上消化道出血诊治课件.ppt

1、1.2.3.4.5.6.7.8.9.Zollinger-Ellison SyndromeZollinger-Ellison Syndrome 10.11.Multiple ulcerations in a patient under NSAID therapy.Multiple ulcerations in a patient under NSAID therapy.12.13.14.15.16.Hemorrhagic gastritis with multiple Hemorrhagic gastritis with multiple intramural bleeding spots ac

2、companied intramural bleeding spots accompanied by xanthomataby xanthomata.Hemorragic gastritisHemorragic gastritisSevere Hemorrhagic gastritis Severe Hemorrhagic gastritis in a patient with acute in a patient with acute pancreatitis.pancreatitis.17.Alkaline Reflux Gastritis Alkaline Reflux Gastriti

3、s 18.19.20.21.22.急性食管坏疽急性食管坏疽57岁、男性、上消化道出血 内窥镜发现幽门前溃疡（Forrest II c）以及食管下端2/3广泛发白伴有多发的红或黑色斑点。发病机理不清，缺血看来是一个重要特征。内镜所见可与腐蚀剂损伤相似。近来报道的发病率0.2%。虽然与GER不相关，仍推荐用PPI治疗。抗霉菌疗效不确定。23.24.25.Chronic Mallory-Weiss Chronic Mallory-Weiss 26.27.28.29.Battery ingestionBattery ingestionSewing needle found at Sewing need

4、le found at second portion of second portion of duodenum with successful duodenum with successful endoscopic removal.endoscopic removal.30.Dieulafoys diseaseDieulafoys disease31.32.33.34.35.AngiodysplasiasAngiodysplasias36.37.38.39.40.41.42.43.44.血管炎病人的十二指肠缺血性溃疡血管炎病人的十二指肠缺血性溃疡 45.胃窦继发性淀粉样变性胃窦继发性淀粉样变

5、性46.47.48.49.50.51.52.53.54.许国铭 上消化道内镜学 陆星华 消化内镜学55.56.57.58.59.60.61.Gastric varicesGastric varices62.63.64.65.GU GU 上图的侧面观，由于新近上图的侧面观，由于新近的出血，胃粘膜上钡剂覆盖减少。的出血，胃粘膜上钡剂覆盖减少。GU GU 胃小弯可见一个胃小弯可见一个5cm5cm的的溃疡龛影，由于新近出血的血溃疡龛影，由于新近出血的血凝块覆盖形成充盈缺损。凝块覆盖形成充盈缺损。66.双重对比的双重对比的upper GI upper GI：DU DU posterior wall ul

6、cerposterior wall ulcer上例侧面观上例侧面观 67.68.69.Contrast material injection in the Contrast material injection in the gastroduodenal artery via a microcatheter gastroduodenal artery via a microcatheter demonstrates a tiny saccular aneurysm in a demonstrates a tiny saccular aneurysm in a patient who prese

7、nted with upper patient who presented with upper gastrointestinal bleeding.gastrointestinal bleeding.70.71.72.73.74.75.76.77.78.79.80.81.82.83.84.血液丢失血液丢失(ml)(ml)750 2000 2000 血液丢失血液丢失(%bv)(%bv)15%40%40%脉率脉率 100 100 100 120 120 140 140 血压血压 正常正常 正常正常 下降下降 下降下降 脉压脉压 正常或增加正常或增加 减低减低 减低减低 减低减低 呼吸率呼吸率 1

8、4-20 14-20 20-30 20-30 30-40 30-40 35 35 尿量尿量 30 30 20-30 20-30 30-40 30-40 35 35 精神状态精神状态 轻度焦虑轻度焦虑 中度焦虑中度焦虑 焦虑和意识模糊焦虑和意识模糊 意识模糊和昏睡意识模糊和昏睡 液体补充液体补充 晶体样液晶体样液 晶体样液晶体样液 晶体样液和血液晶体样液和血液 晶体样液和血液晶体样液和血液 85.86.87.止血、蛋白水解胃蛋白酶促进血凝块水解促进血小板凝聚胃蛋白酶不可逆失活最佳的止血状态88.89.90.91.92.93.94.95.Active bleeding gastric Dieula

9、foy Active bleeding gastric Dieulafoy lesion successfully treated with lesion successfully treated with endoclips.endoclips.96.发生于发生于Barrett s 食管的有茎大息肉，息肉摘除术后食管的有茎大息肉，息肉摘除术后出血于内镜下钳夹止血。出血于内镜下钳夹止血。97.血管发育不良予以热探头治疗时的渗血血管发育不良予以热探头治疗时的渗血Ooze bleeding during the initial treatment with the heater probe of

10、this angiodysplasia.98.99.100.101.102.降低肝内血管阻力，扩门脉侧枝循环。降低肝内血管阻力，扩门脉侧枝循环。1 1）硝酸甘油硝酸甘油：静脉（强）动脉（弱）：静脉（强）动脉（弱）10mg+ns400ml iv gtt 1520gtt/min 10mg+ns400ml iv gtt 1520gtt/min BidTid BidTid（降门压（降门压24.7%27.3%24.7%27.3%）或舌下含，保持或舌下含，保持SBP90mmHgSBP90mmHg；103.104.105.早期应用有效率早期应用有效率 6877%6877%并发症：并发症：吸入性肺炎（吸入性肺炎（10%10%）、）、食管或胃穿孔、黏膜坏死、食管或胃穿孔、黏膜坏死、胸痛、疗效不持久。胸痛、疗效不持久。放气后再出血放气后再出血 50%50%。106.107.108.109.110.111./10/29.112NoImage