intestinal bleeding
Introduction
Introduction Intestinal ischemia refers to the obstruction of blood vessels supplying intestinal blood for some reason, resulting in the reduction or loss of blood source of the intestinal tract. It is not required for the physiological activities of the intestinal tract, and the intestinal wall is congested, edematous or ulcerated. Necrosis, hemorrhage, perforation, and peritonitis can occur. Ischemic bowel disease (ischemic boweldisease) is a disease caused by intestinal wall ischemia, hypoxia, and eventually infarction. The disease is more common in elderly patients with arteriosclerosis and cardiac insufficiency. Most of the lesions occur in a segmental manner centering on the spleen of the colon. The direct causes of colonic ischemia are mostly mesenteric arteries and veins, especially vascular occlusion and stenosis caused by atherosclerosis or thrombosis in the superior mesenteric artery. Heart failure, shock caused by lower blood pressure, and insufficient local blood supply to the intestine may also be the cause of the disease.
Cause
Cause
The lesion of the vascular disease itself is the main pathological basis for intestinal ischemia.
(1) atherosclerosis (15 cases): narrowing of the lumen of the blood vessel, poor blood flow caused by a decrease in blood supply to the corresponding site.
(2) embolization (8 cases): hypertensive heart disease, rheumatic heart disease, infective endocarditis, myocardial infarction, atrial fibrillation, traumatic fracture, prolonged bed rest, etc., because of the superior mesenteric artery diameter Larger, oblique angle with the abdominal aorta, it is easy to accept embolism from the heart and embolism. Its incidence accounts for about 50% of acute intestinal infarction.
(3) Systemic vascular disease (1 case of nodular polyarteritis): also one of the local manifestations. In the case of immune system diseases such as nodular polyarteritis and systemic lupus erythematosus, intestinal small arteries are involved, resulting in a poor blood supply to the corresponding intestinal tube and an ischemic change.
Blood lesions in the case of polycythemia vera, thrombocytosis, long-term oral contraceptives, severe ICD infection, chemotherapy, radiotherapy, etc., the blood is in a hypercoagulable state, easy to form a thrombus or embolus and block the intestinal blood vessels, 19 patients One patient was treated with radiation for gynecologic tumors. After 1.5 years, colonic perforation and intestinal gangrene occurred due to ischemic colitis. Partial bowel resection and end-to-end anastomosis were performed. Death in the days.
Insufficient blood flow can cause splanchnic blood flow decline, which can cause intestinal ischemia, leading to ischemic enteritis, such as coronary heart disease, valvular heart disease or arrhythmia caused by decreased cardiac output, peripheral blood vessels during hypotension shock Insufficient perfusion, etc., especially in the treatment of the above diseases, using digitalis drugs, alpha adrenergic agonists or beta agonists can be used as exogenous stimuli to further reduce intestinal blood flow, induced or aggravated In the incidence of bloody bowel disease, 6 of 19 patients belonged to this condition.
Other diseases such as superior mesenteric artery compression, intestinal vascular malformations, intestinal and abdominal malignancies, intestinal obstruction, acute pancreatitis, etc. can also lead to ischemic bowel disease. Acute pancreatitis is a common clinical disease, the incidence of complications is about 20%, vascular complications are not uncommon, 2 of 19 patients belong to acute pancreatitis invading the intestinal artery and vein causing ischemic bowel disease.
Examine
an examination
Related inspection
Gastrointestinal CT examination of gastrointestinal diseases by ultrasound examination of gastrointestinal dysfunction
Serological, CT, angiographic, color Doppler, and endoscopy are available for suspected patients with the disease. Color Doppler examination is a non-invasive and relatively sensitive means of examination. Some scholars conducted color Doppler examination on 24 cases of ischemic bowel disease. By measuring the thickness of the intestinal wall and the blood flow of the intestinal artery, the sensitivity of the diagnosis of ischemic bowel disease was found to be 82%, and the specificity was 92%. The positive predictive value is 81%, so color Doppler ultrasound is important for early diagnosis and prognosis monitoring of ischemic bowel disease. The determination of specific gases in the intestinal lumen also contributes to the diagnosis of this disease.
Diagnosis
Differential diagnosis
The disease is mainly differentiated from ulcerative colitis, colonic cloning, and colon cancer.
Because of the lack of specificity in the symptoms of ischemic bowel disease, early diagnosis based on clinical manifestations is difficult.
If there is a basic lesion of ischemic enteritis, if there is persistent or sudden abdominal pain, the possibility of ischemic enteritis should be considered when there is no special examination, such as occult blood positive or bloody stool in gastrointestinal secretions, elevated peripheral blood leukocytes, etc. Have some help, such as severe abdominal pain, acute abdomen or shock signs need to be alert to the possibility of intestinal perforation. Emergency endoscopy has a definite diagnosis, especially in the blood-sucking period, which is the key to early diagnosis. And can determine the extent of the lesion and the stage of the lesion, and at the same time can obtain histological examination, which is helpful for the differential diagnosis of other inflammatory bowel disease and colon cancer.
