Dieulafoy lezija kao uzrok krvarenja iz probavnog sustava

master's thesis

• Title (english): Dieulafoy`s lesion as the cause of bleeding from the gastrointestinal system
• Author: Lorna Čorak
• Mentor: Neven Ljubičić (mentor)
• Committee member: Mislav Vrsalović (predsjednik povjerenstva)
• Committee member: Marko Jakopović (član povjerenstva)
• Committee member: Neven Ljubičić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2017-07-14, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Dieulafoy lezija rijedak je, ali važan uzrok krvarenja iz probavnog sustava. To je arterija koja unatoč perifernom submukoznom tijeku unutar stjenke gastrointestinalnog sustava zadržava konstantan promjer, što ju čini podložnom oštećenju. Većina lezija nalazi se u proksimalnom dijelu želuca, duž male krivine zbog posebne vaskularne arhitekture tog područja, ali nalazimo ih i u jednjaku te tankom i debelom crijevu. Karakteristična klinička prezentacija je burna sa simptomima poput melene i hematemeze koje nerijetko prati hemodinamska nestabilnost te su potrebne transfuzije krvnih derivata. Prije nastupa krvarenja pacijenti su u potpunosti bez simptoma. Zlatni standard dijagnostike je endoskopija, ali zbog male veličine i neupadljivosti lezije izrazito ju je teško uočiti te ih do 30% ostaje neotkriveno. Endoskopija se tada može ponoviti ili se primjene druge metode poput angiografije,
scintigrafije ili endoskopske kapsule. Osim što se koristi u dijagnostičke svrhe, endoskopija je važna i u terapiji. Nakon stabilizacije pacijenta, važno je pravovremeno zaustaviti krvarenje. Djelotvorne metode endoskopske hemostaze ponajprije uključuju termalne u koje ubrajamo elektrokoagulaciju, argon plazma koagulaciju i lasersku fotokoagulaciju te mehaničke metode poput podvezivanja i postavljanja hemostatskih kopči. Ne postoji konsenzus koji bi izdvojio određenu terapijsku metodu kao najbolju pa izbor ovisi o dostupnosti opreme, iskustvu i vještini liječnika. Kod neuspjeha endoskopskih metoda spasonosna terapija je kirurška i to, u pravilu, klinasta resekcija.

Abstract (english)

Dieulafoy's lesion is a rare, but significant cause of gastrointestinal hemorrhage. This is an artery that despite its peripheral, submucosal course within the gastrointestinal wall, remains the same caliber, which makes it susceptible to damage. The majority of these lesions are located in the proximal part of the stomach, along the lesser curve, and this is due to the
special vascular architecture of the area. Approximately only one third of lesions are extragastric and we can find them in the esophagus, and the small and large intestine. The typical clinical presentation is fierce: patients present with melena and hematemesis, frequently followed by hemodynamic instability which requires blood transfusions. Endoscopy is considered the gold standard in diagnosis as well as in therapy. Up to 30% of Dieulafoy’s lesions remain undetected because they are very small and inconspicuous. Endoscopy can then be repeated or other methods such as angiography, scintigraphy or endoscopic capsules are applied. In therapy the first step should be to stabilize a bleeding patient and only afterwards attend to the hemostasis. Methods available during endoscopy include local injection of epinephrine or sclerosing agents, thermocoagulation that includes electrocoagulation, argon plasma coagulation and laser photocoagulation, and finally, mechanical methods such as band ligation and hemoclip. There is no consensus that would distinguish a particular therapeutic method as the best, and for that reason the choice depends on the availability of equipment, experience, and physicians' skills. When these methods fail to achieve hemostasis, the last choice in the therapy is surgical.

• Keywords: Dieulafoy lezija; krvarenje; probavni sustav; endoskopija
• Keywords (english): Dieulafoy's lesion; bleeding; gastrointestinal system; endoscopy
• Language: croatian
• URN:NBN: urn:nbn:hr:105:244636
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2018-01-08 10:13:10