| 特集名 | 消化管出血に対する診療―JGESガイドラインをふまえて | |
|---|---|---|
| 題名 | 下血・血便の評価と初期治療―両者の鑑別を中心に | |
| 発刊年月 | 2017年 03月 | |
| 著者 | 藤田 朋紀 | 小樽掖済会病院消化器内科 |
| 著者 | 小松 悠弥 | 小樽掖済会病院消化器内科 |
| 著者 | 和賀 永里子 | 小樽掖済会病院消化器内科 |
| 著者 | 高梨 訓博 | 小樽掖済会病院消化器内科 |
| 著者 | 安保 智典 | 小樽掖済会病院消化器内科 |
| 著者 | 勝木 伸一 | 小樽掖済会病院消化器内科 |
| 【 要旨 】 | 下血と血便はともに消化管から出血している状態を示すが，原因疾患が異なっている．下血では上部消化管出血を，血便では下部消化管出血を最初に疑う．病歴，使用薬剤，腹痛・下痢などの随伴症状から原因疾患を推測するが，静脈瘤性出血と非静脈瘤性出血では治療と予後が異なるためとくに肝硬変を思わせる所見に注意を要する．その後，バイタルサインに応じて輸血の必要性・内視鏡検査の緊急性を判断し，速やかに検査・治療に移る必要がある．出血源が明らかでない場合には原因不明消化管出血（obscure gastrointestinal bleeding ; OGIB）として小腸の精査が必要になる． | |
| Theme | Diagnoses & Treatments for Gastrointestinal Bleeding on the Basis of JGES Guidelines | |
|---|---|---|
| Title | Evaluation and Initial Treatment for Melena and Hematochezia -- Differentiation of the Two Types of Bleeding | |
| Author | Tomoki Fujita | Department of Gastroenterology, Otaru Ekisaikai Hospital |
| Author | Yuya Komatsu | Department of Gastroenterology, Otaru Ekisaikai Hospital |
| Author | Eriko Waga | Department of Gastroenterology, Otaru Ekisaikai Hospital |
| Author | Kunihiro Takanashi | Department of Gastroenterology, Otaru Ekisaikai Hospital |
| Author | Tomonori Ambo | Department of Gastroenterology, Otaru Ekisaikai Hospital |
| Author | Shinichi Katsuki | Department of Gastroenterology, Otaru Ekisaikai Hospital |
| [ Summary ] | Both melena and hematochezia are gastrointestinal bleeding, but their causes are different. Upper gastrointestinal bleeding is initially suspected as the cause of melena and lower gastrointestinal bleeding as that of hematochezia. The cause is predicted based on medical history, medication use, and symptoms such as abdominal pain and/or diarrhea. Since treatment and prognosis of variceal bleeding differ from those of non‒variceal bleeding, close attention to the findings is required, similar to liver cirrhosis. Subsequently, according to the vital signs we need to evaluate blood transfusion requirements and urgency of endoscopy. It is necessary to perform examination and treatment as soon as possible. When the bleeding point cannot be detected, it is classified as obscure gastrointestinal bleeding (OGIB) and small intestinal examination should be performed. |
|