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1、呕血与便血HematemesisandHematocheziaDefinitionHematemesis:Bloodyvomitusfromtheuppergastro-intestinal(GI)tract（beforetheligamentofTreitz)Hematochezia:brightred,maroonorblackbloodfromtherectumTreitz:TheligamentofTreitzisananatomiclandmarkfortheduodenal-jejunaljunctionClinicalManifestation1Manner
2、ofbleedingpresentation2Hypovolemia(低血容量)orshock3Anemia(贫血)Patientsmanifestbloodloss(A)Hematemesis呕血CharacterBloodyvomitus,eitherfreshandbrightredorolderand“coffee-ground”(hematin酸化正铁血红素)MannerofbleedingpresentationfromtheGItractinfiveways:causeofdisease90%upperGIbleedingisduetofourlesions
3、:1)pepticulcer(消化性溃疡)2)esophagealorgastricvarices(食管胃底静脉曲张破裂)3)hemorrhagicgastritis(急性糜烂性出血性胃炎)4)gastriccancerpepticulcerhemorrhagicgastritisesophagealvaricesgastriccancerOthercausesofupperGIbleedingMallory-Weisstear食道-贲门撕裂伤Foreignbodyinesophagus食管异物Ancylostomiasis钩虫病Post-sphincterotomy括约
4、肌切开术后DifferentiationNosebleeding?Hemoptysis?DifferntiatinghemoptysisandhematemesisHemoptysisHematemesisCauseofdiseaseTB,bronchiectasis,pneumonia,lungcancer,heartdiseasePU,livercirrhosis,acuteerosiveandhemorrhagicgastritisSyptombeforebleedingitchoflaryngeal,dyspnea,coughepigastricdiscomfor
5、t,nauseaandvomitMannerofbleedinghawkvomit,spurtingBloodcolourfreshredmaroon,coffee-groundMixtureinbloodsputumfoamfooddebrisgastricjuicePowerofhydrogenalkalityacidityMelenanohaveSputumwithbloodysputumnosputumMannerofbleedingpresentation(B)Hematochezia便血Characterbrightredormaroonbloodfromth
6、erectumpurebloodbloodintermixedwithformedstoolbloodydiarrhea(C)Melena黑便CharacterShiny,black,sticky,foul-smellingstoolTarrystool(柏油样便)(degradationofblood)Differentiationexogenousstooldarkeners:animalblood,iron,bismuth(铋剂)MannerofbleedingpresentationMannerofbleedingpresentation(D)Stoolwitho
7、ccultblood隐血便DetectedonlybytestingthestoolwithamonoclonalantibodyforhumanhemoglobinEstimateamountofbleedingfromupperGItract5~10ml/dOB+50~70ml/dMelena250~300mlinshorttimeHematemesisCausesofbleedingColorectalcancerColitisLargehemorrhoid大痔Rectumtear肛裂VascularanomaliesH
