Yoğun Bakımda Gastrointestinal Kanamalı Hastaya Yaklaşım
Özet
Gastrointestinal sistem (GİS) kanamaları, hastaneye yatırılan hastalarda önemli bir mortalite ve morbidite sebebidir. Tanı ve tedavi alanındaki tüm ilerlemelere rağmen, günümüzde hastaneye gastrointestinal kanama şikayetiyle başvuran hastaların %2-10'u hayatını kaybetmektedir.
Olgumuzda acil servise kanlı kusma ile başvuran ve geçmişte tekrarlayan üst gastrointestinal kanama tanısı olan bir hastaya genel yaklaşımdan bahsedilecektir. Daha önce iki defa gastrointestinal kanama geçiren hastanın özgeçmişinde portal ven trombusu ve buna bağlı portal hipertansiyon saptanmış ve takibe alınmıştır. Hastaya olası kanama durumunda en yakın sağlık kuruluşuna başvurması önerilmiş. Hastanın kanlı kusma şikayeti olmuş ve acil servise başvurmuş. Yapılan endoskopide geçmişte de var olan özofageal ve gastrik varisler mevcut olup özofagus varislerinde aktif kanama saptandı. Endoskopik bakıda kanamanın durdurulamaması üzerine sengstaken-blakemore tüpü takılarak yakın takip açısından yoğun bakıma yatırıldı. Gerekli replasmanlar yapıldı. Gastroenteroloji , girişimsel radyoloji ve genel cerrahiye konsulte edildi. Ancak kanaması durduralamayan hastada exitus gelişti.
Gastrointestinal sistem kanamaları, hafif ve kendiliğinden düzelen durumlar olabileceği gibi, hayati önem taşıyan ciddi kanamalara da yol açabilir. Ciddi kanama durumlarında mortalitesinin yüksekliği sebebiyle sıklıkla yoğun bakım gerektiren ve multidisipliner takip edilmesi gerekmektedir.
Gastrointestinal system (GIS) bleeding remains a significant cause of mortality and morbidity among hospitalized patients. Despite all advancements in diagnosis and treatment, 2-10% of patients presenting to emergency departments with gastrointestinal bleeding still succumb to the condition today.
In our case, the general approach to a patient who presented to the emergency department with bloody vomiting and who had been diagnosed with recurrent upper gastrointestinal bleeding in the past will be discussed. A portal vein thrombus and associated portal hypertension were detected in the medical history of the patient, who had gastrointestinal bleeding twice before, and she was followed up. The patient was advised to apply to the nearest health institution in case of possible bleeding, and she applied to the emergency room with the complaint of bloody vomiting. In the endoscopy, there were esophageal and gastric varices and there was active bleeding in the esophageal varices. Since the bleeding could not be stopped during the endoscopic examination, a Sengstaken-Blakemore tube was inserted, and she was admitted to intensive care for close monitoring. Necessary replacements were made. Gastroenterology, interventional radiology and general surgery were consulted . However, the patient could not stop the bleeding and died.
Gastrointestinal bleeding can be mild and self-limiting but can also lead to serious, life-threatening bleeding. In cases of serious bleeding, it often requires intensive care and multidisciplinary follow-up due to its high mortality rate.
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