Title PROCES ZDRAVSTVENE NJEGE KOD KRVARENJA IZ GORNJEG PROBAVNOG TRAKTA Title (english) THE PROCESS OF HEALTH CARE FOR BLEEDING FROM THE UPPER DIGESTIVE TRACT Author Tea Orešković Mentor Saša Uljančić (mentor) Committee member Marija Bukvić (predsjednik povjerenstva) Committee member Kata Ivanišević (član povjerenstva)Granter University of Rijeka Defense date and country 2021-09-10, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Krvarenje iz gornjeg dijela probavnog trakta definira se kao gubitak krvi proksimalno od Treitzovog ligamenta, koji predstavlja anatomsku strukturu koja dijeli probavni trakt na gornji i donji. Učestalost krvarenja iz gornjeg dijela probavnog trakta varira od 80 do 150 slučajeva na 100.000 osoba, a procijenjena stopa mortaliteta je između 2 i 15%. Klinička slika krvarenja iz gornjeg dijela probavnog sustava najčešće uključuje bol u trbuhu, slabost i umor, hematemezu i/ili melenu, a kao
... More posljedice gubitka krvi javljaju se i omaglica, vrtoglavica, sinkopa ili šok. Krvarenje može nastati na bilo kojem dijelu gornjeg probavnog sustava, no najčešći uzrok je krvarenje iz čira na želucu ili duodenumu, što obuhvaća 60% slučajeva svih krvarenja iz gornjeg probavnog trakta. Krvarenje varikoziteta jednjaka uzrok je krvarenja iz gornjeg dijela probavnog trakta kod 50-60% pacijenata sa cirozom jetre, a ponovno krvarenje javlja se u 7–16%, unatoč endoskopskoj terapiji. Druge etiologije uključuju Mallory-Weissov sindrom, gastritis, duodenitis i malignost. Zlatni standard u dijagnostici krvarenje iz gornjeg probavnog trakta je ezofagoduodenoskopija, koja po potrebi može biti i terapijska intervencija. Kod pacijenata s neuspješnom endoskopskom hemostazom, provodi se transkateterska embolizacija arterija, a zatim pristupiti operaciji ukoliko se hemostaza ne postigne. Također, neposredno nakon dijagnosticiranja krvarenja iz gornjeg dijela probavnog trakta započinje se s terapijom inhibitorima protonske pumpe. Smjernice preporučuju liječenje visokim dozama inhibitora protonske pumpe prvih 72 sata nakon endoskopije jer je tada rizik od ponovnog krvarenja najveći. Zdravstvena njega pacijenata s krvarenjem iz gornjeg dijela probavnog trakta uključuje mnoge specifičnosti, kao što su asistencija pri dijagnostičkim/terapijskim endoskopskim metodama ili postavljanje dva venska puta. Proces zdravstvene njege provodi se u 4 faze, koje uključuju utvrđivanje potreba za zdravstvenom njegom, planiranje zdravstvene njege, provođenje iste te evaluaciju. Istraživanje o krvarenju iz gornjeg dijela probavnog trakta provedeno je u kliničkom bolničkom centru Rijeka, a uključeni su pacijenti hospitalizirani tijekom 2020. godine. U istraživanje je bilo uključeno ukupno 112 pacijenata, od čega 68% muškaraca i 32 % žena. Najčešće mjesto krvarenja iz gornjeg probavnog trakta na ispitivanom uzorku je ulkus duodenuma kod 36% ispitanika, 28% imalo je ulkus želuca, varikozitete jednjaka imalo je 14% ispitanika, erozije su bile prisutne kod 9% ispitanika, a na ostala mjesta krvarenja u gornjem probavnom traktu opada 8%. Less Abstract (english) Bleeding from the upper gastrointestinal tract is defined as the loss of blood proximal to the Treitz ligament, which is the anatomical structure that divides the digestive tract into upper and lower. The incidence of upper gastrointestinal bleeding varies from 80 to 150 cases per 100,000 individuals, and the estimated mortality rate is between 2 and 15%. The clinical picture of upper gastrointestinal bleeding most often includes abdominal pain, weakness, and fatigue, haematemesis and
... More / or melena, and dizziness, vertigo, syncope, or shock as a consequence of blood loss. Bleeding can occur in any part of the upper digestive tract, but the most common cause is bleeding from a stomach or duodenal ulcer, which accounts for 60% of all upper gastrointestinal bleeding. Bleeding from esophageal varices causes upper gastrointestinal bleeding in 50-60% of patients with cirrhosis of the liver, and re-bleeding occurs in 7–16%, despite endoscopic therapy. Other etiologies include Mallory-Weiss syndrome, gastritis, duodenitis, and malignancy. The gold standard in the diagnosis of bleeding from the upper digestive tract is esophagoduodenoscopy, which can be a therapeutic intervention if necessary. In patients with failed endoscopic hemostasis, transcatheter artery embolization is performed and then surgery is instituted if hemostasis is not achieved. Also, immediately after diagnosing upper gastrointestinal bleeding, proton pump inhibitor therapy is initiated. The guidelines recommend treatment with high doses of proton pump inhibitors for the first 72 hours after endoscopy because then the risk of re-bleeding is greatest. The medical care of patients with upper gastrointestinal bleeding includes many specifics, such as assistance with diagnostic / therapeutic endoscopic methods or placement of two venous routes. The health care process is carried out in 4 phases, which include the identification of health care needs, health care planning, implementation, and evaluation. The study on bleeding from the upper part of the digestive tract was conducted at the Clinical Hospital Center Rijeka, and included patients hospitalized during 2020. A total of 112 patients were included in the study, of which 68% were men and 32% were women. The most common site of upper gastrointestinal bleeding on the test sample was duodenal ulcer in 36% of subjects, 28% had gastric ulcer, esophageal varices had 14% of subjects, erosions were present in 9% of subjects, and other sites of bleeding in the upper gastrointestinal tract tract decreases by 8%. Less Keywords
probavni sustav
krvarenje
čir za želucu
endoskopija
zdravstvena njega
Keywords (english)
digestive system
bleeding
gastric ulcer
endoscopy
health care
Language croatian URN:NBN urn:nbn:hr:184:815443 Study programme Title: Professional study of nursing (Biomedicine and Healthcare; clinical medical sciences) Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2021-09-10 11:08:12
