Massive haemorrhage _ general knowledge of gastroduodenal ulcer

Massive haemorrhage _ general knowledge of gastroduodenal ulcer
[Sum up ]
Gastroduodenal ulcer bleeds because the ulcer base bottom blood vessel is corroded and breaks to cause. The majority bleeds for the artery. The bleeding at various degrees will take place to about 20% of the ulcer patients of - 30%. And the speed that its clinical manifestation depends on the quantity of losing blood. Small quantity bleed repeatedly, show as anaemia, stool latent blood tests the masculine gender; Bleeding amount 80mk) slightly more (50-Clinic can present the pitch kind and relieve oneself; Massive haemorrhage refers to having obvious gastrointestinal bleeding symptoms, namely spitting blood and have blood in one's stool in a large amount, hemoglobin is reduced, blood pressure drops even the person who presents shock. Cause the cause of disease of ulcer of massive haemorrhage, generally lie in the wall after the lesser curvature or duodenum ball. About 5% of the massive haemorrhage cases of - 20% needs surgery to treat.
[Symptom and body disease ]
1.Spitting blood and pitch kind, or both appear at the same time. 2.Short-term internal haemorrhage> 400mk, there can be circulatory systems and compensate the phenomenon; Bleeding amount> 800mk, can present shock. 3.The tenderness of upper abdomen, the gurgling sound is active.
[Diagnose the basis ]
1.There is medical history of typical ulcer (10% of the patients of - 15% can not have) ; 2.Spitting blood or pitch a kind of piss; 3.Behave back to enclose compensating or shock; 4.The tenderness of upper abdomen, the gurgling sound is active; 5.Gastrocopy can find the bleeding source; 6.The arteria coeliaca radiography of the alternative, visible radiography pharmaceutical bleeds in a place to overflow the digestive tract from ulcer sometimes.
[Treat the principle ]
1.Fasting, the intestines and stomach reduce pressure. 2.Blood transfusion, infusion. 3.Employ styptic pharmaceutical. 4.Surgery treats indication: Have not been improving or worsening without performing the operation and treating 24- symptom of 48 hours; It is fast to bleed, the person who takes place shock (through 6- blood transfusion 600- 800mk of 8 hours, blood pressure can't be maintained, press the erythrocyte, accumulate, drop suddenly; Repeated numerous bleeding person; Person who suspected to has canceration; Over age 45, or the person who has arteriosclerosis. Operation way has stomaches including ulcer that excises the skill mostly; If it is difficult for ulcer to excise, feasible the intersection of Bancroft and operation, must bleed some with the intersection of silk thread and ligature.
[Curative effect is appraised ]
Cure: Bleed and stop after treating, there is not complication.
[The expert briefs on ]
Face it on the skill, about 10%- 15% of the ulcer massive haemorrhage patients, there is no medical history of ulcer previously, it is comparatively difficult to diagnose, should be variceal with the hyperbarism esophagus of portal vein, fundus of stomach to break massive haemorrhage and biliary tract to bleed, it is distinguished that irritable ulcer bleeds and bleeds etc. with gastric carcinoma. Ulcer and and massive haemorrhage are most can arrest blood by the treatment of internal medicine department, only 5% of the patients of - 20% need surgery. Do the comprehensive review of the stomach duodenum at the time of the operation, pay attention to compounding ulcer or existence of ulcer of occuring frequently, especially should notice whether there is pathological change on the cardia, stomach bottom, in case that omit the cause of disease of bleeding and cause the serious consequence.
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