If the amount of bleeding above the pylorus is small, and the blood does not cause vomiting reflex in the stomach, then all the blood flows into the intestine, showing that the person with black stool can not vomit blood, and the person who vomits blood is black stool. The characteristics of hematemesis mainly depend on the amount of bleeding and the time of staying in the stomach. People who spit bright red blood or blood clots indicate a large amount of bleeding and a short stay in the stomach. The amount of blood discharged is small and slow, and it stays in the stomach for a long time. The blood spit out by stomach acid is red bean color or coffee grounds color. The color of melena mainly depends on the length of time that blood stays in the intestine, followed by the location of bleeding. When the upper digestive tract bleeds, the iron of hemoglobin in enterohematocele combines with intestinal sulfide to form iron sulfide feces, which is tar-like black. If the amount of bleeding is large and the intestinal peristalsis is too fast, dark red or even bright red will appear. After massive hematemesis and melena, the body temperature rises and azotemia appears. The temperature is generally 38.
Around t, the reason for the continuous increase of body temperature in 3-SD is the sudden decrease of blood volume and the failure of peripheral circulation, which leads to the dysfunction of thermoregulation center. Blood urea nitrogen often rises after massive hemorrhage, which is called enterogenous azotemia. Usually, blood urea nitrogen begins to increase about 24-48 hours after bleeding.
H reached its peak, 3-4
Back to normal after D. The increase of urea nitrogen is mainly due to the absorption of protein hydrolysate by human intestine. Secondly, due to peripheral circulation failure after massive hemorrhage, renal blood flow and glomerular filtration rate decreased, leading to prerenal azotemia. Etiology:
Etiological classification
One. Vascular rupture and bleeding caused by pulse hypertension
Common in posthepatitic cirrhosis. Schistosomal cirrhosis, alcoholic cirrhosis. Bile cirrhosis can lead to esophageal and gastric varices rupture and bleeding, as well as portal vein phlebitis. Venous thrombosis, portal vein obstruction caused by compression of adjacent tumors. Portal hypertension caused by hepatic vein occlusion,
Two. Inflammation and ulcer
(1) inflammation
Reflux esophagitis and acute erosive hemorrhagic gastritis are often caused by alcoholism or oral methylamine. Prednisone salicylic acid drugs ...
View Details] Diagnosis:
One. Medical/medical records
Upper abdominal pain
There is a history of chronic periodic rhythmic epigastric pain, which indicates that bleeding is most likely from the stomach. Duodenal ulcer and ulcer bleeding are large enough to be born in the active period of ulcer, which is more common in winter and spring. If the upper abdominal pain is relieved after bleeding, it continues, or gradually develops without obvious rhythm, or disappears regularly after the beginning, we should consider the malignant transformation of gastric cancer or ulcer, the history of chronic liver disease or long-term drinking, the history of schistosomiasis, massive hematemesis and melena without abdominal pain or abdominal discomfort. ...[
See details] Differential diagnosis:
differential diagnosis
The occurrence of hematemesis and melena should first determine the bleeding site, whether the bleeding comes from the upper digestive tract or the respiratory tract, so as to further examine and find out the reasons and formulate treatment measures. The hematemesis and melena caused by upper digestive tract bleeding should first be related to nosebleeds. Those who swallow blood after tooth extraction or tonsillectomy should be distinguished from those caused by tuberculosis. Bronchiectasis. Broncholung cancer. Hemoptysis caused by mitral stenosis, in addition to mouth blood of domestic animals. Bone charcoal. Bismuth and some of it can cause melena, which should be differentiated from melena caused by upper gastrointestinal bleeding. See table 6-9- 1...[ View details] Prevention: