoncauses.MostlowerGIbleedingisfromthecolon,fromtrivialtomassiveandcanoriginatefromalmostanyregionwithdiverticulaa
4、ndangiodysplasiasaccountingformostcases.1oftheGItract,includingthepancreas,liver,andbiliarytree.Inlessthan5%ofpatients,thesmallintestineinresponsible.Althoughnodemographicgroupisspared,theannualincidenceObscurebleedingisdefinedashemorrhagethatpersistsorrecursofapproximately17
5、0cases/100,000adultsincreasessteadilyafternegativeendoscopy.Occultbleedingisnotapparenttowithadvancingage,andisslightlymorecommoninmenthanpatientsuntiltheypresentwithsymptomsrelatedtotheanemia.1women.Furthermore,GIhemorrhageaccountsfor1%to2%Determinationofthesiteofbleedingisi
6、mportantfordirectingofacuteadmissions,resultinginover300,000annualhospital-diagnosticinterventionswithminimaldelay.However,attempts2izationsintheUnitedStates.Itisalsoacommoncomplicationtolocalizethesourceshouldneverprecedeappropriateresuscita-inpatientshospitalizedforotherill
7、nesses,especiallysurgicaltivemeasures.patients.AlthoughthetotaleconomicburdenofGIhemorrhagehasnotbeenformallyassessed,annualestimateshavesuggestedAPPROACHTOTHEPATIENTthatdiverticularbleedingalonecoststhehealthcaresysteminInpatientswithGIbleeding,severalfundamentalprinciplesof
8、3excessof1.3billiondollars.initialevaluationandmanagementmustbefollo
