Bleeding stomach ulcer symptoms and relief. Ulcerative bleeding

Acute gastrointestinal bleeding is a common surgical pathology, the main reason is. Perforation of the ulcer is often the cause.

With a bleeding stomach ulcer, the symptoms are alarming: characteristic feature serves as either coffee grounds, blood in the stool, stool takes on a black tarry appearance.

Further treatment

Further tactics of therapy for gastric ulcer bleeding directly depends on the localization of the ulcer. If bleeding occurs from the lower esophagus, tamponade is performed using an inflatable balloon catheter inserted into oral cavity sick. The balloon is inflated with air, which compresses the damaged vessel, stopping the bleeding. It is permissible to stop bleeding from the esophageal vessels using chemical sclerosis. A special fibrosing substance is introduced.

Ulcer 12- duodenum often treated in conservative ways... When the damaged area is sutured. A perforated duodenal ulcer is sutured in the transverse direction, preventing the development of cicatricial intestinal strictures.

Endoscopic treatment

Endoscopic therapy occupies an important place in modern operative surgery, sometimes replacing extensive surgical interventions. This category of diseases includes a stomach ulcer complicated by bleeding. With the help of special equipment, the lumen of the damaged vessel is cauterized using electric current a certain frequency. At the same time, a substance is injected into the vein that provokes an increase in blood clotting.

If the above activities do not bring the expected results, the attending physician decides to conduct surgical intervention... In this case, a bleeding stomach ulcer is sutured or the organ is resected. The scope of the operation depends on the location and area of ​​damage.

Hemostatic drugs

1. Epsilon-amincaproic acid - reduces the intensity of blood clots resorption, activates the blood coagulation system. Introduced by intravenous drip.
2. Dicinone - activates the formation of thromboplastin in the bloodstream - one of the main components of the blood coagulation system. Due to the production of thromboplastin, there is an increase in the number and activation of platelets in the vascular bed. The drug is able to quickly stop bleeding.
3. Calcium chloride or gluconate - in contact with atmospheric oxygen, calcium ions help form a blood clot. Prothrombin is converted into thrombin under the influence of ions. There is a decrease in the permeability of the walls of blood vessels, they begin to contract much better, which stops bleeding.
4. Vitamin K activates the synthesis of components of the blood coagulation system. The action is delayed. Vitamin K will take effect 24 hours after administration.
5. Fresh Frozen Plasma - Natural complex preparation, contains a complete set of clotting factors. It is administered intravenously, by drip, to stop bleeding and replenish the circulating blood volume.
6. Cryoprecipitate is a balanced plasma preparation that includes the necessary coagulation factors. An effective remedy for stopping bleeding in case of stomach ulcers.

Mechanical hemostatic therapy

Elimination of bleeding from large vessels with an extensive surface of a stomach ulcer or duodenal ulcer is performed by mechanical methods:

1. Suturing (ligation) of the ulcer under the control of an endoscope. The ulcer is sutured together with the affected vessel.
2. Riveting. For the above method, specialists use a special apparatus called a clipper. The bleeding vessel is isolated under the control of an endoscope; special clips are applied to it. Treatment by the method is widespread in cases where the patient has bleeding from varicose veins of the esophagus. Way similar treatment effective, eliminates vascular damage in a short time. For one intervention, up to 16 special clips are applied to the vessel.
3. Angiographic embolization. The principle of stopping bleeding in this way is based on the introduction of a special embolus into the lumen of the bleeding vessel. As a microembolus, special microscopic spirals are used. Gelatin sponges or polyvinyl alcohol emboli are used.
4. If the listed measures are ineffective, an extended gastric resection operation is performed. The ulcer is excised to the borders of healthy tissue, the walls of the stomach are sutured in the transverse direction. After such an operation, a long recovery period is required.

With the chosen method of treatment, the patient must comply with bed rest and a strict diet. After discharge from the hospital, constant observation by a gastroenterologist and periodic courses of conservative treatment are required.

Ulcerative bleeding Is the most common complication of ulcers. It happens in 10% of patients. Most often, such a malfunction of the stomach occurs against the background of an exacerbated peptic ulcer... Both a new small ulcer and an old erosion that has not made itself felt for a long time can bleed. it dangerous disease, the treatment of which requires a lot of effort on the part of doctors and on the part of the patient.

Types of bleeding with stomach ulcers

Complications of stomach ulcers occur in many patients. Bleeding is the most common among them. Bleeding are:

• open;
• hidden.

With latent blood loss, the symptoms are almost invisible. Classification by origin of bleeding also comes from such ulcers;

• sharp;
• chronic;
• symptomatic.

By location, they are divided into:

• bleeding from a stomach ulcer:
  • body;
  • cardia;
  • gatekeeper channel;
  • antrum;
• duodenum:
  • descending region;
  • postbulbar;
  • bulbous.

By the nature of bleeding with a stomach ulcer is:

• continuing (jet, laminar, capillary, in the form of unstable hemostasis, recurrent);
• held (in the form of stable hemostasis or post-hemorrhagic anemia).

The degrees are as follows:

• bleeding;
• blood loss.

Causes of occurrence

Often it is not possible to determine the cause of bleeding ulcers. It is not suitable for provoking factors such as physical or mental stress, mental trauma, violation of the integrity of the insides abdominal cavity or other.

Gastric bleeding is often associated with the onset of a necrotic process in an exacerbation of the disease as a result of which the integrity of the vessel is disrupted.

Sometimes atherosclerosis is the main cause of the complication. Vitamin deficiency, thrombosis, or other diseases contribute to gastric bleeding vascular network... The process can be triggered by a postponed infectious disease or a violation of the diet. Alcohol and smoking can affect the likelihood of bleeding.

The clinical picture and symptoms of the disease

A striking and first symptom in stomach bleeding is vomiting with blood impurities. Because of this, vomit has a scarlet or dark brown(like coffee grounds). This reaction appears almost immediately. Scarlet blood in the vomit is a sign that.

Another sign of such a complication in ulcers is melena. When chalked, the stool looks like thick tar. This is a symptom of a bleeding duodenal ulcer. As a rule, such stool means that there is a lot of bleeding in terms of blood loss. At the same time, the stool is liquid, black, shiny and sticky. Melena can be like early symptom, and will appear after a couple of days.

A similar stool can be observed after consuming blueberries, blackberries, medicines to raise the level of hemoglobin in the blood, but its consistency is different. Such a chair is called a pseudomelena. At severe bleeding stools may contain impurities of scarlet blood.

A symptom of a complication is depression pain... In general, the symptomatology depends on how serious the blood loss is. If the complication has easy form, the patient practically does not feel discomfort. Symptoms:

• the skin becomes pale;
• pressure decreases;
• limbs become cold;
• the volume of bile excreted decreases;
• the pulse is accelerating.

With average blood loss:

• the skin turns pale more;
• cyanosis of the nasolabial triangle appears;
• tachycardia;
• oliguria;
• the pulse is accelerating;
• the pressure drops.

The following symptoms may indicate severe blood loss:

• black loose stools;
• chills;
• nausea and vomiting;
• loss of consciousness;
• shortness of breath;
• dizziness;
• the pulse becomes threadlike;
• vascular spasm;
• cold and clammy sweat on the forehead;
• systolic pressure cannot be felt;
• oligoanuria.

With single bleeding associated with ulcers, cases of death are rare. Dangerous renewal of complications for 1.5 weeks.

How to stop and cure stomach ulcer bleeding?

It is necessary to stop gastric bleeding, especially if it opened quickly, as soon as possible. This is the main condition for preserving the life and health of the patient. A patient whose open ulcer is bleeding should be called ambulance, lie on your back and do not move. If possible, in the conditions in which a person lives, it is recommended to apply ice or other cold on the stomach.

If a bleeding ulcer has opened, it is forbidden to eat anything inside, even drink water. You just need to lie still. Ambulance doctors will provide stretcher transportation.

First aid consists in doing everything to stop the ulcer that has opened.

Endoscopic homeostasis is performed. It is carried out by physical or medication... The ulcer can be cauterized by thermal, laser or electrical methods. Bleeding is stopped with coagulants, hemostatics, vasoconstrictor drugs, oil, physiological or sclerosing solution.

Stopping bleeding with surgical intervention carried out only if it was not possible to do this by other methods. If you do not immediately seek treatment or if doctors do not see the severity of the disorder, complications associated with bleeding may be irreversible.

Sometimes bleeding associated with the stomach will stop on its own. But in such a situation medical consultation no less important, since without treatment, the next exacerbation will come soon. To stop the bleeding, you need hospitalization. The patient is shown bed rest and the consumption of food and liquids is prohibited. First, for hemostatics, injections of a chloride solution, "Vikasol", are given, the patient is given a dropper with epsilon-aminocaproic acid.

If the blood loss is very strong, the patient undergoes a blood transfusion. When the number of red blood cells stabilizes, the patient is carefully monitored. In this case, you need additional diagnostics etymology. How gastric bleeding is treated depends on where it occurs.

In addition to traditional and operational methods, for the treatment of the disease, you need to adhere to a special diet. Absolutely everything is prohibited for about 3 days. When strong thirst they are allowed to drink 2 teaspoons of water or dissolve a small piece of ice.

After that, the patient is injected with liquid food. The diet consists in the use of eggs, jelly, milk, juices, jelly, cream, etc. useful substances that can help with illness. The patient is allowed any puree food. Allowed meals:

• liquid mashed porridge;
• soufflé from cottage cheese or meat;
• vegetable puree;
• meatballs;
• compotes and rosehip broth and others.

A peptic ulcer can be life-threatening and lead to complications such as gastrointestinal bleeding or perforation. However, with proton pump inhibitors and the ability to destroy the bacteria Helicobacter Pylori, stomach ulcer (bleeding), the symptoms and manifestation of which are pain 3 hours after eating or fasting, do not give such frequent consequences therefore they are relatively less common. The main causes of bleeding are an open stomach or duodenal ulcer, which is possible in 35-50% of cases. The problem occurs in every 5 people.

Bleeding is a complication of gastric ulcer

Bleeding disease

Now the treatment of stomach and duodenal ulcers is possible, since pathology leads to a widespread complication, during which blood from damaged vessels enters the organ cavity. Define this pathology it is possible for the main symptoms:

• vomiting with impurities;
• violation of hemodynamics;
• tarry stools;
• hypovolemia.

Peptic ulcer, bleeding which is severe and dangerous complication, occurs in 10% of patients of different ages, and also the problem is 50% of all possible lesions of the gastrointestinal tract. In classification medical diseases pathology has ICD 10 code K25.

The patient is vomiting with foreign impurities

But the patient is not always diagnosed on time, because this process may not be essential, therefore it is impossible to fix it.

Irritating factors

The main cause of peptic ulcer disease is an imbalance between the protection of the mucous membrane and the processes of aggression. The latter include:

• hydrochloric acid;
• pepsin;
• non-steroidal anti-inflammatory drugs;
• stress;
• Helicobacter Pylori, whose DNA multiplies rapidly in the mucous membrane.

Stress makes the ulcer worse

This bacterium takes a special interest in the gastric epithelium, being under a protective layer of mucus. It produces urease so that it can be safely in the very acidic pH of the stomach. If the patient develops a stomach ulcer long time, he does not adhere to a diet and eats forbidden foods, then it threatens bleeding ulcers and perforation (development of a through hole).

Clinical picture

The symptom is often found among other pathologies. digestive system... But sometimes the problem does not give itself out as obvious symptoms, then the hidden problem is diagnosed according to such a list of sensations:

• the skin becomes pale;
• vomit is colored in the color of milk coffee grounds;
• the patient complains of general weakness;
• frequent dizziness begins.

The patient notes regular dizziness.

The profuse nature of bleeding can be recognized by one-time or repeated vomiting of a red tint. Somewhat less often, doctors record the release of a huge volume of scarlet blood from an artery with clots.

A bleeding stomach ulcer, the main symptoms of which are pain, appears about 3 hours after eating or fasting. If discomfort develops on right side abdomen on an empty stomach, this is the first sign of duodenal ulcer. Pain in the middle and left epigastric region is most common when pathological changes in an organ (bleeding stomach ulcer).

The symptom is accompanied by dyspeptic and reflexive symptoms, a sharp weight loss. Phenomena requiring immediate medical attention include gastrointestinal bleeding in the form of black, tarry stools and coffee grounds-colored vomit. They are often accompanied by general weakness, pallor.

If black stools develop, seek immediate medical attention.

Signs of an open ulcer and stage

The main symptoms of lesions of the duodenum or stomach depend on the intensity and duration of blood loss. These include vomiting with clear melanosis, blood, and loose, sometimes smooth, tarry stools. Patients with the first symptom account for 30% of cases, while the second symptom appears in only 20% of patients. They can form several days after the bleeding stops.

Usually, the intensity of the phenomena increases 2-5 days before the onset of internal bleeding, and after this process clinical picture fades out. The brightest signs of the period:

• palpation of the abdominal cavity is accompanied by pain;
• thirst;
• diuresis is lowered;
• the skin becomes dry.

Heavy bleeding accompanied by thirst

How many signs and in what intensity the patient will feel depends on the severity. It will be easier to live if a person immediately begins to treat the ulcer, and does not wait for the development of complications (opening of lesions), which are eliminated only by surgery. But it all depends on the amount of blood lost. So, the following stages are distinguished:

1. Less than 5%. The person feels almost normal, the pathology of hemodynamics is disturbed to a small extent. BP is unchanged, but the pulse is slightly higher.
2. 5-10% - second degree. Symptoms: fainting, lethargy, increased heart rate, blood pressure less than 90.
3. Up to 30% - the third stage. It is difficult to transfer, the pulse becomes threadlike and frequent, blood pressure decreases (from 60), the skin turns pale.
4. From 30% - the fourth degree. A very serious condition with impaired consciousness and a lack of pulse, blood pressure is lowered to fatal levels.

Internal bleeding can cause blackouts

The treatment course should be prescribed at the most early stages when such serious damage and consequences can be dispensed with.

Danger of ulcers with hemorrhage

Accumulation of blood can lead to perforation. The patient experiences epigastric discomfort, an early feeling of fullness, nausea that goes away and then recurs. Usually, patients tend to underestimate the manifestations of pathology, attributing them to dietary errors. This leads to the fact that they do not want to do the necessary actions, and the therapy time is running out.

The clinical picture becomes an early symptom of cancer, which develops as a consequence of an ulcer with hemorrhage.

Bleeding may be early sign stomach cancer

Diagnostic measures

A set of measures to establish gastrointestinal bleeding usually small. There are typical clinical symptoms facilitating diagnosis. Further research is aimed at determining the source of the bleeding.

To do this, it is necessary to conduct a long interview with the patient, paying attention to the symptoms that preceded and accompanied bleeding, the history of past and concomitant pathologies, nutrition, the use of drugs, especially anticoagulant, analgesic, anti-inflammatory and alcoholic stimulants. The next step is the inpatient hospital physiotherapy and rectal manipulation.

Biochemicals are undoubtedly important additional research... For example, an image of red blood cells, which informs the doctor about the intensity of bleeding and allows him to make a decision about the need for a transfusion. It must be remembered that in the first 6-8 hours after the onset of bleeding, changes in the level of hemoglobin, hematocrit and the number of red blood cells are usually not observed. But the first day is very important, so you should not lie at home, delaying the complication.

A rectal exam is performed to detect bleeding.

Health care

The disease is emergency in gastroenterology and requires intensive therapeutic treatment... If the hemorrhage is severe, a short time a person loses up to 1 liter of blood. When discussing the most common causes of this process, it is necessary to distinguish between upper and lower gastrointestinal bleeding.

There are other clinical symptoms, and the diagnosis of these conditions is different, so doctors will take different therapeutic measures. Pathology requires immediate hospitalization, since an open stomach ulcer with bleeding can lead to the death of the patient.

There is only one conclusion from this - ethnoscience at home using herbal infusions will in no way stop or replace blood loss.

The patient is urgently hospitalized

A course of treatment

Gastrointestinal bleeding sometimes stops spontaneously, and with peptic ulcer disease, this percentage is 70-80% of cases. However, this does not relieve the doctor from the need to apply appropriate therapeutic manipulations, which should always be carried out in a hospital setting. The conservative course consists of the following points:

• pharmacotherapy;
• endoscopic treatment;
• catheter therapy;
• surgical intervention.

The drug regimen is reduced to use medicines against bleeding that reduce secretion: H2 blockers or proton pump inhibitors (PPIs) and drugs for local hemorrhagic action.

Prevention of recurrent episodes is an important aspect of treatment. The Helicobacter pylori eradication method, introduced over the years using antibiotics and PPIs, is showing promising results.

Methods for endoscopic control of bleeding (acute form):

• injection of decongestants (adrenaline);
• thermal contact (heat probe);
• non-contact thermal variations (laser);
• mechanical methods;
• combined actions.

The patient is given adrenaline injections

Each of them reduces the rate of rebleeding by about 75%, the number of operations in case of an emergency by 60%, and the mortality rate by 30%. The choice depends on the capabilities of the Center and the experience of the endoscopist. Some have suggested combining the two methods to improve the effectiveness of treatment.

If it is impossible to control bleeding with conservative techniques, including endoscopic techniques, you need to act quickly, since each delay increases the risk of death. Catheter therapy is performed, which is used to embolize bleeding. This method is recommended in case serious condition patient when surgical or endoscopic treatment carries a high risk. Only hospitals with a well-equipped radiological laboratory and experienced staff are involved in this task.

Endoscopic assessment of the state of the gastrointestinal tract occurs after hemodynamic stability. Such examination should be carried out within 24 hours if the patient's condition is not serious and therapeutic decisions have been made in advance.

The patient undergoes diathermocoagulation by the endoscopic method

The purpose of endoscopy is not only to determine the source of bleeding, but also to assess the prognosis and to make appropriate local treatment attempts. It is recommended to use 2 endoscopic methods at the same time. For example, the injection and thermal process will give best effect than applying one of them.

For the injection of bleeding ulcers, adrenaline is usually used in a ratio of 1: 10,000 s. saline, concentrated sodium chloride or pure alcohol. The addition of obliterating drugs does not improve hemostasis results, and the importance of medications (thrombin and fibrin glue) is uncertain.

Clamps have acquired a good reputation among other endoscopic methods and can be used alone or in combination with various manipulations. The effectiveness of the clamps is comparable to injection and thermal methods.

With a low hemoglobin level, manipulation is more difficult

The efficiency of endoscopy during the treatment of bleeding peptic ulcer disease is high and exceeds 90%. But after successful initial hemostasis, in about 20% of cases, such episodes are one of the main causes of death. Factors that increase the risk of relapse:

• low hemoglobin levels;
• active bleeding;
• fresh blood in the stomach and the diameter of the ulcer is more than 2 cm.

To prevent relapse, try different methods pharmacotherapy. Research confirms the use of high doses of Omeprazole on the first day of treatment, as it is necessary to achieve an increase in gastric pH.

Chemotherapy is usually delayed until it heals.

Forecast and preventive measures

Further condition with perforated hemorrhage is improved by control endoscopy performed 16-24 hours after hemostasis. If ulcerative bleeding recurs after initial success, one of the endoscopic techniques should be used and the patient should not be referred to surgery, which poses a greater risk of complications and death. However, subsequent episodes require surgical treatment.

In patients with bleeding ulcers and Helicobacter Pylori infection antibiotic therapy practically eliminates relapse. It is now necessary to screen all bleeding patients for the presence of these bacteria.

Recurrent bleeding requires surgical treatment

The test should be performed at the first endoscopy, but provided that there is not too much blood in the stomach, since its presence causes a false negative result. During the same bleeding, histological examination using special staining methods is more accurate than urease.

Perforation of gastric ulcers can be prevented with nutrition and proton pump inhibitors in the morning on an empty stomach. Drinking alcohol is prohibited. It should be remembered that some drugs irritate the stomach lining, causing erosion. People diagnosed with peptic ulcer disease should use NSAID analgesics with caution. There is also a hypothesis that the consumption of vitamin C helps in the fight against the number of H. pylori bacteria.

For help with stomach bleeding, see below:

According to statistics, with a stomach ulcer, bleeding occurs in about 5-15% of patients who have a similar disease. Basically, the intensity depends on the area of ​​the lesion, and the patient's well-being depends on the timely and correct assistance provided.

The consequences of such a complication can be serious, therefore it is very important to know for what reason the bleeding occurred, as well as exactly how first aid is provided to the patient.

Features of pathology

Bleeding ulcer - enough dangerous disease causing significant discomfort. Intensity pathological process largely depends on the size of the affected vessel. The consequences of such a complication are quite serious, therefore, timely provision of first aid and the appointment of subsequent treatment are important.

One of the causes of ulcerative bleeding can be problems with cardiovascular system... In addition, it can be triggered by defects in the ulcer, which begins to develop after the use of glucocorticosteroids. As a result of the presence of various kinds of disorders, inflammatory and destructive processes begin to progress. This leads to the fact that there is a violation of capillary coagulability. can come from arteries, veins, as well as small blood vessels.

Forms and degrees

With a stomach ulcer, bleeding can lead to hemorrhagic shock, which can be:

• compensated;
• subcompensated;
• decompensated;
• very heavy.

The pathological condition can be latent and explicit. Latent bleeding in the initial stages does not cause a deterioration in well-being. An explicit form is observed with defeat large vessel, while it is accompanied by nausea, vomiting with blood splashes.

In addition, a distinction is made between arterial and venous bleeding. Arterial bleeding characterized by the spread of erosion to the walls of blood vessels, and venous can be caused by thrombosis.

Causes of occurrence

With a stomach ulcer, bleeding mainly occurs due to damage to the walls of the stomach, resulting from mechanical or chemical attack... Other provoking factors include the following:

• physical stress;
• hypovitaminosis;
• drops emotional state;
• damage to the gastric walls at the cellular level.

Blood loss adversely affects general condition organism, aggravating it. With significant blood loss, the heart rate increases, and systemic circulation is impaired. Internal organs become edematous, which is fraught with the occurrence of a heart attack.

The main signs

Basically, the occurrence of bleeding with stomach ulcers occurs unexpectedly. The reason for this is damage to arteries or veins, and sometimes it can be a consequence of a long-standing, but untimely resolved problem. Symptoms of bleeding with stomach ulcers are quite pronounced, especially in the case of significant blood loss. With the course of a latent lesion, the signs practically do not appear.

Among the most frequent symptoms bleeding with stomach ulcers can be distinguished such as:

• the presence of bloody vomiting;
• dark-colored feces;
• painful sensations.

A fairly characteristic sign is vomiting with bloody discharge or dark in color.

Dark-colored stools are considered another sign that you are bleeding with a stomach ulcer. Similar symptoms occur with significant blood loss.

In acute bleeding stomach ulcers, there are a number of signs that can lead to hemorrhagic shock... Shortness of breath, pallor are also noted. skin, weak pulse, low blood pressure.

With a latent form, the signs may not be sufficiently pronounced, so the patient may not notice them. The bleeding is mostly minor, but it recurs regularly.

First aid

If there are signs of bleeding with a stomach ulcer, then it is imperative to call an ambulance, and the patient should be given first aid before she arrives. First of all, you need to forbid him to move. It is best to put the patient in a horizontal position on his back and put an ice pack on his stomach before the doctors arrive.

You can additionally give a piece of ice to swallow, as the cold helps to stop the bleeding. It is strictly forbidden to give food and water to the patient. In the presence of an acute or chronic ulcer with bleeding, the patient is transported only on a stretcher by experienced paramedics.

In almost all cases, the patient is hospitalized in a hospital, and in some cases in intensive care unit.

Diagnostics

If the first signs of bleeding appear with a stomach ulcer, it is imperative to carry out diagnostics to accurately determine the presence of a problem. The main diagnostic method is endoscopy, which should be performed at the most as soon as possible... Endoscopic examination is performed under general anesthesia.

In addition, special tests are assigned to determine the presence hidden blood in the chair. Required laboratory diagnostics to determine hemoglobin, the number of erythrocytes, platelets, blood clotting time. In some cases, you may need differential diagnostics to exclude the defeat of others internal organs.

Treatment feature

If a stomach ulcer opens with bleeding, then you should immediately consult a doctor for treatment. The main therapy is carried out in the hospital. Immediately after hospitalization, the patient is prescribed drugs that help reduce the risk of severe blood loss. For treatment, administration of "Vikasol" is indicated.

If the bleeding is severe enough, the patient may be given a blood transfusion. After the required volume is restored, additional therapy is required, aimed at the subsequent elimination of symptoms and the risk of subsequent bleeding.

In some cases, endoscopy is used for treatment. This method involves cauterizing the damaged vessel with an electric current. A substance may also be injected into the vein to help clot blood and help prevent subsequent bleeding.

If all these methods have not brought any result, then surgical intervention may be indicated. This treatment consists of a gastric resection.

Treating bleeding stomach ulcers with conservative therapy implies the use of colloidal and crystalloid solutions. To compensate for the lost blood, an infusion of the required volume of rheopolyglucin and polyglucin is required.

Also required are agents for improving blood clotting, in particular, such as platelet mass, fibrinogen, plasma, aminocaproic acid. Also doctors prescribe antibacterial agents, in particular, such as "Tetracycline", "Metranidozole", "Clarithromycin". Then you need to take proton pump blockers ("Omeprazole") and histamine receptors ("Diazolin"). Additionally, antispasmodics are prescribed, for example, "Spazmolgon", "No-Shpa". This treatment is designed for 2 weeks.

Physiotherapy and endoscopic techniques

Physiotherapy plays a very important role in recovery. Correctly selected physical exercises, laser therapy, magnetotherapy, as well as treatment mineral waters acute or bleeding will speed up recovery and reduce the risk of relapse.

V recent times endoscopic therapy is gaining in popularity. Among the most popular techniques, it is necessary to highlight such as:

• laser coagulation;
• thermal electrode;
• bipolar coagulation;
• injection sclerotherapy;
• clipping of vessels.

When using the thermocoagulation method, it is best to combine it with injection endoscopic hemostasis. Clipping of blood vessels helps to quickly stop bleeding, as well as prevent the likelihood of relapse. If endoscopic techniques have not brought positive result, then the doctor may prescribe an operation.

In many cases, with bleeding stomach ulcers, surgery is the only way to save the patient's life. The method of surgical intervention largely depends on the severity of the patient's condition and the localization of the ulcer crater. The most popular surgical method is gastric resection. This type of operation refers to organ-preserving, and is also quite simple and safe.

In debilitated patients alternative method surgical intervention is suturing the defect with vagotomy, as well as subsequent drainage of the wound. It should be noted that all these techniques are not complicated and do not pose a particular risk, since during their implementation there is no danger of injury to the vessels.

Dieting

In the case of bleeding in gastric ulcers, nutrition after treatment plays a very important role in preventing relapse. During the first 2-3 days, complete abstinence from food and drink is indicated. Thirst can be quenched by drinking a little water or a small piece of ice, which must be slowly absorbed in your mouth. After that, the patient can gradually introduce liquid food into the diet. In this case, you can consume:

• milk;
• eggs raw or soft-boiled;
• jelly;
• semi-liquid jelly;
• juices.

During the recovery period, the body should receive enough calories to keep you going. However, it is worth remembering that food should be semi-liquid or puree. Alcohol, spicy, fatty and fried foods should be excluded from the diet.

What can be dangerous

Like any other bleeding, such a pathology is very dangerous because the body loses a lot of blood, unable to replenish it. With significant blood loss, over permissible norm the patient may die, so it is important to provide him with first aid and prescribe treatment as soon as possible. Especially dangerous is bleeding provoked by the defeat of large vessels, which leads to complications such as:

• swelling of the brain;
• heart failure;
• intoxication of the body with toxins and blood decomposition products.

As a result of bleeding, organ failure syndrome can develop, when many organs and systems are damaged.

Prevention

Prevention of bleeding during ulcerative lesion stomach is basically a regular balanced diet, abstinence from smoking and alcoholic beverages. In addition, it is important to harden and periodically undergo treatment in sanatoriums.

Ulcerative bleeding occurs suddenly and does not depend on the stage of development and the nature of the underlying disease. In rare cases, a complication becomes the first symptom of a stomach ulcer. Hemorrhage is life-threatening and with delayed help often ends in the death of the patient.

Causes

The main cause of bleeding in gastric ulcer disease is deep ulceration of the walls, when the bottom of the lesion reaches the arteries and blood vessels. Hemorrhage is most often complicated by acute and chronic calcified defects in the presence of predisposing factors.

They can be:

• excessive consumption of rough foods that injure the walls and bottom of the ulcer;
• preference for very hot or cold foods that are irritating open wound and makes her bleed;
• drinking and smoking, especially on an empty stomach;
• abdominal trauma;
• long-term treatment with glucocorticosteroids, NSAIDs, antibiotics;
• poor blood clotting;
• gastrointestinal diseases;
• pathology of the heart and blood vessels;
• stress, emotional breakdown.

Sometimes stomach bleeding arise under the influence of excessive physical stress or a sharp lifting of weights, prolonged mental stress. Pathology can also be provoked by vitamin deficiency, vein thrombosis lower limbs, non-observance of the regime of work and rest.

An open stomach ulcer often bleeds in patients diabetes mellitus, atherosclerosis, patients with high blood pressure... Some clinicians note the hereditary nature of the complication - if a defect is present in one of the parents, the likelihood of its occurrence in children increases markedly.

Symptoms

Signs of a bleeding stomach ulcer are usually divided into latent, typical for any hemorrhage, and obvious, characteristic of internal hemorrhage.

Latent symptoms are manifested by weakness, impaired coordination of movements, tachycardia, shortness of breath, and darkening of the eyes. A drop in blood pressure, the appearance of profuse sweating, agitation or loss of consciousness are considered signs of hemorrhagic shock and require urgent replacement therapy.

With intraluminal bleeding from the stomach, the symptoms become obvious:

• sharp pain and burning in the abdomen;
• the appearance of nausea;
• pallor of the skin;
• vomiting blood;

Localization unpleasant sensations depends on the place where the stomach ulcer burst. To alleviate suffering, the patient takes the position of an embryo with knees pulled up to the abdomen.

With slight bleeding, feces acquire a dark color, for profuse hemorrhages, the appearance of melena is characteristic - a tarry stool of a viscous consistency with unpleasant odor... In the case of massive blood loss, black feces may not be present, and scarlet blood begins to stand out from the rectum.

The manifestations of ulcerative blood loss can increase over several days or weeks, or occur simultaneously.

First aid

If a stomach ulcer has opened and a person has the first symptoms of hemorrhage, it is necessary to act very quickly. The first step in helping the victim is to call a medical team.

• to provide the patient with complete immobility;
• lay it on a horizontal surface by placing a pillow or roller of rolled clothes under your feet;
• cool the stomach area with ice or frozen food;
• talk to the patient without losing consciousness.

What should not be done in case of acute bleeding stomach ulcer? It is forbidden to feed or water the victim, give analgesics, lift and plant him.

Which doctor treats a bleeding stomach ulcer?

A bursting ulcer rarely makes it possible to consult a doctor on your own. Most often, the patient is taken to the hospital in an ambulance, where a gastroenterologist and a surgeon are engaged in his health. If there are concomitant pathologies that have caused bleeding, other specialists are involved in the treatment.

If the hemorrhage is moderate in nature and the patient is able to reach the clinic, he should contact a gastroenterologist, and in his absence, a therapist.

Diagnostics

Initial examination of a patient with characteristic symptoms even with low blood loss suggests rupture of a stomach ulcer. To clarify the diagnosis, the victim is prescribed a number of studies:

• clinical blood test;
• coagulogram;
• bilirubin test;
• Ultrasound of the abdominal cavity.

The main diagnostic method for bleeding stomach ulcers is esophagogastroduodenoscopy. With persistent hemorrhage, a radionuclide study may be prescribed.

When a patient is admitted to the hospital, if the state of health permits, first of all they carry out endoscopic examination, and then the rest of the diagnostic measures.

Treatment

An ulcer with open bleeding is always a risk for the patient. Such a patient needs round-the-clock supervision, modern equipment and competent restoration of hemostasis.

Drug therapy

A bleeding stomach ulcer that requires treatment intravenous infusion plasma substitutes and erythrocyte mass, is carried out in the intensive care unit.

Hemostatic therapy includes:

• intravenous drugs - Aminocaproic acid, Dicinone, Fibrinogen, Hemophobin, calcium gluconate or chloride;
• therapeutic endoscopy;
• local therapy - bed rest, norepinephrine or adrenaline intake, cold to the epigastric region;
• vascular embolotherapy through the femoral artery.

Additionally, the patient is prescribed heart medications to normalize acid balance use sodium bicarbonate. Restoration of microcirculation and an increase in the volume of fluid in the arteries is carried out with Reopolyglucin and Trental.

Antiulcer therapy after stopping bleeding includes taking Pilobact. The question of the cessation of hemorrhage is decided with the help of a probe or EGD.

Operation

If conservative treatment of an open stomach ulcer does not give the expected result or the patient is in old age, the option of surgical intervention is being considered. There may be other reasons for the operation:

• massive bleeding;
• regular relapses of hemorrhage;
• finding an ulcer near large arteries.

Today, gastric resection is considered the most effective and organ-preserving type of intervention. In aged and debilitated patients, incision suturing can be performed vagus nerve or without it. With any method of intervention, the patient must adhere to strict bed rest and follow all the doctor's instructions.

Proper nutrition

Diet for stomach ulcers is necessary condition Get well soon... In the first week after bleeding, the patient is assigned a table number 1, excluding the following products:

• fatty, salty, fried and smoked foods;
• legumes and peas;
• sour vegetables and fruits;
• bread and pastry;
• carbonated water, coffee, alcohol.

Observing the diet, you can not only speed up recovery, but also avoid the risk of repeated relapses.

Complications

Untreated gastric ulcer with bleeding can provoke many serious complications:

• swelling of the brain;
• impaired liver function;
• toxic poisoning;
• anemia;
• disorder of the body systems.

And these are not all the consequences. Complicated bleeding from ulcers often leads to the death of the patient. The relevance of the problem is underlined by figures - the mortality rate from hemorrhage is 10-15%, and among patients with massive bleeding it reaches 50-55%.

Prevention

There is no specific prevention of ulcerative blood loss, but compliance with certain rules will help preserve the health, and sometimes the life of the patient.

Preventive measures:

• timely treat all diseases of the stomach and duodenum;
• eat fractionally and often;
• avoid stress, mental and physical fatigue;
• regularly undergo medical examination and follow all the doctor's prescriptions.

It is very important for a stomach ulcer patient to maintain a moderate rhythm of life, to maintain an accessible physical activity, follow a strict diet and completely give up alcohol and smoking.

The prognosis of a peptic ulcer with bleeding depends on the timeliness and literacy of the assistance provided, as well as the amount of blood loss. A great responsibility lies with the patient himself. Do not wait for the ulceration to open. For any, even the slightest, suspicion of bleeding, it is recommended to immediately seek help. This is exactly the case when it is better to play it safe.

Useful video about first aid for gastrointestinal bleeding