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UGI bleeding ´ëÀå°æ Á¤¸®

1. NG tube¸¦ ³Ö¾úÀ» ¶§ ³»¿ë¹°ÀÌ ¸¼À¸¸é Áö¼ÓÀûÀÎ ÃâÇ÷ÀÌ ÀǽɵÇÁö ¾Ê´ÂÇÑ Á¦°ÅÇØµµ µÈ´Ù.

2. melena¸¦ À¯¹ßÇÏ´Â ÃÖ¼Ò ÃâÇ÷·®: 60ml

3. UGI bleedingÈÄ 1ÁÖÀϰ£ melena°¡ Áö¼ÓµÉ¼ö ÀÖÀ¸¸ç,

´ëº¯»ö±òÀÌ Á¤»óÀ¸·Î µÈ ÈÄ¿¡µµ ÀáÇ÷¹ÝÀÀÀº 1ÁÖ ÀÌ»ó ¾ç¼ºÀ¸·Î ³ª¿Ã¼ö ÀÖ´Ù.

4. ´ëº¯ÀáÇ÷°Ë»çÀÇ 1-2%¿¡¼­ À§¾ç¼ºÀÌ ³ªÅ¸³¯ ¼ö ÀÖÀ¸¸ç vit C´Â À§À½¼ºÀ» ÃÊ·¡ÇÒ¼ö ÀÖ´Ù.

5. ÃâÇ÷Á¤µµ¸¦ ³ªÅ¸³»´Â °¡Àå ¹Î°¨ÇÑ ºñħ½ÀÀû ÁöÇ¥ 2°¡Áö

orthostatic hypotension, tachycardia

6. melena·Î ³»¿øÇÏ¿© GFS, CFS¿¡¼­ ÃâÇ÷ºÎÀ§¸¦ ãÁö ¸øÇß´Ù¸é ´ÙÀ½À¸·Î ½ÃÇàÇØ¾ß ÇÒ °Ë»ç?

99mTc bleeding scan

7. red cell scintigraphy¿¡¼­ bleeding focus¸¦ ãÁö ¸øÇÑ´Ù¸é ´ÙÀ½À¸·Î ½ÃÇàÇØ¾ß ÇÒ °Ë»ç´Â?

small bowel enteroclysis or small bowel enteroscopy

8. ´ëº¯ÀáÇ÷°Ë»ç¿¡¼­ ¾ç¼ºÀ¸·Î ³ª¿Ã¼ö ÀÖ´Â ÃÖ¼ÒÇÑÀÇ fecal blood loss¾ç? 20ml/d

9. ´ëº¯ÀáÇ÷¹ÝÀÀ°Ë»ç¿¡¼­ ¾ç¼ºÀ¸·Î ³ª¿Ã¼ö ÀÖ´Â °æ¿ì

physiologic blood loss, UGI or LGI bleeding, dietary peroxidase, undercooked meat

10. UGI bleedingÀÇ ÈçÇÑ ¿øÀÎ: peptic ulcer, varix, Mallory-Weiss, gastritis d/t alcohol or

NSAIDs

11. ³»½Ã°æÀ¸·Î´Â È®Àΰ¡´ÉÇϳª UGI·Î´Â È®ÀÎÇÒ¼ö ¾ø´Â UGI bleedingÀÇ ¿øÀÎ

Mallory-Weiss tear, stress ulcer, telangiectasia, erosive gastritis, esophagitis

12. BUN/Crºñ°¡ ³ôÀº °ÍÀº UGI bleedingÀ» ½Ã»çÇÑ´Ù.

13. UGI bleedingÄ¡·á¿¡ »ç¿ëÇÒ¼ö ÀÖ´Â ¾àÁ¦

antacid, H2 blocker, vasopressin, antifibrinotic agent(tranexamic acid), somatostatin,

prostaglandin

14. UGI bleeding¿¡¼­ octreotide¸¦ »ç¿ëÇÒ¼ö ÀÖ´Â Áúȯ

portal hypertensive gastropathy, varix

15. peptic ulcer bleeding¿¡¼­ ÁöÇ÷Ä¡·áÀÇ ´ë»óÀÌ µÇ´Â ³»½Ã°æ ¼Ò°ß?

Forrest class Ia(spurting), Ib(oozing), II(exposed vessel or adherent blood clot)

16. peptic ulcer disease¿¡¼­ emergent/urgent op indications

1) perforation

2) gastric outlet obstruction unresponsive to medical therapy

3) bleeding

i) exsanguinating hemorrhage

ii) bleeding > 6 units of blood

iii) "visible vessel", expecially if bleeding

iv) rebleeding on medical therapy

v) slow persistent bleeding over days

17. ÀçÃâÇ÷ÀÌ ÀǽɵǴ ¼Ò°ß

i) hematemesis or hematochezia > 100 ml

ii) BP down > 20mmHg

iii) HR Áõ°¡ > 20 bpm(10ºÐÀ̻󵿾È)

iv) Hb °¨¼Ò > 2g/dLÀÌ»ó or p/c 2UÀÌ»ó ÇÊ¿ä(24½Ã°£µ¿¾È)

20. Mallory-Weiss bleeding¿¡¼­ Áö¼ÓÀûÀ¸·Î ÃâÇ÷ÀÌ ¸ØÃßÁö ¾ÊÀ» °æ¿ì Ä¡·á¹æ¹ý 2°¡Áö?

vasopressin, angiographic embolization

21. Ä¡·á³»½Ã°æÀÇ ÀûÀÀÁõ

i) hemostasis

ii) dilatation, stent, ablation

iii) polypectomy

iv) PEG(percutaneous endoscopic gastrostomy)