upper gastrointestinal bleeding
Introduction
Introduction From the esophagus to the rectum is called the digestive tract of the human body. The boundary between the duodenum and the jejunum is bounded by the upper digestive tract and the lower digestive tract below. Therefore, the upper digestive tract should include esophageal, gastric, duodenal and pancreatic, biliary bleeding, collectively referred to as upper gastrointestinal bleeding. Among them, ulcer disease accounts for about half, and esophageal and gastric varices account for 25%. In recent years, cases of acute hemorrhagic gastritis and erosive gastritis with blood have also increased, and about 5% of cases have not been confirmed, even if The laparotomy failed to find the cause of the bleeding. Its clinical manifestations are mainly hematemesis and black feces, often accompanied by clinical manifestations of hypovolemia, which is a common emergency.
Cause
Cause
There are many causes of massive bleeding in the upper digestive tract. Commonly, there are peptic ulcers, acute gastric mucosal damage, esophageal varices, and gastric cancer. The causes of massive bleeding in the upper digestive tract can be summarized as follows:
Upper gastrointestinal disease
(1) Esophageal diseases: esophagitis, esophageal cancer, esophageal peptic ulcer, esophageal injury, etc.
(2) Gastroduodenal diseases: peptic ulcer, acute gastritis, chronic gastritis, gastric mucosal prolapse, gastric cancer, acute gastric dilatation, duodenitis, Zhuo-Eye syndrome, post-surgical lesions, etc.
(3) jejunal disease: jejunal cloning, jejunal ulcer after gastrointestinal anastomosis.
2. Portal hypertension
(1) Decompensation of various cirrhosis.
(2) portal vein obstruction: portal venous inflammation, portal vein thrombosis, portal vein compression by adjacent masses.
(3) Hepatic vein occlusion syndrome.
3. Upper gastrointestinal tract adjacent to organs or tissues
(1) Biliary hemorrhage: biliary or gallbladder stones, gallbladder or cholangiocarcinoma, postoperative choledochal drainage tube caused by biliary compression and necrosis, liver cancer or hepatic aneurysm broke into the biliary tract.
(2) pancreatic disease: involving duodenal pancreatic cancer, acute pancreatitis complicated with abscess ulceration.
(3) The aneurysm breaks into the esophagus, stomach or duodenum, and the aortic aneurysm, liver or spleen aneurysm ruptures.
(4) The mediastinal tumor or abscess breaks into the esophagus.
4. Systemic diseases
(1) Hematological diseases: leukemia, thrombocytopenic purpura, hemophilia, disseminated intravascular coagulation, and other coagulation disorders.
(2) uremia.
(3) vascular diseases: atherosclerosis, allergic purpura, hereditary hemorrhagic telangiectasia, elastic pseudoxanthoma, etc.
(4) Nodular polyarteritis: systemic lupus erythematosus or other vasculitis.
(5) Stress ulcer sepsis: stress after trauma, burns or major surgery, shock, adrenal glucocorticoid therapy, cerebrovascular accident or other craniocerebral diseases, emphysema and pulmonary heart disease .
Examine
an examination
1, X-ray examination: can understand the bleeding site and the nature of the lesion.
2, gastroscopy: the bleeding site and the cause can often make a rapid and correct diagnosis, has been listed as the preferred method of examination.
3, selective angiography: for the above diagnosis failed to confirm the additional examination, more diagnostic value for vascular malformations.
4, radionuclide imaging: detection of markers from the vascular spillover, active bleeding lesions can be found.
5, containing line capsule test: the location of the duodenal distal and proximal jejunal lesions caused by bleeding has a certain value.
Diagnosis
Differential diagnosis
The location of the bleeding and the judgment of the cause:
1 First, there are hematemesis and black feces, the bleeding site is mostly stomach or esophagus, and the black fecal bleeding is often located in the duodenum.
2 Chronic, rhythmic history of upper abdominal pain, often stomach or esophagus, often bleeding from ulcer disease, especially before the bleeding, the pain is relieved or relieved after bleeding.
3 Those who have stress before bleeding should first consider the bleeding of stress lesions.
4 patients with chronic liver disease, portal hypertension, more consideration of esophageal, gastric fundus rupture and bleeding.
5 middle-aged and elderly people with first bleeding, and those with anorexia and weight loss should consider gastric cancer.
