Xuất huyết tiêu hoá cấp nghi do bệnh lý túi thừa đại tràng

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Tác giả: Văn Linh Phạm

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Khoa học Sức khỏe, 2023

Mô tả vật lý: tr.181

Bộ sưu tập: Báo, Tạp chí

ID: 340244

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Bối cảnh: Xuất huyết tiêu hóa cấp là một tình trạng phổ biến có nguyên nhân đa dạng. Xác định nguyên nhân và xác định vị trí chảy máu đôi khi còn gặp khó khăn. Hiểu biết tổng thể về các tình trạng bệnh và nguyên nhân kết hợp với các thông tin chi tiết từ người bệnh kết hợp với các kết quả khám và thăm dò có thể cho phép tiếp cận, chẩn đoán, xử trí và điều trị phù hợp. Ca bệnh: Bệnh nhân nam, 85 tuổi, thường bị táo bón trong tiền sử, có thói quen ăn ít rau, vào viện vì mệt nhiều, hoa mắt, chóng mặt sau nhiều đợt đại tiện phân đen trong một tháng trước khi tới viện. Bệnh nhân đã được soi dạ dày, soi đại tràng, soi ruột non và chụp cắt lớp bụng trước đó. Nhập viện người bệnh đại tiện phân đen, sệt, mùi khẳn liên tục từ 3 ngày trước. Huyết động và sinh hiệu ổn định với nhịp tim 70 nhịp/phút, huyết áp 110/70 mmHg, nhiệt độ 36,5oC. Khám lâm sàng ghi nhận toàn trạng mệt mỏi và niêm mạc nhợt. Công thức máu (cấp) có hồng cầu (RBC) 1,5 T/l, hemoglobin (HGB) 44 g/l, hematocrit (HCT) 0,132 l/l. Chẩn đoán vào viện là xuất huyết tiêu hoá chưa cầm nghi do bệnh lý túi thừa đại tràng (viêm, chảy máu), thiếu máu mức nặng. Bệnh nhân được truyền dịch, truyền máu và điều trị kháng sinh (metronidazole 1,5 g/ngày), nội soi dạ dày và chụp cắt lớp ổ bụng. Tình trạng lâm sàng cải thiện sau 5 ngày, người bệnh xuất viện ở ngày thứ 11 trong tình trạng ổn định. Kết luận: Xuất huyết tiêu hoá cấp cần được tiếp cận một cách hệ thống, xử trí cấp cứu, điều trị triệu chứng và định hướng theo nguyên nhân một cách hợp lý theo các hướng dẫn dựa trên chứng cứ.Context: Acute gastrointestinal (GI) bleeding is a common condition with diverse etiologies. Determining the cause and location of bleeding can sometimes be challenging. A holistic understanding of conditions and causes combined with detailed patient information, examination and tests findings, could enable approach for appropriate diagnosis, management, and treatment. Case report: A 85 year-old man, often constipated in history, having a habit of eating few vegetables, was admitted to the hospital because of fatigue and dizziness after several episodes of tarry bowel movements in the month before going to hospital. The patient had undergone previously gastroscopy, colonoscopy, capsule endoscopy and abdominal CT scanner. At admisson, the patient had black, viscous and pungent stools continuously from the previous 3 days. Patient had stable hemodynamic state and vital signs with heart rate 70 beats/min, blood pressure 110/70 mmHg, temperature 36.5o C. Clinical examination noted marked tiredness and pale mucosa. Complete blood count (urgently done) showed RBC 1.5 T/l, HGB 44 g/l, HCT 0.132 l/l. He was then diagnosed acute gastrointestinal bleeding, severe chronic anemia with colonic diverticular disease (diverticulitis, diverticular bleeding) as suspected cause. The patient received fluid infusion, blood transfusion, antibiotic treatment (metronidazole 1.5 g/day), underwent the oesogastroscopy and abdominal CT. The clinical condition improved after 5 days under treatment and the patient was discharged on the 11th day in stable state. Conclusions: Acute gastrointestinal bleeding needs a systematic approach, emergency management and appropriate symptomatic and cause-oriented treatment according to evidenced-based guidelines.

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