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PostSubject: the lack of signs   Fri Apr 06, 2007 2:20 pm

Currently, there has been, and have dire forecast. Among the reasons, it should be noted erosivno-azwenne mucosal damage (esophagus, stomach, PDK), with ulcers, ulcers drugs such rare diseases such as Zollingera-ellison syndrome; Gantries with hypertension development varikoza veins oesophagus; Mallori-weissa syndrome; Diseases and conditions with increased krovotochivostyu (Villebranda disease, hemophilia, trombozitopenia, vascular disease); Leiomiome. Clinical presentation and diagnosis of the main clinical manifestations of bleeding from the upper gastrointestinal divisions are : bloody vomiting (gematemezis), a black chair degteobrazny (melena), a very rare, it can develop into bloody stool (gematohesia), but it happens only when a very massive bleeding and rapidly blood kishechniku. Milena is also a measure krovopoteri massiveness, as appears when krovopotera is not less than 200 millilitres of blood; Two very important feature melena is its duration, which is not always indicative of the continuing hemorrhage, and describes the intensity to blood kishechniku. In determining whether krovopoteri need to be resolved following tasks : determine the intensity and urgency of therapeutic benefit, the location of damage and its cause, the disease and the impact on bleeding associated pathology, and the impact related to the pathology bleeding, its intensity and duration. Thus, the clinical manifestations of bleeding from the upper gastrointestinal divisions depends on its source, the speed and basic or opportunistic diseases, which contribute to bleeding or affect it. Thus, the bleeding in patients with liver disease, can lead to a worsening of the disease or cause liver failure, engjefalopatiu who; , The combination of illness, which led to the bleeding, and coronary heart disease can be triggered by stroke, or myocardial infarction, and the exacerbation of hypertension, diabetes mellitus, increased renal failure, etc. There are special to be remembered - bleeding could lead to a reduction or disappearance of the signs of the disease that led to the delay, and causing an escalation of opportunistic diseases, clinical signs may go to the fore. Thus, all set shows that in the diagnosis and determine the cause krovopoteri can, and should, be used method of differential diagnosis, but it is important to establish quickly an accurate diagnosis prior to the diagnostic studies should stabilize the patient. The first set massivnosti krovopoteri (Nb, blood, blood group and Rh affiliation). At lower haemoglobin levels below 80 g / l-odnogroupna transfusions or blood eritrocitarna estate. Then an endoscope to study with a view to identifying the source of bleeding, determine its activity, the life hemostasis, the accompanying changes oesophagus, stomach and left. To assess the activity of the most bleeding upotrebima is modified classification I. Forrest (1974) : 1-continuing haemorrhage; 1a - jet bleeding; 1b-podtekanye blood from the bunch; 2 Held bleeding; 2a - trombirovannogo a receptacle or fresh bunch of bleeding source; 2b-availability trombov point, solanokislogo hematin the bleeding source; 3 is the lack of signs of bleeding at the time of the study with the local losses. After completing the necessary emergency measures, stabilizing the patient, a full interview, and a physical examination, other instrumentalno-labo atorne techniques that will be not only immediate, but also the tactics of the patient as a whole. Thus, the spread of disease in history, pain localized in epigastralna area kupeerootesa receiving food or antatidami allowed to think of ulcers, loss of body weight and anorexia on zlokacestvennom defeat, disfagia on oesophageal pathology. If history were other forms of bleeding, they may indicate blood diseases.

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