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세종병원 내과 전공의 강의 (1) - 혈변시 감별진단

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Myounghwan Kim

on 5 March 2012

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Transcript of 세종병원 내과 전공의 강의 (1) - 혈변시 감별진단

Hematochezia ? Melena vs Hematochezia A rough estimate is that it takes about 14 hours for blood to be broken down within the intestinal lumen

; therefore if transit time is less than 14 hours the patient will have hematochezia, and if greater than 14 hours the patient will exhibit melena.

One often-stated rule of thumb is that melena only occurs if the source of bleeding is above the ligament of Treitz although, as noted below, exceptions occur with enough frequency to render it unreliable. Hematochezia의 감별진단 입원 환자에서 혈변 관찰시
감별해야 할 진단 Melena vs. hematochezia

Bleeding originating from the lower GI tract (such as the sigmoid colon and rectum) is generally associated with the passage of bright red blood, or hematochezia, particularly when brisk.

Blood acts as a cathartic agent in the intestine, promoting its prompt passage.

Only blood that originates from a high source (such as the small intestine), or bleeding from a lower source that occurs slowly enough to allow for enzymatic breakdown is associated with melena.

For this reason, melena is often associated with blood in the stomach or duodenum (upper gastrointestinal tract), for example by a peptic ulcer. Lower GI bleeing ? Take Home Message

1. Hematochezia
2. Rule out Upper GI bleeding
3. Hemodynamic & Resuscitation
4. Consider Comorbid condition & Associted symtoms
5. Colonoscopy ? When? Anal(Rectal) bleeding ? Clinical Approach of Lower GI bleeding
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