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UpperGIbleedingMassiveupperGItractbleedingUpperGIbleeding2/27DefinitionBloodlost>800ml/pervomitOr>20%ofcirculatoryvolumeShockSBP<100mmHg HR>100bpmUpperGIbleeding3/39CMHematemesis（血便）Melena,blackstool（柏油便）ShockUpperGIbleeding4/27CommonreasonsPepticUlcerPortalhypertensionHemorrhagicgastritis(stressulcer)Gastriccancer(tumor)Billiarytractbleeding(hemobilia)UpperGIbleeding5/27Gastricduodenalulcer

Accountfor>50%MainlyduodenalulcerEspecialchroniculcerUlcerintheposteriorduodenalwallorlessergastriccurveUpperGIbleeding6/27PepticulcerDeepulcerinlessercurveUpperGIbleeding7/27PepticulcerUpperGIbleeding8/27CMEpigastricpainonsetregularity

ofayearbeginnigofspringandautumn（規(guī)律性）Rhythmicityinaday（節(jié)律性）Duodenalulcer:hungerpain（饑餓痛）Gastriculcer:postmealpain（餐后痛）Vomitofbloodorbloodstool30%withoutanulcerhistory

UpperGIbleeding9/27Case1UpperGIbleeding10/27DistalgastrectomyandBillrothIorIIreconstructionUpperGIbleeding11/27PortalhypertentionAccountfor25%History:chronichepatitisandcirrhosisSM:darkface,jaundice,pale,SN:splenomegaly,anemiaAbnormalHepaticfunction,Ultrasound:dialatedsplenicveinTerriblemassivehematemeisisMay>2000ml(abasin,orsprayoutonwallandground50%mortalityforthefirsttime80%secondtimeUpperGIbleeding12/27UpperGIbleeding13/27UpperGIbleeding14/27ConservativetreatmentsSengstaken-Blakemoretube(2capsule,3lumentube)Thrombininjection ivorendoscopicSomastatin

effectiveEndoscopicinjectionofsclerosingagentUpperGIbleeding15/27Sengstaken-Blakemoretube(2capsule,3lumentube)UpperGIbleeding16/27LigationUpperGIbleeding17/27LigationUpperGIbleeding18/27Injectiontherapy——Sclerosis

UpperGIbleeding19/27Operativeindications:Noascites,nojaundice,normalhepaticfunctionsOperativemethodPeriesophagogastricdevascularization賁門周圍血管離斷術(shù)PlussplenectomyUpperGIbleeding20/27HepaticcirrhosisUpperGIbleeding21/27UpperGIbleeding22/27DilatedperiesophagogastricveinUpperGIbleeding23/27UpperGIbleeding24/27MassiveblotUpperGIbleeding25/27Actuehemorrhagicgastritis

stressulcerEtiology:Stress:trauma,shock,burn,DrugsDiagnosisGastroscopyTreatmentMainlydrugs(antiacid)Operations(??Mayfail,totalgastrectomy?)UpperGIbleeding26/27Gastriccancer Painnaturechanged,thin,historyGoldenstandard:gastroscopyUpperGIbleeding27/27TreatmentMassivebleeding-----emergentoperationGastrectomyTotalgastrectomyPalliativegastrectomyLigationofgastricartery(tumortoolarge)UpperGIbleeding28/27NeoplasmsofthestomachUpperGIbleeding29/27Cases

MassivebleedingfromDep.InternalMedicine

UpperGIbleeding30/27BilliarytractbleedingCauses:stone?Trauma?TreatmentMainlynonoperativeOperation????LobectomyHardUpperGIbleeding31/27總體原則TreatmentsGenerally>80%upperGIbleedingcanbecontrolledwithnon-operativemethodsOperativemethod:laparotomyYourcourageanddeterminationExplorationUpperGIbleeding32/27Exploration:StomachandduodenumLiver—cirrhosis,splenomegalyBilliarytractsystemUpperjejunumIleumColonUpperGIbleeding33/27OtherreasonsDuodenaltumorsVasculardeformityMallory-WeisstearingetcUpperGIbleeding34/27Mallory-WeisstearingUpperGIbleeding35/27DuodenaltumorUpperGIbleeding36/27QuestionsCommonreasonsofupperGIbleedingHowtodowhenmassivebloodvomit,communicatewithsurgeonfo

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