ﺧﻮﻧﺮﯾﺰي ﻫﺎي دﺳﺘﮕﺎه ﮔﻮارش

Gastrointestinal Hemorrhage

ﺧﻮﻧﺮﯾﺰي دﺳﺘﮕﺎه ﮔﻮارش از ﻣﻌﻀﻼت ﺷﺎﯾﻊ اﺳﺖ و ﺑﻄﻮر ﻣﺨﺘﻠﻒ ﺗﻈﺎﻫﺮ ﻣﯽ ﮐﻨﺪ ﮐﻪ از ﺧﻮﻧﺮﯾﺰي ﺟﺰﺋﯽ ﮔﺮﻓﺘﻪ ﺗﺎ ﺧﻮﻧﺮﯾﺰي ﺷﺪﯾﺪ ﻣﺘﻔﺎوت ﺑﻮده و ﻣﻤﮑﻦ اﺳﺖ از ﻫﺮ ﻧﻘﻄﻪ اي از دﺳﺘﮕﺎه ﮔﻮارش ﺑﺎﺷﺪ. ﺧﻮﻧﺮﯾﺰي ﻫﺎ ﺑﻪ ﺧﻮﻧﺮﯾﺰي از دﺳﺘﮕﺎه ﮔﻮارش ﻓﻮﻗﺎﻧﯽ، ﻣﯿﺎﻧﯽ و ﯾﺎ ﺗﺤﺘﺎﻧﯽ ﺑﺴﺘﻪ ﺑﻪ ﻣﺤﻞ ﺧﻮﻧﺮﯾﺰي و از ﻧﻈﺮ ﻣﯿﺰان آن ﺑﻪ ﺟﺰﺋﯽ، ﺷﺪﯾﺪ، ﻣﺨﻔﯽ و ﯾﺎ ﺑﺴﯿﺎر ﺷﺪﯾﺪ ﺗﻘﺴﯿﻢ ﻣﯽ ﺷﻮﻧﺪ. ﻫﻤﭽﻨﯿﻦ ﮔﺎه ﻣﺒﻬﻢ ﺑﻮده و ﻣﺤﻞ و ﻋﻠﺖ آن ﺑﻪ آﺳﺎﻧﯽ ﺷﻨﺎﺧﺘﻪ ﻧﻤﯽ ﺷﻮد. در ﭼﻨﺪ دﻫﻪ ﮔﺬﺷﺘﻪ از ﻃﺮﻓﯽ ﻃﯿﻒ وﺳﯿﻌﯽ از داروﻫﺎي ﭘﯿﺸﮕﯿﺮي ﮐﻨﻨﺪه ﺑﻪ ﺑﺎزار آﻣﺪه و از ﻃﺮف دﯾﮕﺮ داروﻫﺎي ﻣﺴﺘﻌﺪ ﮐﻨﻨﺪه ﮐﻪ ﻣﻤﮑﻦ اﺳﺖ آﻏﺎزﮐﻨﻨﺪه آن ﺑﺎﺷﺪ ﺑﻪ وﻓﻮر ﻣﺼﺮف ﻣﯽ ﺷﻮد. درﻣﺎن اﯾﻦ ﺑﯿﻤﺎري اﺣﺘﯿﺎج ﺑﻪ ﻫﻤﮑﺎري ﻣﺠﻤـﻮﻋﻪ اي از ﺗﺨﺼﺺ ﻫﺎ، ﻣﺎﻧﻨﺪ ﻃﺐ اورژاﻧﺲ، ﮔﻮارش و ﻣﺮاﻗﺒﺖ وﯾﮋه و ﭘﺮﺗﻮﺷﻨﺎﺳﯽ ﮐﺎرﺑـﺮدي و ﺑﺎﻻﺧﺮه از ﻫﻤﻪ ﻣﻬﻤﺘﺮ ﺟﺮاﺣﯽ اﺳﺖ. ﺣـﺪود 5 درﺻﺪ ﺑﯿﻤﺎران ﻧﯿﺎز ﺑﻪ ﻋﻤﻞ ﺟﺮاﺣﯽ دارﻧﺪ ﮐﻪ ﻣﺘﺄﺳﻔﺎﻧﻪ اﯾﻦ ﺗﻌﺪاد ﺷﺎﻣﻞ اﻓـﺮاد ﺳﺎﻟﻤﻨﺪ و آﻧﻬﺎ ﮐﻪ ﺑﯿﻤﺎرﯾﺸﺎن ﺷﺪﯾﺪﺗﺮ اﺳﺖ ﻣﯽ ﺷﻮد. ﺧﻮﺷﺒﺨﺘﺎﻧﻪ ﺧـﻮﻧﺮﯾﺰي در اﮐﺜـﺮ ﻣﻮارد ﺧﻮدﺑﺨﻮد ﻗﻄﻊ ﻣﯽ ﺷﻮد و ﻓﻘﻂ ﺣﺪود ﭘﺎﻧﺰده درﺻﺪ از آﻧﻬﺎ اﺣﺘﯿـﺎج ﺑﻪ اﺣﯿﺎء و درﻣﺎن ﻓﻮري دارﻧﺪ. آن دﺳﺘﻪ از ﺑﯿﻤﺎران ﮐﻪ داروﻫﺎي ﺿﺪ اﻧﻌﻘﺎدي ﻣﺼﺮف ﻣﯽ ﮐﻨﻨﺪ، ﭼﺎﻟﺶ ﺑﺰرﮔﺘـﺮي در درﻣﺎن اﯾﺠـﺎد ﻣﯽ ﮐﻨﻨﺪ. زﯾﺮا ﻗﻄـﻊ آن ﻣﻤﮑـﻦ اﺳﺖ ﺑﯿﻤﺎري ﻫﻤﺮاه را ﺑﺪﺗﺮ ﮐﺮده و اداﻣﻪ آن ﻧﯿﺰ ﺑﻪ ﺗﻮﻗﻒ ﺧﻮﻧﺮﯾﺰي ﮐﻤﮏ ﻧﻤﯽ ﮐﻨﺪ.

Gastrointestinal bleeding is a common problem and yet sometimes difficult to manage. It could be occult or overt, and may start in any part of the gut. The source of bleeding could be in upper (UGIB) or lower (LGIB) or less likely the small bowel (MGIB); which can become obscure and difficult to find the source. In the past few decades, many drugs has become available for acid suppression and thus prevention of bleeding and at the same time patient especially the elders use ulcerogenic drugs such as analgesics, NSAIDs, SSRIs and different anticoagulants for their accompanying illness which makes the treatment decisions precarious. Most bleeders stop spontaneously and only 15% need urgent resuscitation and intensive treatment of these only 5% need surgical intervention; which are usually the aged with severe comorbidties.