Initial Evaluation and Resuscitation for Gastrointestinal Bleeding Tsutomu Hamada 1 1Department of Gastroenterology, Social Health Insurance Medical Center Keyword: 吐血 , 下血 , 出血性ショック , 緊急内視鏡検査 pp.431-437
Published Date 2005/4/25
DOI https://doi.org/10.11477/mf.1403100055
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We speak here about initial evaluation and resuscitation for overt GI bleeding presented with the passage of fresh or altered blood through the mouth or in the stool. The organs of origin of hematemesis and coffee-ground emesis are located at the oral side of Treitz ligament. Important points in the medical history of the patient include the quantity of blood lost, prior bleeding episodes, alcohol use, stress in ordinary life and liver disease. Furthermore, we should recognize that nonsteroidal anti-inflammatory drugs(NSAIDs)and aspirin can cause mucosal damage anywhere in the GI tract. Usually melena, a tarry stool, indicates bleeding from an upper source. Lesions lower down the bowel from the duodenum give rise to dark bright red blood in the stool and, in cases of piles, fissure or fistula the blood is passed unmixed with the feces. The first thing to be decided is whether the blood has originated from piles or other anal lesions or from a lesion higher up in the alimentary canal.

 Patients in shock with GI bleeding might require volume dose administration and packed RBC transfusion until the patient's condition is hemodynamically stable. An NG aspiration is useful in assessing the activity and severity of upper GI bleeding. To diagnose the origin of the bleeding and to perform suitable therapeutic procedures, emergency endoscopy is recommended for patients as early as possible in the clinical course. The over-sixty-years old group accounts for 64.6 % of patients with GI bleeding. On endoscopy, bloody residue in the stomach was still observed in 52.6 % of the patients and, in 9.6 % of them, the source of the bleeding was not able to be recognized.

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