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October 19, 2016 23:03

Endoscopy in gastrointestinal bleeding

Bleeding from the upper gastrointestinal tract

Gastrointestinal bleeding - secondary pathological condition.The most common cause of bleeding from the upper gastrointestinal tract is chronic ulcer of the stomach or duodenum.In recent years, the number of patients hospitalized with peptic ulcer disease, is largely decreased, but the number of patients with bleeding chronic ulcers remains unchanged.

Patients with gastrointestinal bleeding are divided into 2 groups:

  1. Patients who have clear clinical manifestations of ongoing gastrointestinal bleeding, which quickly worsens the patient's condition.These patients should be evaluated in the surgical intensive care unit of the hospital where it is possible to provide assistance until the RAM.Restoring compensatory capacities should be combined with the survey.
  2. Patients who at the time of receipt of the clinical manifestations were, but the condition is not heavy and does not deteriorate progressively and gastrointestinal bleeding are registered on the b
    asis of medical history and currently the patient's life is not threatened.These patients can be examined in any diagnostic study and in any sequence.

main causes of gastrointestinal bleeding from the upper gastrointestinal tract

Duodenal Ulcer

20-30%

erosion of the stomach or duodenum

20-30%

varicose veins of the esophagus and stomach

15-20%

gastric

10-20%

syndrome Mallory-Weiss

5-10%

Erosive esophagitis

5-10%

Angioma

5-10%

Fibrogastroduodenoscopy - the most sensitive and informative methodstudies with gastrointestinal bleeding.Diagnosis based on clinical data is accurate only in 50% of cases.When X-ray of the stomach can not be detected blshuyu of the mucosal diseases.

challenges facing the endoscopist.

  1. find out whether or not the continuous bleeding there.
  2. To determine the intensity of the bleeding: - profuse,
    • moderate,
    • poorly marked.
  3. determine the cause of bleeding: nosological form and localization.
  4. Rate nature of the source of bleeding: mucosa blood vessels, muscle, or submucosal layers, the bottom or the edges (ulcerative defect).
  5. Rate nature of the changes of the tissues surrounding the source of bleeding.
  6. : determine whether there is a threat of the resumption of bleeding when the bleeding stops.

Classification of gastrointestinal bleeding from the upper gastrointestinal tract.

  • I group.At the time of the inspection there is profuse or marginally pronounced bleeding.
  • II group.The bleeding stopped, but there is a clear threat to his resume.
  • III group.At the time of the inspection there is no bleeding and no explicit threat of resumption.

indication to fibroscopy is suspected or the fact of gastrointestinal bleeding.

Contraindications to fibroscopy with gastrointestinal bleeding:

  1. bleeding If the cause is set on the basis of the recently preceding the study.
  2. technically impossible to conduct the study because of existing pathological changes or bends in the esophagus.
  3. Patients in the agonal state, when the diagnosis is no effect on patient management tactics.

In a study of patients with gastrointestinal bleeding devices are used only with the end optics.