Repeated vomiting of blood
Introduction
Introduction Hematemesis refers to the patient's vomiting of blood, due to acute bleeding of the upper digestive tract (the esophagus, stomach, duodenum, jejunum, pancreas, biliary tract after gastrojejunostomy). But it can also be seen in certain systemic diseases. Bleeding and hemoptysis in the mouth, nose, throat, etc. must be excluded before determining hematemesis. .card-tab{font-size:12px;border:1px solid #ddd;width:685px;overflow:hidden}.card-tab .title{margin-bottom:4px}#card-tab-list{position:relative;z-index:1;top:1px}#card-tab-list dd{font-size:14px;line-height:32px;font-weight:bold;display:inline-block;color:#136ec2;text-align:center;border:1px solid #e7ecf0;border-bottom:1px solid #ddd;height:32px;width:97px;cursor:pointer;margin-right:-1px;background:transparent url("/static/lemma/view/img/yiyao_57e4439e.png") repeat-x 0 0;*display:inline;*zoom:1}#card-tab-list .card-cur-tab{background-image:none;background-color:white;border-color:#ddd;border-top:2px solid #666;position:relative;border-bottom-color:white;font-weight:bold;color:black}#card-tab-container .card-tab{display:none}#card-tab-container a{text-decoration:none}#card-tab-container a:hover{text-decoration:underline}#card-tab-container .show-tab{display:block!important}#card-tab-container .show-tab,#card-tab-container .card-tab{padding:25px 18px 18px 18px;text-indent:2em;height:120px}
Cause
Cause
Western medicine:
Digestive system disease
(1) Esophageal diseases: esophageal varices, esophagitis, esophageal diverticulitis, esophageal cancer, esophageal foreign body, hiatal hernia, esophageal trauma, etc. Esophageal varices bleeding is often the most serious. Esophageal foreign bodies (such as fish bones) piercing the aorta can cause fatal bleeding.
(2) Gastroduodenal diseases: peptic ulcer, acute erosive gastritis, stress ulcer, gastric cancer, gastric mucosal prolapse, gastric arteriosclerosis, etc. Hemorrhage often occurs in duodenal bulb ulcers, and bleeding from stress ulcers, gastric cancer, and gastric arteriosclerosis is also severe.
(3) Hepatobiliary diseases: such as cirrhosis, esophageal and gastric varices, acute hemorrhagic cholangitis, ampullary cancer.
(4) Pancreatic disease: pancreatic cancer.
2. Blood diseases: leukemia, thrombocytopenic purpura, hemophilia, Hodgkin's disease, polycythemia vera, hereditary hemorrhagic telangiectasia.
3. Acute infectious diseases: leptospirosis, hemorrhagic measles, fulminant hepatitis, etc.
4. Other causes: uremia, nodular polyarteritis, hemangioma, excessive treatment with anticoagulants.
Although there are many causes of hematemesis, the main three major causes are:
1 peptic ulcer;
2 esophageal or gastric varices bleeding;
3 acute gastric mucosal bleeding.
Chinese medicine:
Stomach heat sputum: vomiting blood is bright red or purple, sudden onset, mixed with food residue, more often accompanied by annoying heat thirst, stomach sputum burning, swallowing acid and noisy, thirsty like cold drink, or induced after drinking, The constipation is not smooth, the color is black as lacquer, the urine color is red, the lips are red and bad smell, the tongue is red, the moss is thick, and the pulse slips.
Liver fire smother stomach: vomiting blood red or purple dark, mixed with food residue, chest pain and pain, chest tightness is not good enough, bitter mouth, upset and irritated, less dreams, urine yellow dry, red tongue yellow, The number of pulse strings.
Both heart and spleen deficiency: vomiting blood is light and not fresh, lingering, sputum, sputum, pain, sigh, sigh, pale, pale, weak, stagnant, bloating, loose stools, white fur, weak pulse.
Stomach yin deficiency: vomiting blood repeatedly, less red color, stomach cramps, not thinking about diet, dry throat, low fever, five upset hot, less dreams, fatigue, weight loss, red tongue, less moss, fine pulse number.
Stomach sputum blood stasis: vomiting blood, purple and black sputum, with stomach tingling, pain, have a fixed position, refused to press, look dark, thirsty but want to drowning water without swallowing, tongue has purple spots, pulse string number.
Examine
an examination
Related inspection
Gastric examination of the gastrointestinal tract CT examination of gastrointestinal diseases by ultrasound
Laboratory inspection:
1. Routine examination of blood routine platelets, outflow, clotting time, prothrombin time and other general examinations. In general, coagulation disease, abnormal changes in the blood coagulation phase, such as DIC or vitamin K deficiency, such as congenital allogeneic or passive immune thrombocytopenic purpura or various congenital coagulation factor deficiency, coagulation The phase is abnormal.
2. Fecal examination found red blood cells, occult blood test strong positive acute gastroenteritis children may have mucus bloody stools, blood and so on.
3. Apt test to identify blood as maternal blood or newborn's own blood. Take the baby's vomit or blood in the feces, add 5 times water and mix well, centrifuge at 2000 rev / min for 2 min, take the pink supernatant (5 parts) in a test tube, add 1% sodium hydroxide (1 part), After 2 minutes, if the test solution changes from pink to yellowish brown, it shows that adult hemoglobin (HbA) indicates that the blood is maternal blood. If it is still pink, the blood comes from the newborn, and the newborn swallows into the nasopharyngeal cavity or gas. The blood in the Tao is mainly fetal hemoglobin (HbF).
Other auxiliary inspections:
Endoscope
(1) fiber esophagoscopy gastroscope, duodenoscopy: it is superior to X-ray barium angiography, the diagnosis rate is 75% to 90%, while the latter is only 50% to determine the bleeding above or below the Treitz ligament; See the source of bleeding (positive rate of 77%) and specific bleeding; biopsy and hemostasis can be performed under direct vision; superficial and microscopic lesions that are difficult to detect by X-ray examination can be observed; can also be examined during acute bleeding . Pediatric use of GIF-P2 or GIF-P3 type mirror under general anesthesia or local anesthesia plus atropine, must correct the coagulopathy and hemodynamic instability before microscopy, keep the airway open, and use antibiotics to prevent infection.
(2) fiberoptic colonoscopy, colonoscopy: first to perform a colonoscopy before the colonoscopy to do a bowel enema examination is different from the upper digestive tract examination. With PCF (Olympus) or FC-34MA endoscopes, small babies can also be replaced with small-caliber gastroscopes.
2. X-ray inspection
(1) Abdominal plain film: Take the supine, erect or lateral lateral abdominal plain film, which can exclude the intestinal obstruction and intestinal perforation, which is especially important for neonatal small intestine torsion necrotic enteritis and meconium peritonitis.
(2) barium angiography: rare meal in the non-acute bleeding period has a certain value, often with methyl cellulose as a double layer comparison. Oral sputum can also be injected into the small intestine after intubation of the duodenum (with or without methylcellulose). Barium enema often helps in the diagnosis of intussusception.
3. Radionuclide scanning is an effective and accurate method of examination using 99mTc-sulfur or other citrate-labeled red blood cell scans, which is most valuable for subacute or intermittent bleeding. False positives reached 15%, while false negatives reached 25%.
4. Angiography is used for hemorrhagic cases of 1.5 to 2.0 ml/min or more. In cases where the amount of bleeding is too large to be operated, embolization can be used to stop bleeding. However, due to the above-mentioned series of more advanced and non-invasive inspection methods, this method is currently rarely used.
Diagnosis
Differential diagnosis
1. Exclusion of pseudo-heavy hemorrhage and/or blood in the stool: The blood Apt test including the blood swallowed into the mother and the neonatal gastrointestinal tract is helpful for this differential diagnosis.
2. Exclusion of systemic coagulopathy is detected before transfusion (or plasma), injection of vitamin K and other anticoagulants, coagulation phase is essential, the most important is to make early diagnosis and treatment of neonatal hemorrhagic disease. At the same time, the infection of the central nervous system is damaged by respiratory distress and heart failure.
The difference between hematemesis and hemoptysis:
(1) History: Patients with hematemesis have a history of stomach, duodenal ulcer, tumor or cirrhosis, and hemoptysis patients usually have tuberculosis, bronchiectasis or cardiopulmonary disease.
(2) bleeding mode: hematemesis is caused by vomiting, hemoptysis is usually spit after coughing.
(3) Blood color: The color of hematemesis is purple or brown, no foam, and hemoptysis is bright red with foam.
(4) Content: food residue and gastric juice of hematemesis, sputum mixed with sputum.
(5) Symptoms before hemorrhage: upper abdominal pain often occurs before hematemesis, fullness and discomfort; hemoptysis often causes itchy throat, cough, chest tightness.
(6) Blood reaction: The blood of hematemesis is acidic; the blood of hemoptysis is weakly alkaline.
(7) stool examination: patients with hematemesis often tar (black)-like stool, fecal occult blood test is positive; hemoptysis patients with fecal occult blood test are often negative, unless the blood is swallowed, the general feces are normal.
