大量饮酒后消化道出血,不是胃的问题,这是怎么回事?

文摘   2024-11-17 19:31   湖南  

















一例罕见原因的消化道出血!




 


撰文 | 陈徐佳

急诊科来了一个患者,脸色苍白,此前曾大量饮酒,怎么回事?

病例摘要


 现病史


患者,男性,46岁,有酒精滥用史,先前曾患急性胰腺炎,并发急性肺栓塞予抗凝治疗。3周前大量饮酒后表现为深度疲乏,急诊入院。

 体格检查


皮肤黏膜苍白,腹部柔软,触诊无触痛。

 实验室检查


血红蛋白为29g/L,红细胞压积(HCV)为11.9%,平均红细胞体积(MCV)为71.7fL,血小板计数为557k/μL。血生化指标显示低钠血症,钠含量为126mmol/L,尿素氮为3.56mmol/L,肌酐为60μmol/L。除此之外,患者的实验室检查均在正常范围内。患者一年前基线血红蛋白为172g/L。无呕血、黑便或便血的证据。

 影像学检查


食管胃十二指肠镜检查(EGD)显示反流性食管炎(洛杉矶分型D级),Vater乳头区域有血迹(图A),但无明显出血。CT血管造影见图B,EGD显示乳头区域有血迹,进一步行内镜逆行胰胆管造影(ERCP)和内镜下胰胆管造影(EUS)检查,没有进一步的证据提示胰腺出血。

患者进一步接受了CT血管造影,除了胃十二指肠动脉假性动脉瘤(gastroduodenal artery pseudoaneurysm,GDA)外,还显示了一个非特征性的胰腺肿块,胰腺肿块的特征是良性囊性改变,结合ERCP、EUS可能与他先前的急性胰腺炎发作有关。


图A


图B

                         

Q

结合以上信息,你认为最有可能的诊断是?后续如何处理呢?


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