下消化道出血病因分析

目的探讨下消化道出血的病因。方法对71例下消化道出血的患者（男40例,女31例）常规行电子结肠镜检查,部分患者行小肠气钡双重造影、肠系膜上或下动脉造影检查、及手术探查。结果71例病例中,溃疡性结肠炎5例（7％）,结肠息肉9例（12．7％）,结肠新生物10例（14％）,缺血性肠病4例（5．6％）,感染性结肠炎9例（12．7％）,肛周疾患3例（4．22％）,空肠憩室4例（5．6％）,血管畸形或血管瘤6例（8．45％）,小肠平滑肌瘤2例（2．8％）,另有19例未明确诊断（26．77％）。结论下消化道出血的病因主要以恶性肿瘤、肠息肉、肠道炎症性病变最多见;其次是痔、肛裂、肠血管畸形、肠憩室等。注重电子结肠镜等相关检查,可提高确诊率及治愈率。     

下消化道出血654例诊断及病因分析

我院自 1988年 6月～ 2 0 0 0年 8月使用ＯｌｙｍｐｕｓＣＦ 30 1型纤维结肠镜检查 3787例患者 ,其中有下消化道出血者 6 5 4例 ,现就其诊断及病因分析如下。1　资料和方法6 5 4例下消化道出血患者均有不同程度便血史 ,病程 5天至 14年不等。大便带血 2 89例 ,脓血便 136例 ,粘液血便 196例 ,全血便 4 3例 ,其中全血便均经胃镜检查排除上消化道出血的可能。以上均经结肠镜及/或钡餐、肠系膜上动脉造影检查确诊为下消化道出血。男 390例 ,女 2 6 4例 ,年龄 6～ 81岁 ,平均年龄为4 8 3岁。按年龄分为 4组 :儿童组≤ 13岁 ,共 8例(1 2 2 % ) ;…     

下消化道出血的少见病因

下消化道出血病因复杂,随着诊疗技术的发展,人们对一些少见病因有了越来越多的了解,现就部分少见病因作一综述,以帮助临床诊断与治疗.     

小儿消化道出血52例病因分析

小儿消化道出血病因较多,不易定位,而明确病因对治疗帮助更大.我院自1990年1月至1995年6月共收住小儿消化道出血52例,现总结报告如下.1 临床资料1.1 诊断依据 ①呕血或由鼻胃管吸出血性咖啡色液者:②排黑色柏油样便或鲜红色血便及潜血试验阳性者.具上述之一,同时排除吞入母亲血液和上呼吸道出血吞入胃内者.凡肠套、菌痢及临终前消化道出血不予列入.1.2 一般资料 男35例,女17例.呕鲜血或咖啡色液11例,黑便32例,暗红色大便5例,鲜红色大     

隐源性消化道出血28例病因分析及诊断

隐源性消化道出血２８例病因分析及诊断王建勋，罗金燕隐源性消化道出血系指经常规检查仍无法明确其出血部位或／和病因的一类疾病。虽属少见，但却常常造成诊治上的困难。本文收集两家医院５年来所见２８例，现报告如下，并就其病因和诊断进行粗浅探讨。临床资料本组２８...     

小儿消化道出血病因的内镜诊治

小儿消化道出血病因的内镜诊治欧弼悠吴秀英陈肖肖陈洁江米足章许平小儿消化道出血并非少见，各年龄组均可发生，自１９８５年～１９９５年本院共诊治患儿６９８例，现将资料分析如下：一、一般资料：男４５８例，女２４０例，年龄３个月～１４岁，病程２天～７年余。６９...     

885例下消化道出血病因分析

近两年中我们对８８５例下消化道出血的患者进行电子结肠镜检查，现将结果分析报告如下。１．临床资料与方法本组８８５例患者均以便血为主诉，病程最短１　ｄ，最长１０年。其中男４３１例，女４５４例，按年龄分为４组：儿童组≤１３岁，２５例（２．８２％）；青年组１４～３４岁，２９０例（３２．７７％）；中年组４０～５９岁，３２０例（３６．１６％）；老年组≥６０岁，２５０例（２８．２５％）。全部患者均用电子结肠镜检查，中等以上程度出血一般在出血停止后进行检查，小量出血随时检查，但需胃镜检查排除上消化道出血。除１８…     

隐源性消化道出血五例病因分析

隐源性消化道出血五例病因分析杜文礼，刘健波隐源性消化道出血系指经常规检查仍无法明确其出血部位或／和病因的一类疾病。虽属少数，但却往往成为诊治上的难点。本文收集５例，现报告如下。临床资料一、蓝痣综合征患儿男，１３岁。因排血便，体检时发现其四肢、腹壁分别...     

小儿消化道出血116例病因分析

小儿消化道出血病因较多，不易定位，而明确病因对治疗有重要意义。我科自1995～2001年共收治小儿消化道出血116例，现总结报告如下。     

潜源性消化道出血诊断

消化道出血病因中,无论是上消化道或下消化道,成人或小儿,经常规的X线钡剂检查摄片、胃镜、肠镜等检查,一时得不到确诊,均称为潜源性。但通过全面收集病史,详细的体格检查,密切观察病情变化,必要时运用辅助检查手段,潜源性出血亦可查明其病因。国内外学者报道,不明原因消化道出血占5％～10％左右。一、潜源性消化道出血不能查出原因分析 (一)消化道粘膜病变浅表,X线检查不易     

208例上消化道出血患者的病因分析及胃镜诊断体会

目的对208例上消化道出血患者的病因进行分析,探讨胃镜的诊断价值。方法回顾性分析我院2010年6月-2012年6月收治的208例上消化道出血患者胃镜诊断结果。结果消化性溃疡是不同年龄组上消化道出血的主要病因,中青年组消化性溃疡出血比率(42.4%)高于老年组(27.7%,P<0.05)。消化道肿瘤在老年组上消化道出血中所占的比例为23.7%,明显高于中青年组的7.6%(P<0.01),是老年人上消化道出血的常见原因。急诊胃镜组病因检出率为97.5%,高于非急诊胃镜组的87.5%(P<0.05)。结论上消化道出血的病因较多,以消化性溃疡最为常见。胃镜对上消化道出血病因诊断有较高价值,可作为首选方法。     

Upper gastrointestinal bleeding etiology score for predicting variceal and non-variceal bleeding

AIM： To identify clinical parameters, and develop an Upper Gastrointesinal Bleeding （UGIB） Etiology Score for predicting the types of UGIB and validate the score. METHODS： Patients with UGIB who underwent endoscopy within 72 h were enrolled. Clinical and basic laboratory parameters were prospectively collected. Predictive factors for the types of UGIB were identified by univariate and multivariate analyses and were used to generate the UGIB Etiology Score. The best cutoff of the score was defined from the receiver operating curve and prospectively validated in another set of patients with UGIB. RESULTS： Among 261 patients with UGIB, 47 （18%） had variceal and 214 （82%） had non-variceal bleeding. Univariate analysis identified 27 distinct parameters significantly associated with the types of UGIB. Logistic regression analysis identified only 3 independent factors for predicting variceal bleeding; previous diagnosis of cirrhosis or signs of chronic liver disease （OR 22.4, 95% CI 8.3-60.4, P 〈 0.001）, red vomitus （OR 4.6, 95% CI 1.8-11.9, P = 0.02）, and red nasogastric （NG） aspirate （OR 3.3, 95% CI 1.3-8.3, P = 0.011）. The UGIB Etiology Score was calculated from （3.1× previous diagnosis of cirrhosis or signs of chronic liver disease） ＋ （1.5× red vomitus） ＋ （1.2× red NG aspirate）, when 1 and 0 are used for the presence and absence of each factor, respectively. Using a cutoff ≥ 3.1, the sensitivity, specificity, accuracy, positive predictive value （PPV）, and negative predictive value （NPV） in predicting variceal bleeding were 85%, 81%, 82%, 50%, and 96%, respectively. The score was prospectively validated in cases （46 variceal and 149 another set of 195 UGIB non-variceal bleeding）. The PPV and NPV of a score ≥ 3.1 for variceal bleeding were 79% and 97%, respectively. CONCLUSION： The UGIB Etiology Score, composed of 3 parameters, using a cutoff ≥ 3.1 accurately predicted variceal bleeding and may help to guide the choice of initial therapy for UGIB before endoscopy.     

The etiology of upper gastrointestinal bleeding in patients with liver cirrhosis

108 patients suffering from the cirrhosis of the liver and acute bleeding into the upper digestive tract underwent a prospective endoscopic examination with diagnostic and therapeutic objectives. The most frequent causes of acute bleeding included oesophagus varices (57.4%) followed by peptic gastric ulcer (13.9%) and peptic ulcer of duodenum (11.1%), then portal hypertension gastropathy (5.6%), gastric varices (4.6%), reflux oesophagitis (2.8%), Mallory-Weiss syndrom (2.8%) and erosive gastropathy (0.9%). The endoscopy of the upper digestive tract in one patient resulted in negative diagnosis. 69% of examinations showed multiple findings in the upper digestive tract, each of which could have been a potential cause of bleeding. To determine the source of bleeding the specialist's attitude presented at the end of the endoscopic examination was taken into consideration. In 67.6% of patients the bleeding was a direct consequence of portal hypertension, in 62% it was caused by varices. The emphasis is put on early and thorough endoscopic examinations aimed at proper diagnosis and therapy.     

Incidence and etiology of acute non-malignant upper gastrointestinal bleeding in northern Greece

AIM: To evaluate the incidence and etiology of acute non-malignant upper gastrointestinal bleeding (ANMUGIB) in northern Greece due to increased use of non-steroidal anti-inflammatory drugs (NSAIDs), including low-dose aspirin (L-A), exposure and geographical variability of Helicobacter pylori (Hp) seroprevalence. METHODS: A retrospective study of 110 patients admitted for hematemesis or melena during a 6-month period. All patients had undergone a gastrointestinal (GI) endoscopy during hospitalization. The presence of Hp was identified by biopsies and a (13)C-urea breath test in the case of Hp(-) biopsy bleeding peptic ulcer (BPU). The activity of ANMUGIB was assessed according to Forrest's classification. Statistical analysis was made by the chi(2)-test and Yates' correction. RESULTS: Most patients were in the two medium age groups with no significant difference between them (P < 0.001). NSAID or L-A (100 mg/day) use was reported in 42.73% of patients in a ratio 1:1 (P > 0.1) and Hp infection was found in 29.09% of patients. BPU, with approximately two-thirds in the bulb, erosions and varices were the most frequent sources. Hp infection was found in 60.65% of BPU, 65.57% were related to NSAIDs or L-A and 8.19% were non-Hp non-NSAID/L-A BPU. Flat spots were most commonly found with a significant difference (P < 0.001) to other stigmata of recent bleeding, except for clean base. CONCLUSIONS: In northern Greece, persons aged over 40 years are prone to ANMUGIB with a non-significant relationship to males. Hp infection and medication use, such as NSAIDS and L-A, are deeply involved in its etiology. Non-Hp non-NSAID/L-A BPU are a small proportion. ANMUGIB seems to have a generally good prognosis.     

Uncommon etiology of gastrointestinal bleeding: duodenal metastases from renal cell carcinoma

Because of its unpredictable behavior, renal cell carcinoma is one of the most controversial neoplasms. On the one hand, patients frequently show metastases at diagnosis because of its slight manifestations, while on the other, the neoplasm can remain stable after nephrectomy and can then metastasize many years later. When this happens, the metastases usually involve more than 2 organs. The most frequent sites of metastases are the lung and lymph nodes, followed by the bones and liver, while duodenal involvement is rare. Indeed, intestinal metastases are found in only 2% of autopsies and of these, renal cell carcinoma metastases account for 7.1%. We present a case of a solitary late recurrence presenting as upper gastrointestinal bleeding 19 years after nephrectomy for clear cell renal carcinoma.     

The etiology and clinical characteristics of acute lower gastrointestinal bleeding in patients hospitalized for comorbid illnesses

BACKGROUND/AIMS: To determine whether there are different causes of acute lower gastrointestinal bleeding and different clinical courses in patients (a) with comorbid illnesses vs. (b) patients with only severe hematochezia. METHODOLOGY: From January 2001 to December 2003, 107 hospitalized patients with acute lower gastrointestinal bleeding were evaluated by urgent colonoscopy. Our analyses compared the etiology and clinical characteristics of bleeding in patients with (group A) and without (group B) one or more comorbid illnesses. RESULTS: Group A patients tended to have longer hospital stays, more severe anemic conditions, and more transfusion requirements. The overall mortality rate was 29.5% in group A and 4.3% in group B (p < 0.05). Bleeding-related mortality was not significantly different between groups. Colitis, rectal ulcer, and angiodysplasia were the leading causes of lower gastrointestinal bleeding in group A. Rectal ulcer was a more common cause of bleeding in group A (16.4%) than in group B (2.1%) (p < 0.05), and it resulted in longer hospital stays and more severe anemia and leukocytosis compared to patients with other causes of lower gastrointestinal bleeding. CONCLUSIONS: Patients with acute lower gastrointestinal bleeding that starts after hospitalization for other comorbid illnesses have distinctive etiologies and clinical characteristics compared with ordinary patients admitted to the hospital with only bleeding. Rectal ulcer is an important but obscure cause of acute lower gastrointestinal bleeding in elderly patients with significant comorbid diseases.     

Lower gastrointestinal bleeding

BACKGROUND: Lower gastrointestinal bleeding can be a confusing clinical conundrum, the satisfactory evaluation and management of which requires a disciplined and orderly approach. Diagnosis and management has evolved with the development of new technology such as selective mesenteric angiography and colonoscopy. PURPOSE: This study was undertaken to review the available data in the literature and to determine the current optimum method of evaluation and management of lower gastrointestinal hemorrhage most likely to result in a successful outcome. METHODS: Data available on the topic of lower gastrointestinal bleeding in the English literature were obtained via MEDLINE search and were reviewed and analyzed. RESULTS: The colonic origin of lower gastrointestinal hemorrhage in order of decreasing incidence is diverticulosis, inflammatory bowel disease, including ischemic and infectious colitis, colonic neoplasia, benign anorectal disease, and arteriovenous malformations. Approximately 10 to 15 percent of all cases of rectal bleeding are attributable to a cause that is proximal to the ligament of Treitz. Small intestinal sources such as arteriovenous malformations, diverticula, and neoplasia account for between 3 and 5 percent of all cases. Colonoscopy successfully identified an origin in severe hematochezia in 74 to 82 percent of cases. Mesenteric angiography has a sensitivity of 42 to 86 percent. The best method of management depends on whether hemorrhage persists, the severity of continued hemorrhage, the cumulative transfusion requirement, and the specific origin of bleeding. CONCLUSION: Lower gastrointestinal hemorrhage is a complex clinical problem that requires disciplined and sophisticated evaluation for successful management. Diverticulosis is the most common cause. Colonoscopy is the diagnostic procedure of choice both for its accuracy in localization and its therapeutic capability. Selective mesenteric angiography should be reserved for those patients in whom colonoscopy is not practical. Precise identification of the bleeding source is crucial for a successful outcome. Specific directed therapy, such as segmental colonic resection for bleeding diverticulosis, is associated with the highest success rate and the lowest morbidity. A complete review of lower gastrointestinal bleeding is contained herein.