




版權(quán)說(shuō)明:本文檔由用戶提供并上傳,收益歸屬內(nèi)容提供方,若內(nèi)容存在侵權(quán),請(qǐng)進(jìn)行舉報(bào)或認(rèn)領(lǐng)
文檔簡(jiǎn)介
上消化道出血2G.I.BleedingPresentedby: AhmedT.Al-Suwaidi MohamedS.Al-Hoqani上消化道出血2G.I.BleedingCase50yrs,Pakistani,maleC/O:Bleeding/rectum&Abd.painPainlessbleeding,1yr–excessbleeding,1monthBlack,4-5times/day,littlequant.Abd.painVomiting,1week上消化道出血2G.I.BleedingCaseM.H: *nopepticulcerdisease *nomedications(NSAIDs) *nourinarysymptoms *notknownDM,HPTN,IHD **weightloss上消化道出血2G.I.BleedingCaseO/E: *Afebrile *nopallor *notdyspneaic *nolymphoadenopathies *noS.C.L.N上消化道出血2G.I.BleedingCaseVitalSigns: *Pulse:78bts/min *BP:130/80 *RR:18br/minHeart:NADLung:NAD上消化道出血2G.I.BleedingCaseAbd.: *notdistended *noepigast.tenderness *tender,firm,partlymobilemassatRt lumbarregion. *spleennotpalpable *Ltlobeliverpalpable,mildlytender *bowelsoundspresent上消化道出血2G.I.BleedingCasePR: *noenlargedpiles *noactivebleeding *nopalpablemass *nobloodonfingerECG,CBC,SrAmylase,Bleedingprofile,AbdX-ray,fecalloadingascendingcolon上消化道出血2G.I.BleedingCaseLabResults: *Hb:14.1g/dl *Plt:252*103 *Hypochromic,microcytic *PT:17.3sec *aPTT:35.4sec *SrAmy:129U/l106U/l *Na+:140mmol/l *K+:4.1mmol/l *BUN:17mg/dl上消化道出血2G.I.BleedingAcuteVsChronicAcuteUpperG.I.Bleeding:AcuteLowerG.I.Bleeding:上消化道出血2AcuteUpperG.I.BleedingHaematemesisMelaenaSite&Time上消化道出血2AcuteU.G.I.Bleeding·
Aetiology:
1.Drugs(Aspirin&NSAIDs)2.Alcohol3.Chronicpepticulceration(50%ofGIhemorrhage)4.Others:refluxesophagitis,varices,gastriccarcinoma,acutegastriculcers&erosions.上消化道出血2AcuteU.G.I.Bleeding·
Clinicalapproach:1.recent(24hrs),thenhospitalized.2.ifsmallamount,noimmediateTx,becauseCVScancompensate3.85%stopbleedingduring48hrs4.historyhelpsindiagnosingthecauseofthehemorrhage,eg:longhistoryofindigestion,orprevioushem.fromulcers.上消化道出血2AcuteU.G.I.Bleeding
·
Clinicalapproach:5.factorsinclude: ·
age(60+)·
amountofbldlost·
continuingvisiblebldloss.·
signsofchronicliverdisease·
classicalclinicalfeaturesofshock上消化道出血2AcuteU.G.I.Bleeding
·
Clinicalapproach:
6.liverdisease
severe,recurrentbleeding (iffromvarices) 7.splenomegaly
portalhypertension上消化道出血2AcuteU.G.I.Bleeding·
Immediatemanagement: **Emergencymanagement:·
History+exam.·
Monitor:pulse&BP/30min·
Bldsample:haemoglobin,urea,electrolytes,grouping&cross-matching·
I.v.access上消化道出血2AcuteU.G.I.Bleeding**Emergencymanagement(cntd):· Bldtransfusionincaseof1)shock 2)haemoglobin<10g/dl·
Urgentendoscopy·
Surgerywhenrecommended上消化道出血2AcuteU.G.I.Bleeding
**Shockmanagement:·
ABC·Airway:endotrachealtube,oropharyngealairway. *Giveoxygen上消化道出血2AcuteU.G.I.Bleeding
**Shockmanagement(cntd):·
Breathing:supportrespiratoryfunction *Monitor:resp.rate,bldgases,chest radiograph·Circulation:expandcirculatingvolume:blood,colloids,crystalloidssupportCVSfunction:vasodilators *Monitor:skincolor,peripheraltemp.,urine flow,BP,ECG上消化道出血2AcuteU.G.I.Bleeding·
GeneralInvestigations: 1.
Hb,PCV 2.
CBC(WBC…etc) 3.
Bldglucose 4.
Platelets,coagulation 5.
Urea,creatinine,electrolytes 6.
Liverbiochem. 7.
Acid-basestate
8.Imaging:chest&abd.radiography,US,CT上消化道出血2AcuteU.G.I.Bleeding **Generalmanagement:·
Bloodvolume 1.restorevolumetonormal 2.transfusion·
Endoscopy 1.shock,suspectedliverdiseaseor continuedbleeding 2.controlvaricesorulcerstoreduce re-bleeding上消化道出血2AcuteU.G.I.Bleeding **Generalmanagement:·
Drugtherapy 1.H2–receptorantagonists 2.protonpumpinhibitors·
Factorsinreassessment 1.age:60+
greatermortality 2.recurrenthemorrhage:+++mortality 3.re-bleeding:mostlywithinthe1st48hrs 4.surgicalproceduresincaseofsevere bleeding.上消化道出血2LowergastrointestinalhaemorrhageCausesDiverticulardiseaseAngiodysplasiaInflammatoryboweldiseaseIschaemiccolitisInfectivecolitisColorectalcarcinoma上消化道出血2InvestigationMayshowangiodysplasticlesionsevenoncebleedinghasceasedMost
patientsarestableandcanbeinvestigatedoncebleedinghasstoppedIntheactivelybleedingpatientconsiderColonoscopy-canbedifficultSelectivemesentericangiographyRequirescontinuedbleedingof>1ml/minute上消化道出血2RadionuclidescanningUsestechnetium-99mlabeledredbloodcells上消化道出血2ManagementIfsourceofcolonicbleedingunclearperformasubtotalcolectomyandend-ileostomyAcutebleedingtendstobeselflimitingConsiderselectivemesentericembolisationiflifethreateninghaemorrhageIfbleed
溫馨提示
- 1. 本站所有資源如無(wú)特殊說(shuō)明,都需要本地電腦安裝OFFICE2007和PDF閱讀器。圖紙軟件為CAD,CAXA,PROE,UG,SolidWorks等.壓縮文件請(qǐng)下載最新的WinRAR軟件解壓。
- 2. 本站的文檔不包含任何第三方提供的附件圖紙等,如果需要附件,請(qǐng)聯(lián)系上傳者。文件的所有權(quán)益歸上傳用戶所有。
- 3. 本站RAR壓縮包中若帶圖紙,網(wǎng)頁(yè)內(nèi)容里面會(huì)有圖紙預(yù)覽,若沒(méi)有圖紙預(yù)覽就沒(méi)有圖紙。
- 4. 未經(jīng)權(quán)益所有人同意不得將文件中的內(nèi)容挪作商業(yè)或盈利用途。
- 5. 人人文庫(kù)網(wǎng)僅提供信息存儲(chǔ)空間,僅對(duì)用戶上傳內(nèi)容的表現(xiàn)方式做保護(hù)處理,對(duì)用戶上傳分享的文檔內(nèi)容本身不做任何修改或編輯,并不能對(duì)任何下載內(nèi)容負(fù)責(zé)。
- 6. 下載文件中如有侵權(quán)或不適當(dāng)內(nèi)容,請(qǐng)與我們聯(lián)系,我們立即糾正。
- 7. 本站不保證下載資源的準(zhǔn)確性、安全性和完整性, 同時(shí)也不承擔(dān)用戶因使用這些下載資源對(duì)自己和他人造成任何形式的傷害或損失。
最新文檔
- 醫(yī)療行業(yè)中的安全培訓(xùn)與質(zhì)量管理研究
- 醫(yī)療器械生產(chǎn)中的清潔與消毒要求
- 醫(yī)療科技引領(lǐng)電子健康記錄的全面發(fā)展
- 醫(yī)療健康科技創(chuàng)新與人才培養(yǎng)
- 醫(yī)療安全培訓(xùn)從理論到實(shí)踐的轉(zhuǎn)化
- 春季消防工作總結(jié)模版
- 升職表態(tài)發(fā)言稿模版
- 個(gè)人質(zhì)押合同范例
- 5服務(wù)合同范例
- 醫(yī)療產(chǎn)品回收與再利用-生命周期末端的新商機(jī)
- 個(gè)人裝修施工合同范本
- 慢性肝病的預(yù)防與管理
- 綠城江南里資料整理
- SN-T 2696-2010煤灰和焦炭灰成分中主、次元素的測(cè)定X射線熒光光譜法
- 工會(huì)乒乓球比賽競(jìng)賽規(guī)程
- qpq處理工藝流程
- 經(jīng)典美味的手抓飯
- 體育產(chǎn)業(yè)與生態(tài)環(huán)境的共同保護(hù)
- 讀后續(xù)寫制作稻草人(T8聯(lián)考)講義-高考英語(yǔ)作文復(fù)習(xí)專項(xiàng)
- 食堂員工培訓(xùn)內(nèi)容-食堂從業(yè)人員培訓(xùn)資料
- 中職電子商務(wù)班級(jí)建設(shè)方案
評(píng)論
0/150
提交評(píng)論