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)