Biliary bleeding
Introduction
Introduction to biliary bleeding Biliary hemorrhage or blood biliary disease is a pathological communication between the intrahepatic or extrahepatic vessels and the biliary tract caused by various reasons, the upper gastrointestinal bleeding occurs when blood flows into the duodenum through the biliary tract, and biliary bleeding is upper digestion. One of the main causes of bleeding is not rare in China. General biliary bleeding manifests as hematemesis or melena, but most cases are often recessive mild bleeding. According to the etiology and location of biliary bleeding, it is usually divided into intrahepatic and extrahepatic. 90% of biliary hemorrhage comes from the liver, and there are fewer extrahepatic biliary tract and gallbladder. The case fatality rate is 7.2% to 33%. basic knowledge The proportion of sickness: 0.01% Susceptible people: no specific people Mode of infection: non-infectious Complications: jaundice
Cause
Causes of biliary bleeding
Massive bleeding of the intrahepatic and extrahepatic biliary system caused by hepatobiliary diseases, trauma, surgery or systemic factors.
Prevention
Biliary tract bleeding prevention
Life is temperate, pay attention to rest, work and rest, and orderly life.
Complication
Biliary bleeding complications Complications
The liver and gallbladder are swollen and tender.
Symptom
Symptoms of biliary tract bleeding common symptoms upper gastrointestinal bleeding jaundice chills bleeding blood in the stool tends to upper right abdominal pain
Different causes, the time interval from disease to onset varies, such as patients with hepatic aneurysm rupture, biliary bleeding soon after aneurysm rupture, biliary bleeding caused by injury, the time from injury to onset is about 1 day to 2 years, Usually 4 weeks.
Pain, jaundice and gastrointestinal bleeding are typical triads of this disease. Granl et al reported a group of cases with 80% of biliary colic, 63% of major bleeding, and 55% of jaundice.
1 Pain: Intrahepatic hematoma enlargement pulls the Glisson capsule, causing dull pain in the right upper abdomen or mid-upper abdomen, and can radiate to the right shoulder and back. When the biliary tract breaks, the pressure in the biliary tract suddenly rises, or there is coagulation in the biliary tract. Block, can cause bile duct obstruction or sphincter spasm and severe biliary colic.
2 gastrointestinal bleeding: pain lasts for several minutes to several hours, followed by gastrointestinal bleeding, when the amount of bleeding is large, both hematemesis and blood in the stool; in some cases hematemesis with bile duct-like blood clots, less bleeding Only blood in the stool, long-term fecal bleeding, can cause obvious anemia, gastrointestinal bleeding, due to decreased pressure in the biliary tract, pain symptoms can be alleviated.
3 jaundice: clots, necrotic liver tissue or stones obstructing the common bile duct, jaundice occurs, the degree of jaundice depends on whether the common bile duct is completely obstructed, due to obstruction of the common bile duct, the gallbladder can be swollen, in addition, biliary tract infection or biliary tract Hematoma secondary infection, there are chills, fever and hepatomegaly and other symptoms, clinical observation also found that biliary bleeding has the characteristics of periodic recurrent episodes, the interval of each cycle is generally 5 to 14 days, repeated symptoms, duration The longest is 36 years.
According to the typical symptoms, combined with history of abdominal trauma, liver surgery and liver and gallbladder disease, the diagnosis is generally not difficult, but the literature reports that the disease can be confirmed before surgery, usually once to several times It is diagnosed after the operation. It is believed that the causes of misdiagnosis of this disease are various:
1 Insufficient understanding of this disease.
2 In the analysis of the condition, the history of trauma was ignored, or the history of trauma was not related to gastrointestinal bleeding.
3 gastrointestinal bleeding is often considered as ulcer disease, in order to determine the presence or absence of ulcers, often repeated GI examination, thus delaying the diagnosis; GI test negative, it is mistaken for stress ulcer; when jaundice occurs, then Also mistaken for a large number of blood transfusion caused by serum hepatitis or hemolysis.
4 patients with a history of surgery, further complicate the situation, such as easy to mistake the postoperative stress ulcer, bleeding tendency caused by vitamin K deficiency, or gastrointestinal damage.
5 The amount of bleeding in this disease has certain limitations, and there is a long period of time, which is also a cause of delay in diagnosis.
Examine
Biliary bleeding examination
History
Before biliary bleeding, there are often liver and gallbladder surgery, liver puncture, history of liver trauma, or history of cholelithiasis, biliary tract mites, and liver tumors.
2. Abdominal pain
Colic or pain in the upper abdomen or upper right abdomen and radiate to the right shoulder and back.
3. Hematemesis and black stools
Often in the upper abdominal cramps hematemesis, black stools or only black stools.
4. Huang Wei
Most patients may have systemic skin, sclera yellow staining and varying degrees of hypothermia, and chills and high fever occur when the infection is combined.
5. Physical examination
Different degrees of tenderness or muscle tension in the right upper abdomen, liver and gallbladder enlargement.
6. Laboratory test
Total bilirubin and elevated bilirubin in 1 minute.
7.B-ultrasound
It can be found that the intrahepatic and extrahepatic bile ducts are dilated, and the gallbladder and hepatolithiasis stones, and the occupying lesions of the liver and pancreas are found.
8. Selective hepatic angiography
Intrahepatic space-occupying lesions, tumor-like lesions of the hepatic artery, hepatic artery bile duct fistula, hepatic artery portal vein spasm, and abnormal lesions of the hepatic artery can be found. The positive result of selective hepatic angiography provides a basis for treatment of biliary bleeding.
9. Fiber endoscopy
Endoscopically, blood was found to flow from the ampulla opening, and the diagnosis was biliary bleeding. At the same time understand and exclude bleeding lesions of the esophagus, stomach and duodenum.
10. Other
Liver CT scan, magnetic resonance (MRI) and radionuclide scans.
Diagnosis
Diagnosis and diagnosis of biliary bleeding
1. Fever, chills, jaundice, hematemesis, melena or T-tube drainage after the upper abdominal cramps, bleeding is periodic.
2. A series of manifestations of hemorrhagic shock.
