In which blood is poured into the lumen of the stomach. In general, the term "gastrointestinal bleeding" is usually used in medicine. It is more general and denotes all bleeding, which occur in the digestive tract (esophagus, stomach, thin and fat intestines, straight intestine).
Facts about gastric bleeding:
- This state is the bottom of the most frequent causes of hospitalization of patients into surgical hospitals.
- Today more than 100 diseases are known that can be accompanied by bleeding from the stomach and intestines.
- Approximately three fourth (75%) of all bleeding from the stomach or duodenum occur due to ulcers.
- Bleeding develops about each fifth patient who suffered from a stomach or duodenal ulcer, and did not receive treatment.
Features of the structure of the stomach
A man's stomach is a hollow organ, a "bag" that takes food from the esophagus, partially digested, mixes it and sends further to the duodenum.Anatomy of the stomach
Stomach departments:- entrance department (cardia) - the transition of the esophagus in the stomach and the stomach site, directly adjacent to this place;
- bottom of the stomach - the upper part of the organ, having a view of the arch;
- body stomach - the main part of the body;
- output part (gastric gatell) - The transition of the stomach into the duodenum and the stomach section directly adjacent to this place.
The stomach is at the top of the abdominal cavity on the left. Its bottom adjacent to the diaphragm. Nearby are duodenum, pancreas. Right - liver and gallbladder. 
The wall of the stomach consists of three layers:- Mucous membrane. It is very thin, since it consists of only one cell layer. They produce gastric enzymes and hydrochloric acid.
- Muscles. Due to the muscle tissue, the stomach can be reduced, mix and push food into the intestines. In the place of the transition of the esophagus in the stomach and stomach in the duodenum there are two muscular vows. The top does not allow the contents of the stomach in the esophagus, and the lower - the contents of the duodenum in the stomach.
- The outer shell is a thin film from the connective tissue.
Stomach functions
The stomach food accumulates, stirred and partially digested. The main components of the gastric juice:- hydrochloric acid - destroys proteins, activates some digestive enzymes, contributes to disinfecting of food;
- pepsin - enzyme splitting long protein molecules on shorter;
- geitinism - Enzyme, splitting gelatin and collagen.
Blood supply stomach
Arteries, blood supplying stomach, pass through its right and left edge (due to the curved form of the organ, these edges are called small and large curvature). Numerous small arteries depart from the main arteries.
In the place of the transition of the esophageal in the stomach is venous plexus. In some diseases of the veins, of which it consists, expand and easily traumatize. This leads to strong bleeding. 
Types of gastric bleeding
Depending on the cause:- yazvnaya - due to ulcerative disease, most common;
- non-union - caused by other reasons.
Depending on the duration of bleeding:
- sharp - develop quickly, require emergency medical care;
- chronic - Less intense, continue for a long time.
- explicit - pronounced, there are all the symptoms;
- hidden - There are no symptoms, it is usually characteristic of chronic gastric bleeding - only the patient's pallor is noted.
Causes of gastric bleeding
| Cause of gastric bleeding | Development mechanism | Features of manifestations |
| Diseases of the stomach itself |
||
| Stomach ulcer | Approximately 15% -20% of patients with a stomach ulcer is complicated by bleeding. The reasons for the development of bleeding at pressing stomach ulcer:
 | The main symptoms of the stomach ulcers:
|
| Malignant stomach tumors | Stomach cancerit may arise independently or be complicated by peptic ulcer. When the tumor begins to decay, bleeding occurs.  | Basic Stomach Cancer Symptoms:
|
| Diverticulus stomach | Diverticul - This is a protrusion in the stomach wall. In order to understand how it looks, you can imagine rubber surgical gloves: each "finger" is "diverticul". This disease is rare. Bleeding arises as a result of damage to the vessel when inflammation of the wall of the diverticulus.  | The main symptoms of the diverticula of the stomach:
|
| Diaphragmal hernia | Diaphragmal hernia - This is a disease in which part of the stomach rises through the hole in the diaphragm into the chest cavity. Causes of bleeding with a diaphragmal hernia:
 | Bleeding with a diaphragmal hernia develops approximately 15% -20% of patients. In most cases, it is hidden, that is, not accompanied by any symptoms. But maybe quite strong. |
| Polyps of stomach | Polyps of stomach- These are quite common benign tumors. Bleeding arises as a result:
 | Before bleeding, the polyps usually do not show themselves. If they have large enough dimensions, then the passage of food on the stomach is disturbed. |
| Mallory Wece Syndrome | Mallory Wise Syndrome -bleeding, which occurs when the mucous membrane is breaking at the venue of the esophagus in the stomach. Causes:
 | Bleeding can be very intense, so much so that the patient may die if emergency medical care is not provided. |
| Hemorrhagic gastritis | A variety of gastritis, in which erosion (surface defects) appear on the gastric mucosa (surface defects), the risk of bleeding occurs. | Basic symptoms:
|
| Stressful ulcer | Stress has a negative impact on many internal organs. A person who often nerves has a higher probability to get sick of various pathologies. During severe stress in the extreme situation, the bark of adrenal glands begins to produce hormones (glucocorticoids), which increase the secretion of gastric juice, cause a circulatory disruption in the organ. This can lead to surface ulcers and bleeding. | Often to identify stressful ulcers is very difficult, as it is not accompanied by pain and other pronounced symptoms. But the risk of bleeding is high. It can be so intense that it is capable of leading the patient's death if emergency assistance will not be provided. |
| Vascular diseases |
||
| Varicose veins of the esophagus and top of the stomach. | In the place of the transition of the esophageal in the stomach is venous plexus. This is the place of compounds of the branches of the portal vein (collecting blood from the intestines) and the upper vein hollow (collecting blood from the upper half of the body). With increasing pressure in these veins, they expand, they are easily injured, bleeding occurs. Causes of varicose veins of the esophagus:
 | In the early stages there are no symptoms. The patient does not suspect that he has varicosely extended veins of esophagus. Bleeding is unexpected, against the background of full health. It can be so strong that quickly leads to death. |
System Vasculitis:
| System Vasculitis - This is a group of autoimmune diseases in which the vessels are defeated. Their walls are affected, resulting in a bleeding. Some of the systemic vasculites are manifested in the form of gastric bleeding. | With systemic vasculites, symptoms of gastric bleeding are combined with the symptoms of the underlying disease. |
| Atherosclerosis, increased blood pressure. | With the damage to the vessels and increasing blood pressure, there is a risk that the wall of one of the vessels during injury or the next jump pressure will burst, and bleeding will develop. | Gastric bleeding is preceded by symptoms characteristic of arterial hypertension:
|
| Blood coagulation disorders |
||
| Hemophilia | The hereditary disease manifested by the blood coagulation impaired and heavy complications in the form of hemorrhages. Only men suffer. | |
| Acute and chronic leukemia | Leukemia - blood tumors, in which hematopopits in the red bone marrow is disturbed. Violates the formation of platelets - blood plates that are necessary for normal coagulation. | |
| Hemorrhagic diathesis | This is a large group of diseases, one of which is inherited, while others occur during life. All of them are characterized by violations of blood coagulation, increased bleeding. | |
| Avitaminosis K. | Vitamin K plays an important role in the process of blood coagulation. With its lack, there is an increased bleeding, hemorrhages in different organs, internal bleeding. | |
| Hypoprotecrimeia | In the process of coagulation, a large number of different substances take part. One of them - Protromine. Its insufficient blood content may be congenital or related to various pathological conditions acquired. | |
Symptoms of gastric bleeding
| Symptom / Group of Symptoms | Description |
| General symptoms of internal bleeding - develop when bleeding in any organ. |
With severe acute bleeding, the patient's condition deteriorates very quickly. All symptoms are growing for a short time. If there is no emergency assistance, death can come. In chronic gastric bleeding, the patient can disturb a small pallor, weakness and other symptoms for a long time. |
| Vomiting with blood | The appearance of vomit masses and blood impurities depend on the source and intensity of bleeding:
|
| Blood adherence in feces |
 |
How much may be a severe condition of the patient with gastric bleeding?
The severity of gastric bleeding is determined by the amount of lost blood. Depending on the degree of blood loss, three degrees of gastric bleeding are distinguished:- Easy degree. The patient's condition is satisfactory. He is in consciousness. Worried about light dizziness. Pulse is not more often 80 shots per minute. Arterial pressure is not lower than 110 mm. RT. Art.
- Average severity. The patient is pale, the skin is covered with cold sweat. Worried dizziness. The pulse is rapid up to 100 shots per minute. Arterial pressure - 100-110 mm. RT. Art.
- Heavy gastric bleeding. The patient pale, heavily inhibited, responsible for questions, does not respond to the surrounding environment. Pulse is more often 100 shots per minute. Blood pressure below 100 mm. RT. Art.
The patient's condition will be able to adequately appreciate only the doctor after inspection and examination. Bleeding is an easy degree at any time can go into heavy!
Diagnosis of gastric bleeding
Which doctor should be handled with gastric bleeding?
In chronic gastric bleeding, the patient often does not suspect that he has a pathological condition. Patients refer to specialists about the symptoms of the underlying disease:- with pain and discomfort in the upper part of the abdomen, nausea, digestive impaired - to the therapist, a gastroenterologist;
- with increased bleeding, the appearance of a large number of bruises - to the therapist, hematologist.
The only symptom that may indicate the presence of chronic bleeding in the stomach is a black tar-shaped chair. In this case, it is necessary to immediately contact the surgeon. 
In what cases do you need to call "ambulance"?
With intense acute gastric bleeding, the patient's condition deteriorates very quickly. In such cases, it is necessary to call the ambulance brigade:- Sharp weakness, pallor, inhibition, rapid deterioration.
- Loss of consciousness.
- Vomiting "Coffee Room".
The ambulance doctor will quickly examine the patient, fulfill the necessary activities to stabilize its condition and takes it to the hospital.
What questions can a doctor ask?
During the conversation and examination of the patient, there are two tasks in front of the doctor: to establish the presence and intensity of gastric bleeding, make sure that the bleeding occurs from the stomach, and not from other organs. Questions that you may ask at the reception:
- What complaints are worried at the moment? When did they arise? How did your condition change from the moment?
- Have you had gastrointestinal bleeding in the past? Did you add to doctors with similar problems?
- Do you have a gastric or duodenal ulcer? If there is - how long? What treatment received?
- Do you have the following symptoms: pain in the top of the abdomen, nausea, vomiting, belching, heartburn, digestion disorders, bloating?
- Have you had operations about the diseases of the stomach and veins of the abdomen? If you were - for what reason when?
- Do you suffer from any liver disease, blood coagulation disorder?
- How often and in what quantity do you drink alcohol?
- Do you have bleeding from the nose?
How does a doctor inspect a patient with gastric bleeding?
Usually the doctor asks the patient to undress the belt and inspects its skin. Then he feels the stomach, makes it carefully not to strengthen bleeding. What survey can be appointed?
| Research name | Description | How is it held? |
| Fibrogastroduodenoscopy | Endoscopic study, during which the doctor examines the mucous membrane of the esophagus, stomach, duodenum. Most often, it is possible to establish a place and a source of bleeding.  | The study is carried out on an empty stomach.
|
| Radiography stomach | To identify the cause of gastric bleeding, X-ray is carried out with contrast. The doctor can estimate the condition of the walls of the organ, to identify ulcers, tumors, a diaphragmal hernia and other pathological conditions.  | The study is conducted on an empty stomach. The stomach should be empty, otherwise the contrast will not be able to fill it evenly.
|
| Angiography | X-ray system of vessels. It is performed when there is a suspicion that gastric bleeding is a consequence of atherosclerosis or other vascular disorders.  | Through a special catheter in the desired vessel, a contrast solution is introduced. Then make X-rays. The scrolling vessel on them is clearly visible. |
| Radioisotope scanning | It is carried out according to the indications when the place of bleeding is not detected by other methods. Erythrocytes are introduced into the blood of the patient, labeled with a special substance. They accumulate at the place of bleeding, after which they can be revealed by making pictures using a special apparatus. | In the Vienna of the patient, a solution is introduced with labeled erythrocytes, after which they take pictures. |
| Magnetic resonance imaging | It is carried out according to the testimony when an additional information is needed for the doctor's correct diagnosis. Using MRI, you can get pictures with layers of layers or three-dimensional image of a certain body area.  | The study is performed in a specialized department using a special installation. |
| General blood analysis | Deviations that can be revealed in the overall blood test during gastric bleeding:
 | Blood is taken in the usual way from the finger or from the vein. |
| Blood coagulation study - Coagulogram | The study is applied in cases where there is a suspicion that gastric bleeding is associated with a violation of blood coagulation.  | Blood is examined using a special apparatus. Evaluate a number of indicators, on the basis of which conclusions about the state of the coagulation system. |
Treatment of gastric bleeding
Patient with gastric bleeding should be immediately hospitalized in the hospital.There are two tactics for the treatment of gastric bleeding:
- without surgery (conservative);
- operation.
The right decision can only take a doctor. It conducts inspection and examination, establishes the cause and place of bleeding, determines the degree of its gravity. Based on this, further action scheme is selected.
Treatment without surgery
| Event | Description | How is it held? |
| Strict bedding | Peace contributes to the elevation of bleeding, and during movements it can increase. | |
| Cold |  | Most often used bubble with ice wrapped with cloth. |
| Washing stomach ice water | Under the action of the cold, the vessels are narrowing, it contributes to stopping bleeding.  | Washing the stomach is carried out using the probe - the tube, which is introduced into the stomach through the mouth or through the nose. |
| Introduction to the stomach through adrenaline or norepinephrine probe | Adrenaline and Noradrenalin - "Stress Hormones". They cause spasm of vessels and a stop of bleeding. | In the patient's stomach, a probe is introduced through which you can enter medicines. |
| Intravenous administration of hemostatic solutions | Special hemostatic solutions contain substances that increase blood clotting. | Medicines are introduced intravenously with a dropper. |
| The transfusion of blood and blood substitutes is carried out in cases where the patient lost a lot of blood as a result of gastric bleeding.  | |
| Other drugs intended to combat existing violations in the body |
Endoscopic treatment
Sometimes gastric bleeding can be stopped during endoscopy. For this, special endoscopic tools are introduced into the stomach through the mouth.Methods of endoscopic treatment:
- Sliding bleeding ulcers of the stomach solutions of adrenaline and norepinephrinewhich cause vessel spasms and stop bleeding.
- Electro-generation - Calculation of small bleeding sections of the mucous membrane.
- Laser coagulation - Calculation with a laser.
- Flashing threads or metal clips.
- Applique of special medical adhesive.
Operation in gastric bleeding
Surgical treatment of gastric bleeding is necessary in the following cases:- attempts to stop bleeding without surgery do not give results;
- severe bleeding and a significant decrease in blood pressure;
- heavy disorders in the body of the patient who can lead to a deterioration in the state: ischemic heart disease, blood flow impaired in the brain;
- repeated bleeding after they have already been stopped.
- Sunning a bleeding area.
- Removal of part of the stomach (or the entire organ completely, depending on the cause of bleeding).
- Plastic Plate of the transition of the gastric in the duodenum.
- Operation on a wandering nerve that stimulates the selection of gastric juice. As a result, the state of the patient with ulcerative disease is improved, the risk of recurrence is reduced.
- Endovascular operations. The doctor makes a puncture in the groin area, turns through the femoral artery probe, reaches a bleeding loan and overlaps his clearance.
Operations on the stomach can be performed through a cut or laparoscopically - through punctures in the abdominal wall. The attending physician chooses the appropriate type of surgical treatment and provides detailed information to the patient, his relatives. Rehabilitation after the operation on the stomach
Depending on the type of operation, its duration and volume can be different. Therefore, the time of rehabilitation may vary.In most cases, rehabilitation activities are carried out according to the scheme.:
- on the first day, the patient is allowed to make movements with hands and legs;
- from the second day, respiratory gymnastics is usually beginning;
- on the third day, the patient can try to stand up;
- on the eighth day, with a favorable flow, the seams are removed;
- on the 14th day they write out of the hospital;
- subsequently, the patient is engaged in therapeutic physical education, physical exertion is prohibited during the month.
Diet in the postoperative period (if the operation was not very heavy, and no complications):- 1st day: It is forbidden to eat and drink water. You can only moisten the lips with water.
- Day 2: You can only drink water, half a cup of day, tea spoons.
- 3rd day: you can take 500 ml of water, broth or strong tea.
- Day 4: You can take 4 cups of liquid per day, separating this amount by 8 or 12 methods, is allowed to be resolved, sophistication, mucous soups.
- From the 5th day you can use any quantities of liquid soups, cottage cheese, manna porridge;
- From the end of the day in the diet, boiled meat is added;
- From the 9th day, the patient passes to the usual gentle nutrition, excluding irritating food (acute, etc.), products prepared on whole milk.
- Subsequently, frequent food is recommended in small portions - up to 7 times a day.
Prevention of gastric bleeding
The main measure of the prevention of gastric bleeding is timely treatment of diseases that lead to them (see above - "causes of gastric bleeding").Gastrointestinal bleeding is the expansion of blood into the cavity of the stomach and intestines, followed by its release only with the feet or with a feet and with vomiting. It is not an independent disease, but the complication of the set - more than one hundred and different pathologies.
Gastrointestinal bleeding (HCR) is a dangerous symptom that says that it is urgent to find the cause of bleeding and eliminate it. Even if a very small amount of blood is distinguished (and even there are situations where blood is not visible without special research), it may be as a result of a very small, but rapidly growing and extremely malignant tumor.
Note! HCR and internal bleeding are not the same. In both cases, the source of bleeding can serve as a stomach or various intestinal deposits, but with HCRD, the blood is released into the cavity of the intestinal tube, and with internal bleeding - in the abdominal cavity. HCR can in some cases treat conservatively, while internal bleeding (after injured, stupid injury and so on) is only operational.
What happens with a loss of more than 300 ml of blood
Massive bleeding from the gastrointestinal tract causes the following changes in the body:
Causes of Gastrointestinal Conditions
The reasons causing acute gastrointestinal bleeding are so many that they are divided immediately in two classifications. One of the classifications denotes the cause of the reasons, the second - causes depending on the localization in the gastrointestinal "tube".
So, depending on the kind of cause, the HCR may be caused:
- The inflammatory, erosive and ulcerative formations of the gastrointestinal tract, as a result of which the "corrosive" vessels that feed this or that structure. Not all of these pathologies arise due to a violation of a diet or infection Helicobacter Pilori. Erosive-ulcerative lesions occur at any severe disease (this is called stress ulcers). They are caused by firm spirits, acids and alkalis, drunk by an error or intentionally. Also, often erosion and ulcers arise due to the admission of painkillers and glucocorticoid hormones.
- Tumors gastrointestinal tract of any degree of malignancy.
- Wounds and injuries of the gastrointestinal tract.
- Blood coagulation diseases.
- Increased pressure in the vessels of the gastrointestinal tract. This mainly happens only with portal hypertension syndrome caused by cirrhosis, thrombami in a carrier vein or squeezing it from outside.
Depending on the localization, bleeding from the upper departments (until the end of the 12-pans) and bleeding from the lower departments (starting from the small intestine) of the gastrointestinal tract. The upper departments suffer more often: they account for about 90% of the HCR, on the lower, respectively, there are a little more than 10% of cases.
If we consider the frequency of damage to individual organs, then bleeding from the stomach is every second HCR, the bleeding from the 12-pans is found in each third case. Thick and straight intestine is every 10 bleeding, the esophagus is every twentieth. The delicate intestine in adults is rarely bleeding - in 1% of cases.
The reasons for the HCR from the upper departments of the gastrointestinal tract are:
- erosive esophagitis, whose main reason is the reception through the mouth of acids or alkalis;
- erosive and hemorrhagic gastritis, including those arising from the admission of painkillers;
- ulcerative ulcer or 12-ripped localization;
- increased pressure in esophageal veins (portal hypertension syndrome). It develops in cirrhosis of the liver, tombach in hepatic or other veins communicating with a portal vein, the compression of the carrier vein at the heart level - with a constrictive pericardius or at any other level - with tumors and scars of nearby tissues;
- penetrating injuries of the chest or the upper departments of the abdomen;
- mallory Weis Syndrome;
- polyps of the stomach;
- injuries of the esophagus or stomach of foreign bodies or rigid (metal) medical equipment during surveys;
- bleeding from diverticuli ("pockets") and tumors of the esophagus, stomach or 12-rosewoman;
- hernia of the esophageal hole of the diaphragm;
- aorto-intestinal fistula;
- wounds of biliary tract (mainly during operations and manipulations), in which blood together with biliary falls into the 12-point intestine.
The reasons for gastrointestinal bleeding from the lower departments is:
- stupid belly injuries;
- wounds of the abdomen;
- tumors;
- thrombosis of mesenteric vessels;
- glisters infection;
- increase in pressure in the veins of the rectum, which is caused by portal hypertension, having the same reasons as in the case of the esophagus;
- nonspecific ulcerative colitis;
- crohn's disease;
- anal cracks;
- hemorrhoids;
- diverticuli;
- infectious colitis;
- tuberculosis of the intestine.
The reasons for gastrointestinal bleeding, which can cause blood expiration from any department of the gastrointestinal tract are the defeat of the vessels at:
- systemic Red Volcanka;
- avitaminosis C;
- nodule Periatheritis;
- atherosclerosis;
- randy Osler's disease;
- rheumatism;
- congenital malformations, teleangectasis and other vices for the development of vessels,
- disorders of the coagulation system (for example, hemophilia);
- reducing platelet levels or violation of their structure (thrombocytopathy)
In addition to sharp bleeding, there are a chronic HCR. This means that in a certain localization there are damaged vessels of a small caliber, where to periodically "leak" small, not threatening life, blood volumes. The main causes of chronic bleeding are the ulcers of the stomach and the 12-rosewood, polyps and tumors.
How to recognize gastrointestinal bleeding
The first signs of bleeding are weakness that increases at different speeds (depends on the speed of blood loss), dizziness, sweating, sensation of rapid heartbeat. With a pronounced blood loss, a person becomes inadequate, and then gradually falls asleep, palena. If the blood is lost quickly, man is experiencing a strong feeling, fear, pale, loses consciousness.
These symptoms are characteristic of any acute bleeding with a loss of more than 300 ml of blood, as well as for any states that can end with shock (intoxication, taking antibiotics against a significant bacterial infection, product reception or allergen medication).
It is about the LCK worth thinking about the available symptoms:
- cyrrosis or liver veins thrombosis. This yellow color of dry skin, weight loss and legs with an increase in the abdomen, in which liquid accumulates, redness of palms and stop, bleeding;
- cutting diseases. This bleeding when cleaning the teeth, bleeding from the site of injections and so on;
- gastritis, duodenitis and ulcerative disease. These are pain in the upper stomach departments immediately after eating (characteristic of damage to the stomach) or 2-4 hours after it (characteristic of lesions of the 12-rig), nausea, belching;
- infectious disease in the intestine. It is an increase in temperature, nausea, vomiting, chills, weakness. At the same time, a person can remember that he ate something "dangerous": crude water, Belyash on the bus station, three-day salad with mayonnaise, cake or cream cake. It must be said that the infectious gastroenterocolites will not cause abundant HCRs, except that it will be a dysentery at which (but not at the very beginning of the disease) in the lower semen deposits, ulcers are formed.
No manifestations have most tumors, diverticulus or gastrointestinal polyps. Therefore, if gastrointestinal bleeding developed acutely, on the background of complete health (or you can only remember the alternation of constipation and diarrhea, inexplicable weight loss), you need to think about it.
Why we immediately do not describe the appearance of blood, because the ROSF is accompanied by it? Yes, indeed, the blood has a laxative effect, it will not remain in the lumen of the gastrointestinal tract and does not eat back. It will not be stagnant, except for the HCRK coincided with acute intestinal obstruction (for example, the intestine overlapping is a tumor), which may coincide extremely rarely
But in order for the blood "seemed" to outside, should pass time until it overcomes the distance from the damaged vessel to the rectum or to the mouth. Immediately describe the appearance of blood can only be bleeding from a sigmoid or rectum. Then the first symptoms will not be weakness and dizziness, but a defecation, when a larger blood was found in the cartoons (most often it is a hemorrhoid or anal crack, so the defecation will be painful)
Further symptoms of gastrointestinal bleeding differ depending on whether the vessels of which department were damaged.
So, if the source of bleeding is in the upper sections of the stomach, and the volume of lost blood exceeds 500 ml, it will vomiting with blood:
- scarlet blood - if the source is an artery in the esophagus;
- looking like a coffee grip (drone) - when the source is in the stomach or 12-rosewood, and the blood was able to mix with the gastric juice and oxidized;
- dark (venous) blood - if the source is an extended esophageal vein.
In addition, with any volume of blood loss from the top department, the feces will also be painted with blood: it will acquire a darker color. The more blood is lost, the chairs will be more black and more liquid. The more bleeding, the sooner this chair will appear.
GCC from the upper gastrointestinal departments have to be distinguished from the states when the blood fell out of the respiratory tract. Need to remember: Blood from the respiratory tract will stand out with the cough, it contains a lot of foam. The chair at the same time practically does not darken.
There are also conditions, the source of bleeding was in the mouth, in the nose or in the upper respiratory tract, the blood was swallowed, after which vomiting was observed. Then the victim need to remember whether the fact was injured by the nose, lips or teeth, whether the foreign body was swamped, was a frequent cough.
For bleeding from a thin and large intestine vomiting with blood is not characteristic. They are characterized only by darkening and challenge chairs. If bleeding:
- from a rectum or anal sphincter - alaty blood appears on the surface of the feces;
- from a blind intestine or ascending colon - calus can be both dark and look like a brown calumnic, mixed with dark red blood;
- from the descending colon, sigmoid or rectum - the feces of the usual color, there are visible streaks or blood clots.
Degrees of gravity housing
To know how to assist in gastrointestinal bleeding in a particular case, a classification has been developed in which several indicators are taken into account, their changes are divided into 4 degrees. To determine, it is necessary to know the pulse, blood pressure, and with the help of blood tests, determine the hemoglobin and (the percentage ratio of the liquid part of blood and its cells), according to which the circulating blood deficiency (DCC) is calculated:
- The amount of heartbeat is within 100 per minute, blood pressure is normal, hemoglobin is more than 100 g / l, Dtskch 5% of the norm. Man in consciousness, scared, but adequate;
- The amount of heartbeat 100-120 per minute, "upper" pressure of 90 mm Hg, hemoglobin 100-80 g / l, 15% DTSC. A person is conscious, but badly, pale, dizziness is noted. Pale skin.
- The pulse is more often 120 per minute, it is bad forgiven. "Top" pressure of 60 mm Hg. Consciousness confused, patient asks to drink all the time. The skin is pale, covered with cold sweat.
- The pulse is not forgiven, the pressure is not determined or a one-time persuaded in the range of 20-30 mm Hg. DTSK 30% or more.
Bleeding in children
Bleeding in children is a very serious reason for addressing the medical institution. "Itself" it will not pass, even if the child snapped with blood, and after that he usually behaves, plays and asks it. Before contacting, remember whether it could have chocolate, hematogen or painting in red products (beets, cakes with a red dye). Also eliminate injuries in the oral cavity and nose (they can be seen with the naked eye).
The reasons for the HCIS in children are quite a lot. In search of the diagnosis, doctors first of all pay attention to the age of the child: there are diseases most characteristic for one or another age period:
| Age | Diseases |
| 2-5 days of life | Hemorrhagic disease of newborns - vitamin K deficiency is characterized by a dark abundant chair 3-4 p / dn |
| Up to 28 days of life | Stomach ulcers (more often), 12-rosewind (less often), ulcer-necrotic colitis of newborns |
| From 14 days to 1 year | 12-Purpose ulcers (more often), stomach ulcers (less often) |
| 1.5-4 months | Invagination of intestine |
| 1-3 years | Juvenile intestinal polyps, meckel diverticulus, Diesel disease, Family polyposis of the colon (5% of untreated children, it is transformed into cancer by 5 years) |
| Older 3 years old | Varicious extended esophageal veins |
| 5-10 years old | Portal hypertension syndrome, nonspecific ulcerative colitis |
| 10-15 years old | Peteza-Jersey syndrome, when many small polyps are found in the intestines. At the same time, skin, lips, eyelids have a characteristic feature - multiple brown spots |
At any age of a child, starting from the newborn period, may occur:
- gastritis: a severe disease can be the cause, hypoxia (for example, in newborns);
- ezophagitis. Most often, it occurs in children with the shortening of the esophagus, the ahalasia of the cardia, the hernia of the esophageal hole of the diaphragm;
- doubling stomach;
- doubling the small intestine;
- mellore-Weis Syndrome;
- hernia of the esophageal hole of the diaphragm;
- eosinophilic gastroenteropathy;
- vascular defects for the vessels of the gastrointestinal tract: hemangiomas and vascular malformations.
Diagnostics and emergency assistance to children with the same principle as adults.
First aid
Algorithm in gastrointestinal bleeding Next:
- Call "ambulance".
- To put the patient, lift the legs, returning the maximum possible amount of blood from the depot in the veins into the bloodstream.
- Provide the influx of fresh air.
- Put the cold on the stomach. Be sure to clothing so as not to cause frostbite. Hold 15-20 minutes, take off for 10 minutes, then put again.
- Only 50 ml of an aminocaproic acid solution and / or 1-2 tsp can be given from drugs inside. Calcium chloride.
- Drink and eat not to give: it can even enhance bleeding.
- To go to the toilet - to the ship, diaper or some kind of container, to get up to him. At the same time, it is impossible to be allowed.
What do in the hospital
From the moment of receipt, the patient has assistance: the colloidal solutions of blood substitute (the solutions of gelatin or starch) are poured, by determining the blood group - overflow blood and plasma (if necessary). This is explained by the fact that if necessary, operations in the operating, even in an emergency, you need to take only the prepared patient. Such a patient has more chances to survive.
It is necessarily introduced to the hemostatic drugs ("TRANSAM", "TINGOGA", "Vikasol", "ethanzilate") in Vienna, produced "aminocaproic acid" in the mouth. In the detection of erosive-ulcerative lesions, drugs are also introduced into the vein, reduced acidity ("DRACK", "Quamatel" or "Ranitidine").
All this time, it is examined in the receiving department or the resuscitation separation (the second option - if the patient was brought in very serious condition, with 3-4 degree of bleeding):
- take a total blood test from the finger or watch only "Red Blood" (red blood cells and hemoglobin);
- blood blood from vein on hematocrit, determining the percentage ratio of the liquid part of the blood and its shaped elements, and the blood on the coagulogram (the state of the coagulation system;
according to these indicators, judge the degree of the HCR and produce further actions tactics;
- fEGDS is performed - inspection of the stomach and a 12-rosewood with fiber-optic equipment in order to determine the source of bleeding. If such a source is detected in the esophagus, a stomach or a 12-risen intestine, it is trying to get root right during the procedure. If it succeeds, there are no surgery;
- if necessary, and if the patient's condition allows, with non-informative FEGDS, angiography can perform.
Further, they look at the results of the survey, the maximum prepare the patient to the operation and perform it one of the methods: or an open operation, or by the introduction of a blocking vessel of a fragment using an intravascular method, or clipping (clipping clips) under the control of an endoscope or laparoscope.
In the syndrome of portal hypertension, the conservative method is trying to stop the conservative method: formulation of the special probe of blackmore and intensive medical hemostatic therapy. If it does not help, shunt operations are performed - they send blood from the veins with high pressure in the veins with lower.
Gastrointestinal bleeding syndrome complicates the course of many diseases of the digestive tract and can cause fatal outcome. All bleeding is divided primarily on bleeding from the upper, lower departments of the gastrointestinal tract (gastrointestinal tract) and bleeding of unexplained etiology. Most often, this syndrome complicates the diseases of the upper gastrointestinal tract (above the conjunction). Thus, in the United States, the annual number of hospitalizations about bleeding from the specified gastrointestinal department ranges from 36 to 102 patients per 100 thousand population. The gastrointestinal tract is visible more often in men. Bleeding from the lower departments of the gastrointestinal tract as a whole are noticeable less often. It should be noted that due to the ubiquitous implementation of endoscopic research methods, the share of bleeding of unidentified etiology decreased from 20-25% to 1-3%, and according to other authors, up to 5-10%. Among the causes of bleeding from the upper sections of the gastrointestinal tract in the first place are erosive-ulcerative lesions of the stomach and twelve-rosewoman (DPK), and the destructive processes in the DPK are twice as often as possible to hemorrhagic complications. The percentage of mortality from bleeding in the upper gastrointestinal departments ranges from 3.5-7% in the United States to L4% in the UK, and the frequency of deaths during bleeding from the lower sections of the gastrointestinal tract is 3.6%.
They distinguish hidden, as a rule, chronic, gastrointestinal bleeding and obvious (massive) hemorrhage.
In acute bleeding, the degree of blood loss can be different.
In the case of massive blood loss, the volume of circulating blood falls, there is a discrepancy between its vascular channel, a decrease in blood pressure, the increase in the pulse, a decrease in the minute volume of blood circulation, which causes an increase in total peripheral vascular resistance due to a compensatory, generalized vessel spasm. This compensatory mechanism is short-lived, and with continuing blood loss in the body, irreversible hypoxic phenomena may occur. First of all, the liver function is suffering, in which the foci of necrosis may occur.
In the development of any bleeding, two periods are distinguished: latent, since blood flow into the digestive tract, and generalized, manifested by such obvious signs of blood, like noise in the ears, dizziness, weakness, cold sweat, heartbeat, decline, fainting. The duration of the first period depends on the pace and volume of bleeding and fluctuates from a few minutes to days.
Bleeding from the upper gasts
The main causes of bleeding from the upper departments of the gastrointestinal tract are presented in Table 1.
Table 1. Causes of bleeding from the top sections of the gastrointestinal tract.
| Reason for bleeding (diagnosis) | Percent |
| Duodenal ulcer | 22,3 |
| Erosive duodenit | 5,0 |
| Ezophagitis | 5,3 |
| Gastritis, including hemorrhagic and erosive | 20,4 |
| Gastric ulcer | 21,3 |
| Varicose veins (esophagus and stomach) with portal hypertension | 10,3 |
| Mallory Wece Syndrome | 5,2 |
| Malignant tumors of the esophagus and stomach | 2,9 |
Rare causes, including:
|
Just 7.3 |
It was revealed that 44% of all hospitalizations about bleeding from the upper sections of the gastrointestinal tract falls on patients over 60 years old, and the indicators of mortality in older people are also significantly higher. However, it should be noted that approximately 80% of the episodes of bleeding from the upper gastrointestinal departments are independently or require non-massive therapy.
Analysis of the causes of death during bleeding from the upper gastrointestinal departments shows that higher mortality rates (from 50 to 70%) are associated with cases of recurrent bleeding from varicose-expanded veins of the esophagus and stomach. In general, it is the recurrent bleeding in predictive terms most dangerous. The risk factors of repeated bleeding include endoscopically detected signs of the threat of repeated bleeding (inkjet continuing bleeding, blood leakage, a tombed vessel and a visible bleeding vessel). These visual features most often accompany erosive-ulcerative lesions of the gastrointestinal tract. It is believed that the indicated signs of bleeding are of greater importance for the stomach ulcers than for duodenal ulcers.
Other features that can cause or influence the outcome of bleeding should be noted such factors such as the size of ulcers (giant ulcers), concomitant pathology (renal failure, liver cirrhosis, acute coronary failure, chronic blood circulation failure, tumor, endocrine, systemic diseases) .
In general, in the first place for the reasons for bleeding (see Table 1) there is an erosive-ulcerative lesion of the stomach and twelve-rosewood. And this despite undoubted success in the treatment of ulcerative diseases achieved in recent years. Apparently, there are several reasons, and the main of them are asymptomatic forces of ulcers and uncontrolled intact anti-inflammatory drugs (NSAIDs), including aspirin, alcohol, as well as a combination of these factors. So, it is the reception of the NSAID in patients with ulcerative disease, it can give an erased picture of the disease, on the one hand, and fatal bleeding on the other. Incidentally important in the etiology of gastrointestinal bleeding of his relapses in patients with ulcerative disease is infected with patients Helicobacter pylori. (HR), especially in cases of defective eradication of HP, as well as an acidic peptic factor.
An explicit period of bleeding from the upper sections of the gastrointestinal tract, as a rule, begins with vomiting with blood (bright red blood, dark clots or vomiting of the "coffee grounding") or the appearance of melan (black, tar-shaped, stool with a specific, silent smell), but should be noted With massive bleeding from the top sections of the gastrointestinal tract, abundant volatile blood can also appear.
At the same time, the patient notes anxiety or inhibition, pallor, decreased blood pressure, tachycardia, and in some cases, bradycardia associated with the vagus influence can be recorded in patients with serious blood loss. The critical hemodynamic situation occurs when the blood loss is at the level of 40% of the total volume of circulating blood. In this period, the presence of bleeding as the syndrome does not represent doubt, but it is much more difficult to determine its specific source.
The main method of diagnosing bleeding from the top department of the gastrointestinal tract is endoscopic visualization of bleeding space for EGDS; Other methods (nitrogen probe, blood nitrogen level) - auxiliary. As a rule, the endoscopic diagnosis of ulcerative bleeding, especially gastric location, does not represent complexity. Otherwise, the case is with gastropathy, as sources of hemorrhagic complications. Endoscopically gastropathy is determined by the presence of a large number of submembraty hemorrhages, erytimes and erosions. Erosion - defect of the mucous membrane, which does not apply to its muscle plate. In fact, most endoscopists determine erosion as a region of hemorrhage or shallow defects in the mucous membrane with a necrosis nucleus of not more than 3-5 mm in diameter. Gastropathy is often induced by the reception of NSAIDs, alcohol and arise as a result of stressful effects.
Bleeding from the extended veins of the esophagus and the stomach is more often noted from large nodes or common varicose veins. Assessing the situation, endoscopists are often focused on the color of the nodes. Red and blue color of one node is considered a risk factor for bleeding. A white spot on a varicose knot may be fibrin cork and considered as a diagnostic factor of previous bleeding, but does not indicate repeated bleeding. Insulated gastric varicose varicose veins in the foundal department can be the result of a spray vein thrombosis that is detected by angiography. Varicosis in DPK Blood is rare.
With Mallory-Weis syndrome, the bleeding source is a break of the mucous membrane near the gastroesophageal transition caused by intense vomiting, which accompanies the prolapse of the stomach sheath. In patients with this syndrome, a link with chronic alcohol use and portal hypertension can be traced.
The maintenance of patients with the presence of bleeding from the upper sections of the gastrointestinal tract, more often associated with erosive-ulcerative damage to the stomach and DPK, is carried out in three stages.
- Emergency measures aimed at identifying the source of bleeding, its stop and correction of hemodynamic and metabolic disorders.
- Treatment aimed at restoring the integrity of the affected organ, taking into account the etiology and pathogenesis of the underlying disease.
- Prevention of bleeding relapses, including rational therapy of the underlying disease.
At the first stage, the complex of the necessary measures includes: ensuring the maintenance of the respiratory tract (position on the side, the introduction of the nastastric probe), as well as intravenous access, the definition of blood type, rees-factor and biological compatibility. In addition, the patient take blood test on hemoglobin and hematocrit, determine the number of uniform elements, the state of the blood coagulation system, urea levels, electrolytes, glucose; conduct functional liver samples; Monitor arterial blood gases. With a significant blood loss, it is necessary to restore the BCC (transfusion of the physiological solution, and in the presence of signs of sodium delay in the body - a 5% decorium solution). If there are signs of the fall of the BCC, it is necessary to carry out overflow within an hour: 500 ml - 1 liter of colloidal solution with subsequent hemotransphus of erythromass or solid blood (with a large volume of blood loss, the second is preferable). During infusion therapy, it is necessary to closely monitor the diuresis to be above 30 ml / h, and beware of overload volume. At the same time, measures should be taken to stop bleeding. If it is impossible to carry out endoscopy for any reason, you can try to stop the bleeding with therapeutic methods: washing the stomach of ice water and the introduction of antisecretory agents with except influence on secretion ability to reduce the blood flow in the mucous membrane. Especially indicated the use of acid blockers in erosive-ulcene bleeding. According to the latest data, the use of H2-histamine receptor receptor blockers and proton pump inhibitors (IPS) can reduce the likelihood of surgical intervention and death of 20 and 30%, respectively. Modern IPPs are especially effective, characterized by rapid effects. Typically, patients intravenously introduced 40 mg of omeprazole (losk) or 50 mg of Ranitidine (Zantak, etc.). The use of Famotidine (quamatel at a dose of 20 mg from two to four times per day, depending on the degree of blood loss and the severity of endoscopic changes, is also advisable. Simultaneously with acid production blockers, it is advisable to assign cytoprotective agents: Sukralfat (VENTER), better in the form of an emulsion 2.0 g each 4 hours, bismuth preparations (de nol, vantryrsol, etc.).
Diagnostic and therapeutic endoscopy (argonoplasma coagulation, electrocoagulation, laser photocoyaging, diathermocoagulation, conscienting, chemical coagulation with dehydration, etc.) significantly improves the results of bleeding therapy from the upper gastroincing departments. According to available data, when bleeding caused by erosions, a good effect (80-90%) gives intraperial infusion of vasopressin during angiography and catheterization, the effect of the intravenous injection of vasopressin is less pronounced. With ulcerative bleeding, the effect of vasopressin is maliciously, possibly due to greater caliber of bleeding vessels. Otherwise, the treatment of bleeding during gastropathy does not differ from the above described.
As for bleeding from the enhanced veins of the esophagus and the stomach, here the selection of the choice is the synthetic analogue of somatostatin (octreotide), which currently pushed Vazopressin. Octreotide (Sandostatin) is introduced in a dose of 25-50 μg / h in the form of long infusion within five days. It also gives the effect of the combined application of methoclopramid and intravenous infusion of nitroglycerin. The main forms of treatment of this type of bleeding are urgent sclerotherapy or imposition of ligatures.
Bleeding during duodenitis almost always stops spontaneously, and therefore therapeutic endoscopy is rarely required, and angiodicias are treated mainly by laser endoscopic coagulating therapy.
It should be noted that for the full-fledged therapy of the patient with bleeding from the top departments of the gastrointestinal tract, it is not enough to stop the bleeding and stabilize the patient's condition, it is necessary to prescribe a rational treatment of the underlying disease that caused blood loss. Thus, for the treatment of erosive-ulcerative processes associated with HP, it is quite obvious the need to appoint full-fledged eradication therapy, which takes into account not only the resistance of HP to the metronidazole, but also polyzerity to other antibacterial agents. According to the results of our research, we can talk about weekly triple therapy with colloid subcitrate of bismuth (240 mg twice a day), tetracycline (750 mg twice a day) and furazolidone (200 mg twice a day). It is possible and weekly, and in resistance to metronidazole - 14-day quadrotherapy: omeprazole (20 mg twice a day), colloid subcitrate bismuth (240 mg twice a day), tetracycline (500 mg four times a day) and metronidazole (500 mg twice a day). HP eradication with this treatment reaches 85.7-92%.
For the prevention of bleeding caused by the reception of the NSAID with an association with HP, patients who continue to take anti-inflammatory funds according to indications, should be carried out similar eradication therapy with the obligatory inclusion in the IPP scheme (the losk, pariets) by 20 mg twice a day, with the transfer to the future Supporting IPP course in a half daily dose. Misoprostol is possible (200 μg four times a day). Mizoprostol is also effective for preventing stressful erosions, although it causes diarrhea in a number of patients.
Bleeding from the lower departments
The most common causes of bleeding from the lower gastrointestinal tract by A. A. Sheptulin (2000) are:
- anchodisplasia of fine and colon;
- intestinal diverticulosis (including mekkelev diverticul);
- tumors and colon polyps;
- tumors of the small intestine;
- chronic inflammatory bowel diseases;
- infectious colitis;
- intestinal tuberculosis;
- hemorrhoids and anal cracks;
- foreign bodies and intestinal injuries;
- aortochean fistulas;
- helmintoses.
The average age of patients with bleeding from the lower departments of the gastrointestinal tract is higher than in patients with bleeding from the top sections of the gastrointestinal tract. In the past few decades, the mortality rates from acute bleeding from the lower sections of the tract are somewhat decreased, which is associated, first of all, with improving the diagnosis of bleeding, due to the use of colonoscopy and angiography, which allow you to choose the optimal algorithm of surgical or angiographic treatment.
As with bleeding from the upper sections of the tract, 80% of all episodes of bleeding from the lower departments are stopped independently, and in 25% of patients with ceiling bleeding, relapses are observed. Unlike bleeding from the top sections of the gastrointestinal tract, most of the bleeding of the lower departments of the gastrointestinal tract are hidden or minor, non-permanent and do not require hospitalization.
Of all the above, the causes of bleeding from the lower sections of the ZhTK are the most common (30%) hemorrhage from the cavernous hemangioms and an angiodisia of the mucous membrane of the thin and colon (arteriovenous malformations I, II and III types). In second place - diverticulosis (17%), and in 5-10% of cases in patients with bleeding from the lower departments, the reason for the reasons for bleeding cannot be installed.
In the diverticulosis, the bleeding diverticulus is often found in the left sections of the colon. More than bleeding occurs with the accompanying diverticulite and traumatization of blood vessels. The degree of blood loss can be dangerous for the elderly.
Tumor processes rarely give acute bleeding, they are mainly caused by chronic, hidden blood loss and iron deficiency. Hidden bleeding also more often accompanies ulcerative colitis and Crohn's disease, since with this pathology, large vessels are usually not damaged.
Bleeding with hemorrhoids is more often inconsisible, but in some cases there may be massive blood loss, requiring emergency operational activities.
Diverticular bleeding often manifests as a sharp, painless and manifests itself with the presence of bright red unchanged blood (hematohesis) in feces, although Melena can be observed if the source of bleeding is located in the small intestine. Moreover, the lighter blood, the distal is the foundation of bleeding. A similar picture is often noted during angiodisyglasia. Differential diagnosis in these cases is usually carried out on the basis of colonoscopy or angiography. In neoplastic processes of the bleeding clinic, as a rule, are represented by weak, intermittent bleeding and chair with a positive reaction to hidden blood. With the inner hemorrhoid pain syndrome, there is often no bleeding, and the bleeding can be in the form of a stakes of the scarlet blood or manifest themselves with the presence on toilet paper or around the blood chair, but not mixed with a fee that saves its usual color. In general, when, if there is signs of bleeding, the bowel content keeps its usual color, this indicates a low location of the bleeding source (in the rectosigmoid sector). Bleeding with hemorrhoids is often noted during a fitting or during the passage of solid carts. Such a picture is also characteristic of patients with bleeding from anal cracks, but in this case it is often accompanied by a sharp pain syndrome. In addition, the same symptoms can accompany the rectal polyps and carcinoma of the rectum. In this regard, patients with these symptoms necessarily need to be carried out aososcopy and rectoromanoscopy.
Bleeding, the source of which is mekkelev diverticulous, are more often observed in childhood. These are painless bleeding, which can be represented by melanic or bright scarlet blood, classically described as a chair in the form of "currant jelly". It also depends on the level of the diverticulus. The diagnosis is made on the basis of radioisotope studies, which, however, are often given both false-taking and false-position results.
Inflammatory bowel diseases characterizes pain syndrome, which, as a rule, is preceded by bleeding. Blood in these patients is usually mixed with a chair, which changes its color, as the source of bleeding is more often located above the rectosigmoid colon department. At the same time, other signs of the disease are also found, such as diarrhea, tenesmas, etc. Infectious colitis caused by pathogenic intestinal flora, can also often be represented by bloody diarrhea, but in this case there is a rare blood loss. The diagnosis in this case is placed on the basis of sigmoscopy with biopsy and sowing feces.
If the intestation of the intestine is ischemic character, there is a collective pain in the abdominal cavity, more often on the left, accompanied in the future (within the day) bloody diarrhea. For this type of bleeding, the minimum blood loss is characteristic, less frequently marked massive bleeding. Diagnosis is usually carried out x-ray and colonoscopically with biopsy.
Of great importance in the diagnosis of bleeding from the lower gasts, the information obtained by collecting anamnesis and the objective examination of the patient. A significant role is played by the burdened heredity, transferred and existing chronic pathology (oncological diseases in the patient and relatives, including family half-blood zoom, hepatitis, liver cirrhosis, urogenital pathology), as well as living conditions and work, animal contact, and so on.
Inspection of the patient often allows you to make a number of conclusions, for example, the presence of multiple teleangectasis on the skin and mucous membranes suggests that they are also in the intestinal wall. In addition, it is important to take into account the symptoms of existing postghemorrhagic iron deficiency anemia, abdominal pain, diarrhea, anorexia, weight loss, or the presence of palpable formations in the abdominal cavity. A colonoscopy is invaluable in the diagnosis of bleeding from the lower departments of the gastrointestinal tract, and in cases of progressive blood loss, the patients show angiography.
However, despite the fact that currently there is a rich arsenal of technical means, do not forget also about simple, but sufficiently informative research methods available in any conditions - finger rectal research, which can answer many questions, especially with pathology rectum. It is not by chance that in the list of diagnostic measures when bleeding from the lower sections of the tract, this procedure is in the first place. In addition to the above events (aososcopy, rectoromanososcopy, colonoscopy with biopsy, angiography) should not forget about the need to study the feces on the hidden blood with benzidin (after careful preparation of the patient). In some cases, radioisotope studies, computed tomography and NMR diagnostics help in the setting of proper diagnosis.
In 80% of cases, sharp bleeding from the lower departments of the gastrointestinal tract stop independently or in the course of therapeutic measures aimed at therapy of the underlying disease. The most effective therapy for diverticular and angiodic bleeding is: selective catheterization with intraartiaric administration of vasopressin; Crachetter embolization of intestinal arteries; Endoscopic electro- and laser coagulation; Sclerotherapy. With hemorrhoids, techniques such as local (in candles) vesseloring therapy can be used; The 10% calcium chloride solution is prescribed (one tablespoon of four or five times a day). During massive bleeding, the rectum tamponade can be used. With repeated bleeding, surgical treatment is shown. With internal hemorrhoids, in some cases, the sclerosing therapy variccide, etaxiclerone and other means is prescribed. Of great importance in the prophylactic of hemorrhoidal repeated bleeding is attached to the treatment of patients of chronic intricate syndrome.
Given the fact that bleeding from the lower sections of the gastrointestinal tract, significantly more often have a hidden character and are accompanied by chronic iron deficiency anemia, it is necessary to diagnose the occult blood loss in each case and their timely therapeutic correction. The presence of the most patients with chronic blood loss of the combined pathology of the gastrointestinal organs (chronic atrophic gastritis, intestinal dysbacteriosis), deficient nutrition with vitamin deficiency, and in some cases and alcohol abuse, creates the need to prescribe complex therapy, which is preferable to carry out with the help of combined drugs. In this case, the preparation of choice is the preparation of ferro-folgamma (which includes 100 mg of iron of anhydrous sulfate or 37 mg of iron, folic acid (5 mg), cyanocobalamin (10 μg) and ascorbic acid (100 mg). Successful combination of the specified Ingredients in one dosage form creates the conditions of the most effective absorption of iron and the correction of pathological processes. In addition, the presence in the preparation of rapeseed oil, as a carrier, protects the gastric mucosa from irritating iron, which is of great importance in its accompanying lesion.
Doses and duration of treatment are selected individually in laboratory and clinical indicators. Usually the drug is prescribed 1 capsule two or three times a day.
In any case, therapy of patients with gastrointestinal bleeding should be comprehensive and take into account the individual features of patients and related pathologies.
For questions about literature, please contact the editor
I. V. Maev, Doctor of Medical Sciences, Professor
A. A. Samsonov, Doctor of Medical Sciences
G. A. Busarova, Candidate of Medical Sciences
N. R. Agapova
MGMS, Moscow
Read 11 min. Views 4K.
Bleeding from the gastrointestinal tract is a dangerous phenomenon that develops with ulcers, vascular, mechanical and other lesions of the gastrointestinal tract. The abundant expiration of blood into the lumen of the digestive organs can lead to severe complications and fatal outcome.
Stopping and therapy of gastrointestinal bleeding (HCRC) is carried out promptly or using conservative medicine methods after receiving the results of laboratory, hardware and instrumental diagnostics.
Why is blood from the stomach
Bleeding in the intestines, stomach or other digestive organs can develop for the following reasons:
The most common causes of gastrointestinal bleeding are duodenal and gastric ulcers. They determine up to 35% of all bleeding from the gastrointestinal tract. The risk factors for the development of ulcerative diseases are frequent stresses, drinking alcohol and smoking.
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21.10.2019
In children, the most frequent reasons for the development of bleeding are the breakdown of the intestines (for infants) and the intestinal polyposis (at preschoolers).
Some causes of intestinal bleeding (for example, hemorrhoids, anal cracks or polyps) provoke only meager bleeding or small blood impurities in feces. For ulcers, vascular pathologies, tumors and bursts, the blood scripts are abundantly mixed with the discharge (vomit, feces) in a changed or unchanged form.
Classification
Bleeding from the digestive path is divided into groups depending on the etiology, the source of hemorrhage and severity. On the etiology of bleeding are divided:
- on caused by diseases of the gastrointestinal tract (ulcerative and non-zeal genesis);
- on provoked blood circulation in a carrier vein ();
- on bleeding with vascular diseases;
- on the blood-forming system caused by pathologies, incl. Hemorrhagic diattes.
In accordance with the classification of localization bleeding, the following types of this violation are distinguished:
- bleeding from the upper departments of the digestive tract (stomach, esophagus, 12 pans);
- bleeding from the lower digestive organs (thin and large intestines, rectum, hemorrhoidal nodes).
The most commonly develops blood release from the top gastrointestinal departments. Esophageal, duodenal and gastric bleeding are diagnosed in 8-9 of 10 patients with hemorrhages in the digestive tract.
Classification of bleeding by severity
| The severity of pathology | Reducing the volume of circulating blood | External manifestations | Systolic blood pressure and pulse frequency | Blood indicators |
| Easy | Less than 20% | The patient's condition is satisfactory: the patient has a normal allocation of urine (diuresis), easy weakness and dizziness is possible. The patient is in consciousness. | Hell - 110 mm Hg. Heart rate - no more than 80 hd. / Min | The concentration of erythrocytes - above 3.5 * 1012, the hemoglobin level is more than 100 g / l, hematocrit - at least 30%. |
| Average | 20-30% | The patient's skin is pale, there is strong sweating (cold sweat), the selection of urine is moderately lowered. The patient is conscious. | Hell - 100-110 mm Hg. Heart rate - 80-100 wt. / Min | The concentration of erythrocytes is higher than 2.5 * 1012, the hemoglobin level -80-100 g / l, hematocrit - 25-30%. |
| Heavy | Over 30% | The patient's condition is heavy: it has a decline of strength, dizziness, severe muscle weakness, pronounced pallor of skin, sweating, decrease in urine released (until complete anouria). The patient's reactions are injected, the loss of consciousness can be noted. | Hell is below 100 mm Hg. Heart rate - more than 100 q / min | The concentration of erythrocytes is below 2.5 * 1012, the hemoglobin level is 80 g / l, hematocrit - less than 25%. |
Some experts also allocate the fourth, the most difficult staging of bleeding. It is characterized by a complete loss of consciousness in a patient and the development of coma.
Massive, accompanied by a strong loss of blood, is called profuse.
Additionally, bleeding in the gastrointestinal tract can be classified according to the following criteria:
- blood release duration (sharp or chronic bleeding);
- availability of external manifestations of pathology (hidden or obvious);
- frequency and number of cases of blood loss (single or repeated, recurrent).
What features and symptoms
Early bleeding symptoms in the gastrointestinal trades include:
- general weakness, adamina;
- dizziness, fainting condition, confusion and loss of consciousness;
- noise in the ears, flickering of flies in the eyes;
- nausea, vomiting;
- changing the color of gastric and intestinal discharges (vomiting and feces);
- sweating;
- severe thirst;
- pulse care;
- pallor of skin, lip cyanosis, formation and decrease in the temperature of the fingertips.
The severity of symptoms of pathology depends on the intensity of bleeding, BCC and the number of lost blood. Due to the larger initial volume of circulating blood, signs of bleeding in adults can manifest later and less bright than in children. Even a minor loss of blood in a small child may entail the need for immediate resuscitation.
Symptoms of internal bleeding in the stomach are often manifested simultaneously with signs of massive blood loss and reduce the volume of circulating blood. Against the background of blood loss manifestations, pain syndrome in the affected gastrointestinal department can be observed, an increase in the volume of the abdomen due to the accumulation of fluid (ascites), a fever caused by intoxication, a decrease in body weight, a sharp change or loss of taste sensations and other pathological phenomena pointing to the cause of HCR.
The main symptom of gastric bleeding is a bloody vomiting, the character of which can indicate the cause of pathology and the duration of bleeding.
Vomiting with different pathologies of the upper sections of the tract, which lead to blood loss:
"Coffee thickness" is a product of blood treatment with hydrochloric acid.
In pressing lesions during vomiting, gastric pain decreases. Bleeding is not accompanied by irritation of peritoneum and the tension of the muscles of the front of the abdomen. With massive blood loss and stomach cancer, the color of the chair also changes.
Repeated vomiting with blood 1-2 hours after the first episode indicates the continuation of bleeding, and vomiting in 4-6 hours - about his recurrence.
With gastric bleeding symptoms of blood loss, in most cases, it is more brightly manifested than when bleeding in the intestine. This is due to the fact that frequent causes of damage to the walls of thin, thick and rectum are injuries of hemorrhoidal nodes, polyposes and small cracks in the mucous membrane. They can provoke a long but minor blood loss, which is accompanied by a small decrease in the concentration of hemoglobin and the development of compensatory tachycardia while maintaining the normal Hell and the patient well-being.
Symptoms of intestinal bleeding, accompanied by massive blood loss, may be:
- black feces;
- malena isolation (unformed tar-shaped chair with a strong unpleasant odor);
- weakness, loss of consciousness, skin pallor and other manifestations of acute blood loss.
Visual changes in the color and structure of the feces are visible only with blood loss more than 100 ml / day and damage to the straight and colon (cracks, polyps, bleeding hemorrhoids). At a time of blood expiration (with the gastric ulcer and pathologies of the lower departments of the digestive tract), the blood is allocated with a chair unchanged. With prolonged massive bleeding a few hours after it starts, a tar-shaped chair is distinguished (dark feces with small clots).
The nature of the changes in the chair at various intestinal pathologies:
In the chronic course of pathology, symptoms of anemia may occur:
- weakness, fast fatigue;
- reduced performance;
- frequent dizziness;
- inflammation of the oral cavity and language;
- pallion of mucous membranes and skin.
Diagnostics
Finding out the causes of gastrointestinal bleeding syndrome requires a thorough clinical examination, conducting laboratory tests, as well as the use of hardware and instrumental diagnostic methods.
Clinical examination
With a primary diagnosis, an internal bleeding in the stomach or intestines is a clinical examination of the patient, during which the following data is analyzed:
- history of the patient;
- list of accepted drugs;
- color and consistency of selection;
- skin coloring (pallor, jaggility);
- the presence of vascular "stars", hemorrhagic manifestations and other vascular pathologies on the skin.
If there is a suspicion of intestinal or gastric bleeding, palpation of the painful abdomen and rectal research is carried out with caution. Inactive procedure can significantly increase blood loss.
Laboratory research
To laboratory analyzes, which are conducted during bleeding in the stomach, esophagus and lower gastrointestinal departments include:
- general blood analysis;
- blood biochemistry (hepatic and renal samples, markers of inflammatory processes, etc.);
- coagulogram;
- coprogram;
- analysis of antibodies to double-stranded DNA and others.
Tool methods
The most informative hardware diagnostic methods that are used in suspected intraskastric and intraish-free hemorrhage are:
- radiographic examination of the esophagus and stomach;
- celiacography;
- MR-angiography of the vessels of the GCT;
- static and dynamic scintigraphy of the digestive tract;
- CT abdominal organs;
- radiography of nasopharynses, bronchi and lungs.
The fastest bleeding in the stomach can be diagnosed with the help of endoscopy of the upper sections of the gastrointestinal tract. In pathologies of the lower departments of the tract, irrigoscopy, rectoromanososcopy and colonoscopy are used.
If it is impossible to establish a source of hemorrhage using endoscopy and hardware methods, diagnostic laparotomy is carried out.
How to stop bleeding
Bleeding stops must be conducted by medical institutions or emergency medical care brigade. Even before rendering urgent help, it is necessary to call "ambulance", outlining the patient's condition and the nature of the discharge.
The algorithm for the provision of emergency prefiguration assistance in suspected bleeding includes the following actions:
- put the patient on the back, lifting legs with the help of rolled clothes or pillows;
- not to give the victim to drink and eat;
- put on a painful area compress made of ice-wrapped in ice cloth;
- during the first aid to monitor the character of breathing and the frequency of heartbeat;
- with the loss of consciousness, bring the patient to the feeling with the help of a mock, moistened in the nasharya;
- with long waiting for the "ambulance" to carry a patient on stretchers to meet the medical team.
During the provision of emergency care for gastric bleeding, it is forbidden to rinse the stomach. With suspected intestinal pathology, it is impossible to make a patient with a sick.
An attempt to stop the blood without the help of doctors can lead to the death of the patient.
How to treat
In gastrointestinal bleeding, treatment is aimed at stopping, eliminating the root cause of pathology, restoration of the hemostasis of the body and the normal volume of blood.
The danger to the patient represents not only the loss of erythrocytes that carry oxygen, but also a sharp decrease in the BCC, which leads to mass thrombosis of small vessels and the development of the DVS syndrome.
Conservative treatment
Conservative treatment of gastric bleeding and intestinal blood loss is carried out as a supplement to surgical intervention. As the main method of therapy, it is used in the following testimony:
- hemorrhagic syndromes;
- cardiovascular diseases;
- inoperable malignant tumors;
- congenital pathology of the blood formation system.
In therapy, hemostatic agents, cytostatics, anti-inflammatory and other drugs can be used.
With a loss of a large volume of blood, the patient is prescribed droppers with salt solutions and the transfusion of blood components.
Surgery
In case of suspected bleeding, the patient's tract is delivered to the surgical department of the clinic where the diagnosis and determination of the therapy tactics occurs.
Depending on the diagnosis, the patient may be carried out by the following operations:
- endoscopic sclerosing, electrocoagulation and ligation of extended intestinal vessels, esophagus, etc.;
- stitching ulcerative defect and partial resection of the stomach;
- flashing ulcers of a 12-rosewoman;
- subtotal resection of a large intestine with stoma imposition.
Diet
Tactics of treatment with diet and therapy depends on the underlying disease. In the pathologies of the stomach, the patient is prescribed table No. 1, №1a (immediately after killing bleeding), №1B or No. 2. In case of intestinal diseases, diet No. 3 or No. 4 is recommended.
If the discharge of blood is a complication of hepatic pathology, the patient is assigned table No. 5 and its variation.
Consequences and complications
To complications of blood expiration from the gastrointestinal tract:
- DVS syndrome;
- anemia of medium and severe;
- acute organ failure;
- coma.
The risk of developing severe consequences and death increases with a late appeal to the doctor.
How to prevent phenomenon
For the prevention of the development of this dangerous pathology, medical examinations must be regularly held, comply with the rules for the reception of medicines and lead a healthy lifestyle.
Appeal to the gastroenterologist at the first manifestations of peptic and vascular diseases (ailment, nausea, pain in the stomach, etc.) increases the likelihood of a favorable forecast of the effectiveness of therapy.
To track intestinal bleeding in the early stages, it is recommended to regularly hand out the feces analysis on hidden blood.
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