上部胃肠道出血由于胃的破裂:一个诊断挑战
Luís Neves da Silva1, Inês M Araújo1, Rui Ribeiro2
1Internal Medicine, Hospital de Braga, Braga, PRT.
胃水出血可能源于非循环门高血压 (NCPH),通常与化疗诱导的状血管疾病 (PSVD) 相关. 早期诊断和多学科护理对于管理这种情况至关重要.
科学领域:
- 胃肠病学 胃肠病学
- 肝病学 肝病学是一种肝病学.
- 血管医学 血管医学
背景情况:
- 胃水出血 (GV) 是门高血压的严重并发症.
- 肝硬化是最常见的原因,但非肝硬化门高血压 (NCPH) 是一个未被认可的病因.
- 带状血管疾病 (PSVD) 是NCPH的一个关键特征,特别是在化疗后.
研究的目的:
- 在患有非腹门高血压 (NCPH) 的患者中,呈现化学疗法诱导的带状血管疾病 (PSVD) 继发的胃水出血病例.
- 突出这一罕见疾病的诊断挑战和管理策略.
主要方法:
- 一名39岁的男性有神经母细胞瘤病史,接受化疗,呈现出血.
- 诊断工作包括内镜,实验室测试,肝弹性图,肝血管图和肝活检.
- 治疗包括血管活性疗法,内镜注射蓝酸盐,输血,抗生素预防和β-阻断剂治疗.
主要成果:
- 患者出现了贫血和血液动力学不稳定性,这是由于基底GV出血.
- 调查排除了肝硬化,但发现与PSVD和升高的端口系统梯度一致的发现,证实了NCPH.
- 最初的治疗使患者稳定,但出血复发,需要重复内镜干预. 长期使用β-阻断剂的治疗可以预防进一步的发作.
结论:
- 化疗诱导的PSVD是NCPH和GV出血的重要原因.
- 彻底的诊断方法,包括详细的病史和专业调查,对于识别PSVD至关重要.
- 多学科管理对于有效治疗NCPH中的GV出血至关重要.
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