Gastrointestinal bleeding: symptoms, emergency. Bleeding from the gastrointestinal tract Bleeding from the gastrointestinal tract symptoms

Gastrointestinal bleeding - is the outflow of blood from damaged vessels into the cavity of the organs that make up the digestive system. The main risk group for this disorder includes older people - from forty-five to sixty years, but it is sometimes diagnosed in children. It is noteworthy that it occurs several times more often in men than in women.

More than a hundred diseases are known against which such a symptom can develop. These can be gastrointestinal pathologies, various damage to blood vessels, a wide range of blood ailments or portal hypertension.

The nature of the manifestation of the symptoms of the clinical picture directly depends on the degree and type of hemorrhage. The most specific manifestations can be considered the appearance of blood impurities in the vomit and feces, pallor and weakness, as well as severe dizziness and fainting.

The search for a focus of hemorrhage in the gastrointestinal tract is carried out by performing a wide range of instrumental diagnostic methods. To stop GCC, conservative methods or surgery will be required.

Etiology

Currently, there is a wide range of predisposing factors that cause the appearance of such a serious complication.

Hemorrhages of the digestive tract associated with a violation of the integrity of blood vessels are often caused by:

organs of the gastrointestinal tract, in particular the stomach or;
the formation of atherosclerotic plaques;
aneurysm or expansion of the vessel, which is accompanied by a thinning of its wall;
diverticula of the gastrointestinal tract;
septic.

Often, hemorrhages in the gastrointestinal tract are the result of blood ailments, for example:

any form of flow;
which are responsible for blood clotting;
- is a genetic pathology, against the background of which there is a violation of the blood coagulation process;
and other ailments.

Bleeding in the gastrointestinal tract against the background of a leak often occurs when:

liver damage;
compression of the portal vein with neoplasms or scars;
the formation of a blood clot in the veins of the liver.

In addition, it is worth highlighting other causes of gastrointestinal bleeding:

a wide range of injuries and injuries to the abdominal organs;
penetration of a foreign object into the digestive tract;
uncontrolled intake of certain groups of drugs, for example, glucocorticoid hormones or non-steroidal anti-inflammatory drugs;
influence or nervous strain for a long time;
traumatic brain injury;
surgical intervention on the organs of the digestive system;

Gastrointestinal bleeding in children is caused by the following factors:

hemorrhagic disease of newborns - the most common reason for the appearance of such a disorder in babies under one year old;
- often causes gastrointestinal hemorrhages in children from one to three years old;
colon - explains the appearance of such a symptom in preschool children.

Children of the older age group are characterized by similar etiological factors inherent in adults.

Classification

There are several types of such a symptom or complication, ranging from the nature of the course and ending with possible sources. Thus, there are two types of gastrointestinal bleeding:

spicy - divided into voluminous and small. In the first case, there is a sharp appearance of characteristic symptoms and a significant deterioration in a person's condition, which can occur even after ten minutes. In the second situation, the symptoms of blood loss gradually increase;
chronic - characterized by the manifestation of anemia, which is of a recurring nature and lasts a considerable time.

In addition to the main forms, there are also overt and hidden, single and recurrent hemorrhage.

At the site of localization of the focus of blood loss, it is divided into:

hemorrhage from the upper gastrointestinal tract - the appearance of a disorder occurs against the background of damage to the esophagus, stomach or duodenum;
bleeding from the lower zones of the gastrointestinal tract, which include organs such as the small and large intestines, as well as the rectum.

Classification of gastrointestinal bleeding according to the severity of their course:

mild - the person is conscious, the pressure and pulse indicators slightly deviate from the norm, the blood begins to thicken, but its composition does not change;
moderate degree - it is distinguished by a more vivid manifestation of symptoms, a decrease in blood pressure and an increase in pulse rate, blood coagulability is not disturbed;
severe - characterized by a serious condition of the patient, a significant decrease in blood pressure and an increase in heart rate;
coma - observed with significant blood loss, which can reach three liters of blood.

Symptoms

The degree of intensity of expression of clinical signs will directly depend on the severity of the course of such a disorder. The most specific symptoms of gastrointestinal bleeding are:

vomiting with blood impurities. With hemorrhages from the stomach or intestines, the blood remains unchanged, but with ulcerative lesions of the duodenum or stomach, it can take on the color of "coffee grounds". This color is due to the fact that the blood enters into contact with the contents of the stomach. It should be noted that with blood loss from the lower gastrointestinal tract, this symptom does not appear;
the appearance of blood impurities in the feces. In such situations, the blood can also be unchanged, which is inherent in hemorrhages from the lower gastrointestinal tract. The blood will be changed about five hours after the onset of bleeding in the upper gastrointestinal tract - the stool at the same time has a tarry consistency and acquires a black tint;
severe bleeding;
the release of a large amount of cold sweat;
pallor of the skin;
the appearance of "flies" before the eyes;
a gradual decrease in blood pressure and an increase in heart rate;
the appearance of tinnitus;
confusion of consciousness;
fainting;
hemoptysis.

Such clinical manifestations are most typical for the acute course of such a disorder. In chronic hemorrhages, the following symptoms predominate:

weakness and fatigue of the body;
decreased performance;
pallor of the skin and mucous membranes;
deterioration of health.

In addition, the chronic form and acute gastrointestinal bleeding will be accompanied by symptoms that are characteristic of the underlying disease.

Diagnostics

Identification of the sources and causes of such a manifestation is based on instrumental examinations of the patient, however, it requires the implementation of other comprehensive diagnostic measures. Thus, the clinician first of all needs to independently perform several manipulations, namely:

to get acquainted with the patient's medical history and anamnesis;
carry out a thorough physical examination, which must necessarily include careful palpation of the anterior abdominal wall, examination of the skin, and measurement of heart rate and blood pressure;
conduct a detailed survey of the patient to determine the presence, the first time of onset and the intensity of the expression of symptoms. This is necessary to establish the severity of the hemorrhage.

From laboratory examinations, the following are of diagnostic value:

general and biochemical blood test. They are carried out to detect changes in the composition of the blood and the ability to coagulate;
analysis of feces for occult blood.

Instrumental examinations to establish the correct diagnosis include the following procedures:

FEGDS - with hemorrhages from the upper gastrointestinal tract. A similar diagnostic endoscopic procedure can turn into a therapeutic one;
sigmoidoscopy or colonoscopy - if the source of blood loss is in the colon. Such examination is also divided into diagnostic and therapeutic;
radiography;
angiography of blood vessels;
irrigoscopy;
celiacography;
MRI of the abdominal organs.

Such diagnostic measures are necessary not only to establish the source of hemorrhage, but also in order to carry out a differential diagnosis of gastrointestinal bleeding. Blood loss with a focus in the gastrointestinal tract should be distinguished from pulmonary and nasopharyngeal hemorrhage.

Treatment

Acute hemorrhage or exacerbation of a chronic one can occur anywhere at the most unexpected moment, which is why it is necessary to know the rules of emergency assistance to the victim. First aid for gastrointestinal bleeding includes:

providing the person with a horizontal position so that the lower limbs are higher than the rest of the body;
applying a cold compress to the area of the alleged source. This procedure should last no more than twenty minutes, after which they take a short break and apply cold again;
taking medications inside - only if absolutely necessary;
exclusion of the use of food and liquids;
a complete ban on gastric lavage and the implementation of a cleansing enema.

Treatment of gastrointestinal bleeding in a medical institution consists of:

intravenous injections of blood-substituting drugs - to normalize blood volumes;
donor blood transfusion - in cases of massive hemorrhage;
the introduction of hemostatic medications.

In cases of ineffectiveness of drug therapy, endoscopic surgical interventions may be needed, which are aimed at:

ligation and hardening of damaged vessels;
electrocoagulation;
chipping of bleeding vessels.

Often they resort to open surgery to stop hemorrhages.

Complications

If symptoms are ignored or if therapy is not started in a timely manner, bleeding of the gastrointestinal tract can lead to a number of serious complications, including the development of:

hemorrhagic shock due to the loss of a large amount of blood;
sharp;
multiple organ failure;
premature birth - if the patient is a pregnant woman.

Prophylaxis

Specific preventive measures for such a disorder have not been developed; in order to avoid problems with hemorrhages in the gastrointestinal tract, it is necessary:

timely treat diseases that can lead to the appearance of such a complication;
undergo regular examination of an adult and a child by a gastroenterologist.

The prognosis directly depends on the predisposing factors, the degree of blood loss, the severity of the accompanying ailments and the age category of the patient. The risk of complications and mortality is always extremely high.

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The diagnosis of GCC is based on a combination of clinical manifestations, laboratory data and instrumental studies. In this case, it is necessary to solve three important issues: firstly, to establish the fact of HCC, secondly, to verify the source of bleeding and, thirdly, to assess the severity and rate of bleeding (V.D.Bratus, 2001; N.N. Krylov, 2001). Of no small importance in determining the tactics of treatment is the establishment of the nosological form of the disease that caused the bleeding.

A carefully collected anamnesis of the disease in a significant part of patients allows you to get an indication not only of the GCC, but also to clarify the cause of its occurrence. Information about the vomiting of blood or stomach contents in the form of "coffee grounds", the presence of "tarry stools" and black stools with a lacquered sheen suggest both the level of the source of bleeding in the gastrointestinal tract and the intensity of blood loss.

The most common cause of bleeding from the upper gastrointestinal tract is ulcerative lesions, as evidenced by data that the patient was previously treated for peptic ulcer disease, or data on hunger and night pain in the upper abdomen, which in most cases are seasonal (spring, autumn ) character. The tumor nature of bleeding is indicated by a gradual progredient course of the disease in the form of "stomach discomfort", causeless weight loss and a number of other so-called "minor" symptoms of stomach cancer (deterioration of health, general weakness, depression, loss of appetite, stomach discomfort, causeless emaciation) ... To diagnose bleeding from the esophagus, it is necessary to have data on liver cirrhosis or alcohol abuse, or chronic hepatitis.

It is also necessary to clarify whether the patient has used medications, especially non-steroidal anti-inflammatory drugs and corticosteroids. To find out the presence of concomitant diseases, especially the liver, heart and lungs, as well as the presence of hemorrhagic diathesis, manifested by petechial rashes, hemorrhagic vesicles or subcutaneous hemorrhages, about the possibility of hereditary hemorrhagic diseases, such as telangiectasia. The appearance of signs of GCC after some time (1-3 hours) after a heavy meal, especially with alcohol, in combination with an increase in intra-abdominal pressure (lifting weights, vomiting) indicates the likelihood of Mallory-Weiss syndrome.

By the nature of vomiting with an admixture of blood, one can assume the severity of bleeding. Vomiting of "coffee grounds" indicates that the rate of bleeding is most likely moderate, but at least 150 ml of blood has accumulated in the stomach. If the vomit contains unchanged blood, this may indicate bleeding from the esophagus or profuse bleeding in the stomach. The latter will be confirmed by rapidly developing hemodynamic disturbances leading to HSS.

It should be borne in mind that sometimes a significant volume of vomit stained with an admixture of blood can create a false idea of large blood loss. It should also be remembered that vomiting with an admixture of blood occurs only in 55% of cases of GI from the upper gastrointestinal tract (up to the Treysevaya ligament), and even profuse bleeding from varicose veins of the esophagus is not always manifested by "bloody vomiting". If vomiting with blood is repeated after 1-2 hours, then it is considered that this is ongoing bleeding, if after 4-5 hours or more it is possible to think about a second, i.e. recurrent bleeding. (V.D.Bratus, 1991; p.K Me Nally, 1999).

An indisputable evidence of GCC is the detection of signs of blood in the feces, visible by eye or established by laboratory. It should be borne in mind that in the patient's complaints and anamnesis there may be an indication of the presence of black feces due to the intake of drugs containing bismuth (de-nol, vikalin, vikair). When examining the feces in appearance, it is necessary to differentiate bleeding (the feces will be black lacquered shiny) from the color of their preparation (black with a gray tint, dull).

With "small" bleeding, mainly of a chronic nature, when up to 100 ml of blood per day enters the gastrointestinal tract, no visible changes in the color of feces are noted. It is detected in the laboratory using a reaction with benzidine (Greggdersen test), which will be positive if the blood loss exceeds 15 ml / day. To avoid a false-positive reaction, it is necessary to exclude from the patient's diet for 3 days meat and other products of animal origin, which contain iron.

The brushing of teeth with a brush, which can cause bleeding of the gums, is canceled. Similar information can also be obtained when conducting a qualitative Weber reaction (with guaiacol resin), but it will be positive with a blood loss of at least 30 ml / day.

More informative is the quantitative study of daily blood loss in feces by the method of P.A. Kanishchev and N.M. Bereza (1982). Positive results of fecal occult blood test persist for 7-14 days after a single injection of large amounts of blood into the stomach (P.R. McNally, 1999).

To speed up the establishment of the fact of bleeding from the upper gastrointestinal tract (above the Treitz ligament) allows the introduction of a nasogastric tube with gastric lavage with boiled water or 0.5% aminocaproic acid solution in an amount of 200.0 to 500.0 ml. But in almost 10% of patients with a bleeding duodenal ulcer, no blood impurities are found in the gastric contents. This is because when the bleeding stops temporarily, blood can quickly pass into the intestines without leaving any traces in the stomach.

A digital examination of the rectum is mandatory in all patients. The presence of a discolored stool glove on the finger allows one to determine the fact of bleeding and to assume the level of its source in the gastrointestinal tract long before the appearance of an independent stool.

Endoscopic tests are the most effective and obligatory tests in case of suspicion of GCC. They allow not only to establish the localization of the source of bleeding, its nature, but also in most cases to carry out local hemostasis. Modern fiber endoscopes can identify the source of bleeding in 9298% [V.D. Brother, 2001, J.E. de Vries, 2006]. With the help of esophagogastroduodenoscopy, the upper gastrointestinal tract, including the duodenum, is confidently examined, and the use of colonoscopy allows you to examine the entire colon, starting with the rectum and ending with the Bauginia valve. The small intestine is less accessible for endoscopic examination.

If there is a suspicion of bleeding from it, laporoscopic and intraoperative intestinoscopy is used. Recently, video capsules have been used, which, moving along the intestine, transmit an image of the mucous membrane to the monitor screen. But this method, due to its complexity and high cost, is inaccessible for widespread use.

A more effective method of endoscopic examination of the small intestine has also been developed: push enteroscopy and double-balloon endoscopy (DBE), performed by stage-by-stage stringing of the small intestine onto a fiber-optic probe using two fixing balloons.

Considering that 80-95% of all HCC falls on the upper parts of the digestive tract [V.D. Brother, 2001; V.P. Petrov, I.A. Eryukhin, I.S. Shemyakin, 1987, J.E. de Vries, 2006, J.Y. Lan, J.Y. Sung, Y. Lam a.otn., 1999] the performance of FGDS takes a leading place in their diagnosis. Colonoscopy is performed only in the presence of obvious clinical signs of intestinal bleeding. An urgent endoscopic examination is mandatory in the presence of clinical manifestations or suspicion of acute GIQ.

A contraindication to its implementation is only the agonal state of the patient. With unstable hemodynamics (systolic blood pressure<100 мм рт.ст.) эндоскопическое исследование проводится после ее стабилизации или на фоне инфузионной терапи (при наличии признаков продолжающегося кровотечения) [В.1. Нпсппаев, Г.Г. Рощин, П.Д. Фомин и др., 2002]. Задержка обследования не дает возможности своевременно обнаружить источник кровотечения, определить его активность, что естественно влияет на тактику и исход лечения.

In the presence of shock, coma, acute cerebrovascular accident, myocardial infarction, decompensation of cardiac activity, at first, they are refrained from performing endoscopy and conservative treatment of GCC begins. If it is unsuccessful and there are clinical signs of ongoing blood loss, it is possible to conduct an endoscopic examination for health reasons, as the only way to establish the source of bleeding with a simultaneous attempt to stop it using one of the endoscopic methods.

The study is carried out on the table (endoscopic operating room), which allows you to change the position of the patient's body, which makes it possible to examine all parts of the stomach, especially if there is a large amount of blood in it [V.I. Rusin, Yu. Yu. Peresta, A.V. Rusin et al., 2001]. Before the study, the endoscopist is assigned the following tasks:
- to verify the source of bleeding, its localization, size and severity of destruction;
- to determine whether the bleeding continues;
- to carry out an endoscopic attempt at local stopping of bleeding;
- in case of stopped bleeding, determine the degree of reliability of hemostasis and predict the degree of risk of recurrent GCC;
- to monitor the reliability of hemostasis for several days in accordance with the stigmas identified by Forrest.

In solving the set tasks, both the preparation of the patient and the methodically correct conduct of it are of great importance [T.T. Roshchin, P.D. Fomsch, 2002]. Before the study, premedication and local anesthesia of the pharynx is carried out by irrigating it with a 2% lidocaine solution. It should be taken into account that the presence of blood in the stomach changes the endoscopic picture. Fresh blood, even in small amounts, stains the mucous membrane pink and masks the affected area, and the developing anemia causes pallor of the mucous membrane. As a result, the visual difference between the altered and unchanged gastric mucosa disappears. The signs of inflammation decrease or completely disappear, which causes a change in the endoscopic picture during repeated examinations. In turn, hemolyzed blood strongly absorbs light rays and thus creates a twilight that reduces the possibility of seeing the source of bleeding.

Its verification is carried out with active water irrigation of the stomach with boiled water or ordinary saline solution of NaCl, which is fed into the stomach through the biopsy channel of the endoscope with a syringe or a special automatic irrigator. Irrigation and careful mechanical removal of blood clots improves the ability to locate the source of bleeding. If the stomach contains the contents of the color of "coffee grounds" and in this regard, it is impossible to detect the source of bleeding, as well as in the absence of clinical data on ongoing blood loss, repeated endoscopic examination is performed after 4 hours, simultaneously performing hemostatic and corrective therapy. Gastric lavage is contraindicated in this case, because it can cause bleeding.

If the stomach contains a large amount of blood and clots, it must be flushed through a thick tube. Water is injected with a syringe, and the contents of the stomach flow out without active aspiration, which can provoke a probe suction to the gastric mucosa and damage it [B.1. Npashaev, G.T. Roshchin, P.D. Fomsch, ta ppsh, 2002].

When the ulcer is located in a bulbous location, verification of the source of bleeding is significantly complicated and becomes almost impossible in the presence of gastric stenosis. In rare cases, there may be two or more sources of bleeding, for example, bleeding from varicose veins of the esophagus and stomach ulcers, or in combination with Mallory-Weiss syndrome.

Signs (stigma) of active or stopped bleeding are used to predict the likelihood of recurrent bleeding according to the Forrest classification of intragastric bleeding (Table 7)

Table 7 Endoscopic classification of intragastric bleeding according to Forrest.

Endosco- picic group	Subgroup	Endoscopic picture	Forecast in% risk bleeding
Forrest 1 Active bleeding continues		The bleeding continues in a stream
Forrest 1 Active bleeding continues		Bleeding continues as capillary or diffuse bleeding
Forrest 2 The bleeding has stopped but the stigma persists for its recurrence		At the bottom of the ulcer, a thrombosed artery of significant size with traces of recent bleeding
		Thrombus clot tightly fixed to the wall of the ulcer crater
		Small thrombosed vessels in the form of dark brown or dark red spots
Forrest 3 Sigma no bleeding		No signs

In endoscopic examination, the source of bleeding is most easily verified when blood enters the stomach in the form of a stream. However, such bleeding is usually accompanied by a significant filling of the stomach cavity with liquid blood with large clots. If they occupy less than 1/2 of the volume of the stomach, straightened by air insufflation, then it is examined by changing the position of the patient.

Inspection of the cardiac parts of the stomach is possible by lifting the head end of the table, and to examine the duodenum and distal parts of the stomach, the leg part of the table is raised. If the suspected source of bleeding is closed by a blood clot, it is washed off with a stream of water or moved by careful mechanical displacement using a manipulator inserted through the biopsy channel of an endoscope.

Bleeding in the form of capillary, diffuse or leakage of blood from under the thrombus becomes visible after gastric lavage and mechanical removal of blood clots. Often, bleeding is observed at the bottom of an ulcer from under a blood clot, which is taken by an endoscopist as a blood vessel. In fact, a blood clot protruding from the lumen of the vessel takes on the appearance of a vessel. Gradually, it is fixed and transformed into a blood clot.

Its spherical protrusion is smoothed out, changing the visual picture. At first, it has a red color, then darkens. Over time, the erythrocytes in it undergo lysis, and platelets and thrombin form a white plug in the lumen of the vessel.

Diagnosis of bleeding from phleboectasias in the lower third of the esophagus is difficult during active bleeding due to constantly flowing blood, more often in the form of a stream. If the bleeding has stopped, the defect in the varicose vein is verified by the presence of submucosal hemorrhage. The presence of ulceration or erosion in the area of phlebectasia is not excluded.

Stepanov Yu.V., Zalevsky V.I., Kosinsky A.V.

- this is the outflow of blood from eroded or damaged by the pathological process of blood vessels into the lumen of the digestive organs. Depending on the degree of blood loss and the localization of the source of the flow, vomiting of the color of "coffee grounds", tarry stools (melena), weakness, tachycardia, dizziness, pallor, cold sweat, and fainting may occur. The source is established taking into account the data of FGDS, enteroscopy, colonoscopy, sigmoidoscopy, diagnostic laparotomy. Stopping bleeding can be done conservatively or surgically.

General information

Gastrointestinal bleeding is the most common complication of a wide range of acute or chronic diseases of the digestive system, which is a potential threat to the patient's life. The source of bleeding can be any part of the gastrointestinal tract - the esophagus, stomach, small and large intestines. In terms of frequency of occurrence in abdominal surgery, gastrointestinal bleeding ranks fifth after acute appendicitis, cholecystitis, pancreatitis and strangulated hernia.

Causes

To date, more than a hundred diseases have been described that can be accompanied by gastrointestinal bleeding. All hemorrhages can be conditionally divided into 4 groups: bleeding with lesions of the gastrointestinal tract, portal hypertension, vascular damage and blood diseases.

Bleeding that occurs with lesions of the gastrointestinal tract can be caused by gastric ulcer or peptic ulcer 12p. intestines, esophagitis, neoplasms, diverticula, hiatal hernia, Crohn's disease, ulcerative colitis, hemorrhoids, anal fissure, helminthiasis, trauma, foreign bodies, etc. Bleeding against the background of portal hypertension, as a rule, occurs in chronic hepatitis and cirrhosis of the liver, thrombosis of the hepatic veins or the portal vein system, constrictive pericarditis, compression of the portal vein by tumors or scars.

Bleeding resulting from vascular damage, etiologically and pathogenetically, can be associated with varicose veins of the esophagus and stomach, periarteritis nodosa, systemic lupus erythematosus, scleroderma, rheumatism, septic endocarditis, avitaminosis C, atherosclerosis, Randyu-Osler's disease and vascular disease dr.

Bleeding often occurs in diseases of the blood system: hemophilia, acute and chronic leukemia, hemorrhagic diathesis, vitamin K deficiency, hypoprothrombinemia, etc. tension, stress, etc.

Pathogenesis

The mechanism of occurrence of gastrointestinal bleeding can be caused by a violation of the integrity of blood vessels (with their erosion, rupture of walls, sclerotic changes, embolism, thrombosis, rupture of aneurysms or varicose veins, increased permeability and fragility of capillaries) or changes in the hemostatic system (with thrombocytopathy and thrombocytopathy disorders of the blood coagulation system). Often, both the vascular and hemostasiological components are involved in the mechanism of bleeding development.

Classification

Depending on the section of the digestive tract, which is the source of hemorrhage, bleeding is distinguished from the upper sections (esophageal, gastric, duodenal) and lower sections of the gastrointestinal tract (small intestine, colonic, hemorrhoidal). The outflow of blood from the upper parts of the digestive tract is 80-90%, from the lower - 10-20% of cases. In accordance with the etiopathogenetic mechanism, ulcerative and non-ulcerative gastrointestinal hemorrhages are isolated.

In terms of duration, acute and chronic bleeding is distinguished; by the severity of clinical signs - explicit and hidden; by the number of episodes - single and recurrent. According to the severity of blood loss, there are three degrees of bleeding. A mild degree is characterized by heart rate - 80 per minute, systolic blood pressure - not lower than 110 mm Hg. Art., satisfactory condition, preservation of consciousness, light dizziness, normal diuresis. Blood indicators: Er - above 3.5x1012 / l, Hb - above 100 g / l, Ht - more than 30%; BCC deficit - no more than 20%.

With bleeding of moderate severity, the heart rate is 100 beats per minute, the systolic pressure is from 110 to 100 mm Hg. Art., consciousness is preserved, the skin is pale, covered with cold sweat, diuresis is moderately reduced. In the blood, a decrease in the amount of Er to 2.5x1012 / l is determined, Hb - up to 100-80 g / l, Ht - up to 30-25%. The BCC deficit is 20-30%. A severe degree should be thought of with a heart rate of more than 100 beats. in min. weak filling and tension, systolic blood pressure less than 100 mm Hg. Art., lethargy of the patient, adynamia, severe pallor, oliguria or anuria. The number of erythrocytes in the blood is less than 2.5x1012 / l, the level of Hb is below 80 g / l, Ht is less than 25% with a BCC deficiency of 30% or more. Bleeding with massive blood loss is called profuse.

Symptoms

The clinic of gastrointestinal bleeding manifests itself with symptoms of blood loss, depending on the intensity of hemorrhage. The condition is accompanied by weakness, dizziness, skin poverty, sweating, tinnitus, tachycardia, hypotension, confusion, and sometimes fainting. When the upper gastrointestinal tract is affected, bloody vomiting (hematomesis) appears, which looks like "coffee grounds", which is explained by the contact of blood with hydrochloric acid. With profuse gastrointestinal bleeding, vomit is scarlet or dark red in color.

Another characteristic sign of acute hemorrhages from the gastrointestinal tract is tarry stools (melena). The presence of clots or streaks of scarlet blood in the stool indicates bleeding from the colon, rectum, or anal canal. The symptoms of hemorrhage are combined with signs of the underlying disease. In this case, pain in various parts of the gastrointestinal tract, ascites, symptoms of intoxication, nausea, dysphagia, belching, etc. may be noted. Latent bleeding can be detected only on the basis of laboratory signs - anemia and a positive feces reaction to occult blood.

Diagnostics

The examination of the patient is carried out by an abdominal surgeon, begins with a thorough examination of the history, assessment of the nature of vomit and feces, and a digital rectal examination. Pay attention to the color of the skin: the presence of telangiectasias, petechiae and hematomas on the skin may indicate hemorrhagic diathesis; yellowness of the skin - about trouble in the hepatobiliary system or varicose veins of the esophagus. Palpation of the abdomen is performed carefully to avoid increased gastrointestinal bleeding.

From laboratory indicators, erythrocytes, hemoglobin, hematocrit, platelets are counted; coagulogram study, determination of the level of creatinine, urea, liver tests. Depending on the suspected source of hemorrhage, various X-ray methods can be used in the diagnosis: X-ray of the esophagus, X-ray of the stomach, irrigoscopy, angiography of mesenteric vessels, celiacography. The fastest and most accurate method of examining the gastrointestinal tract is endoscopy (esophagoscopy, gastroscopy, colonoscopy), which allows you to detect even superficial mucosal defects and the direct source of gastrointestinal bleeding.

To confirm bleeding and identify its exact localization, radioisotope studies are used (scintigraphy of the gastrointestinal tract with labeled erythrocytes, dynamic scintigraphy of the esophagus and stomach, static intestinal scintigraphy, etc.), MSCT of the abdominal organs. Pathology must be differentiated from pulmonary and nasopharyngeal bleeding, for which X-ray and endoscopic examination of the bronchi and nasopharynx is used.

Treatment of gastrointestinal bleeding

Patients are subject to immediate hospitalization in the surgical department. After clarifying the localization, causes and intensity of bleeding, the treatment tactics are determined. With massive blood loss, blood transfusion, infusion and hemostatic therapy is performed. Conservative tactics are justified in the case of hemorrhage, developed on the basis of a violation of hemostasis; the presence of severe intercurrent diseases (heart failure, heart defects, etc.), inoperable cancer processes, severe leukemia.

In case of bleeding from varicose veins of the esophagus, its endoscopic stopping can be carried out by ligating or sclerosing the altered vessels. According to the indications, they resort to endoscopic stopping of gastroduodenal bleeding, colonoscopy with electrocoagulation or injecting bleeding vessels. In some cases, surgical stopping of gastrointestinal bleeding is required.

So, with a stomach ulcer, a bleeding defect is sutured or an economical resection of the stomach. In case of duodenal ulcer complicated by bleeding, stitching of the ulcer is supplemented with stem vagotomy and pyloroplasty or antrumectomy. If bleeding is caused by ulcerative colitis, subtotal colon resection is performed with the imposition of ileo- and sigmoidostomy.

Forecast and prevention

The prognosis for gastrointestinal bleeding depends on the causes, degree of blood loss and general somatic background (age of the patient, concomitant diseases). The risk of an unfavorable outcome is always extremely high. Prevention consists in the prevention and timely treatment of diseases that can cause hemorrhages.

Intestinal bleeding - the release of blood into the lumen of the colon or small intestine - is a symptom that requires prompt medical attention. Its cause may be a pathological process in the intestines and in the organs associated with it, or an injury. If stop measures are not taken in time, it can pose a serious danger to the patient's life.

Duodenal bleeding is the most common after gastric bleeding. It accounts for 30% of all cases of gastrointestinal hemorrhage (the share of gastric hemorrhage is more than 50%). 10% of the sources of damage are localized in the large intestine, and 1% in the small intestine.

It is not easy to distinguish profuse gastric bleeding from intestinal bleeding due to the similarity of their signs, the adjacent arrangement of organs and belonging to a single system. International classification of diseases of the tenth revision (ICD-10) hemorrhages of the stomach and intestines are combined into one group K92.

Types of intestinal bleeding

By localization of blood loss:

Arising in the upper intestine (duodenum 12);
Arising in the lower intestine (small, large, rectum).

By the way of manifestation:

Having obvious signs of presence;
Hidden, invisible to the victim.

By the nature of the course:

In acute form;
Chronic.

By duration:

One-time;
Recurrent.

Causes

A rather wide range of pathologies can be accompanied by blood loss in the intestine.

They are usually divided into 4 groups:

Diseases of ulcerative and non-ulcerative nature. Ulcerative lesions are the most common cause of intestinal bleeding (about 75% of all cases, and separately in men, the figure is higher).

These include:

Duodenal ulcer after resection of the stomach and other surgical interventions in the gastrointestinal tract;
Nonspecific ulcerative colitis;
Multiple colon ulcers accompanying Crohn's disease;
Bleeding ulcers resulting from a burn of the mucous membrane (due to poisoning with concentrated acid, mercury, lead, etc., prolonged use of medications);
Ulcers in places of mechanical trauma of the gastrointestinal tract;
Formed on the background of stress or physical strain.

Non-ulcer intestinal bleeding:

Intra-intestinal effusion in infants can provoke volvulus, intestinal obstruction.

The disease is expressed not so much by the release of blood as by constipation, gas formation, and acute animal pains.

Another factor is congenital bowel anomalies and neoplasms.

In older children, the main culprits of intestinal bleeding are polyps. A common cause of hemorrhage in young children is foreign objects in the digestive tract that damage the mucous membrane.

Symptoms

When internal intestinal bleeding is severe enough, it is not difficult to diagnose it. It is determined by the presence of blood in feces and vomit.

If blood is present in the stool unchanged, then this indicates its one-time loss of over 100 ml. This can be a profuse gastric effusion, or blood loss in the duodenum, which is the result of an extensive ulcer. If the blood runs for a long time, it secretes iron under the influence of enzymes and stains the stool in a black, tarry color. With small discharge, changes in feces are not visually visible.

Not always a dark color of feces is a sign of intestinal bleeding. Sometimes this is a consequence of ingestion of iron-rich foods or certain medications. And sometimes - the result of swallowing blood by a patient (this can happen, including if the nasopharynx or oral cavity is damaged).

When blood clots are visible on the surface of feces, it can be concluded that diseases of the lower part of the large intestine are present. In the case when blood mixes with the stool, forming streaks, the lesion is in the upper sections. Liquid, offensive, with a characteristic shine, stool, most likely, speaks of damage to the small intestine.

Another characteristic symptom is profuse vomiting. Against the background of intestinal bleeding, profuse vomiting is a profuse eruption of the contents of the gastrointestinal tract with blood impurities.

Sometimes, due to the reaction of blood with acidic gastric juice, vomit becomes a rich brown color.

Other symptoms of intestinal bleeding

Anemia. It occurs as a result of prolonged blood loss, when the body is not able to compensate for the lost red blood cells. Anemia, without resorting to medical tests, you can be late for a weak, drowsy state, dizziness, fainting, excessive pallor, cyanosis, brittle hair and nails, tachycardia;
Various disorders of the digestive process: nausea, vomiting, diarrhea or constipation, excessive gas, bloating;
Some of those affected by intestinal bleeding experience unreasonable anxiety, fear, followed by lethargy or a feeling of euphoria.
Intestinal pain. Depending on the disease that provoked intestinal bleeding, the nature of the pain syndrome may be different. So, a duodenal ulcer is accompanied by a strong, sharp, abdominal pain, and it decreases when the bleeding opens. In cancer patients, the pain is aching, dull, and appears sporadically. In ulcerative colitis, it migrates, and in the case of dysentery, it accompanies the urge to defecate.

Portal hypertension, in addition to intestinal bleeding, is manifested by its typical symptoms:

Decrease in the patient's body weight;
The appearance of spider veins;
Severe redness of the palms (erythema).

In such patients, the history often reveals previous hepatitis or long-term alcohol intake.

Blood clotting problems associated with cirrhosis are the cause of massive, persistent intestinal bleeding.

Ulcerative colitis is accompanied by fake urges to the toilet, and the stool itself is liquid, purulent, slimy, with blood impurities. In diseases of an inflammatory nature, intestinal bleeding is observed against a background of high temperature.

Intestinal cancer is characterized by small bleeding, tarry feces, coupled with typical symptoms for this disease: sudden weight loss, impaired appetite.

It should be remembered that sometimes hemorrhage does not manifest itself in any way and is discovered by chance during a medical examination for other diseases, including those not related to the gastrointestinal tract.

Condition of victims of opened intestinal bleeding

It happens:

Satisfactory: the person is conscious, his blood pressure, hemoglobin and the number of red blood cells are at a normal level, but the pulse is quickened;
Medium: coagulability worsens, hemoglobin sharply decreases (to half of normal), blood pressure decreases, tachycardia and cold sweat appear. The skin is pale;
Severe: the face swells, hemoglobin is very low (up to 25% of the norm), the pressure is greatly reduced, the pulse is speeded up. Retardation in movement and speech is observed. This condition often leads to coma and requires urgent resuscitation measures.

How to stop at home

If the intestines are bleeding, first aid consists of measures aimed at reducing blood loss:

The patient should be provided with rest: lay him on his back and slightly raise his legs:
Do not in any way stimulate the digestive tract. Drinking and eating with intestinal bleeding should be excluded;
Narrow the vessels as much as possible: put an ice heating pad or something cold on a possible lesion.

Home first aid should not include enemas and gastric lavage.

Diagnosis of intestinal bleeding

Examination of patients with bleeding is carried out by a gastroenterologist and endoscopist. The condition of the skin is assessed, the abdomen is palpated... A digital examination of the rectum is carried out, the purpose of which is to identify polyps and hemorrhoidal cones, as well as to assess the state of the organs located next to the intestines.

To determine the severity, the patient's blood is urgently examined (clinical analysis and coagulogram), establishing the value of hemoglobin and erythrocytes and the ability of blood to coagulate.

Feces are donated for occult blood. Anamnesis is taken from the patient, blood pressure and pulsation are checked.

To determine the source of intestinal bleeding, instrumental techniques are used:

Endoscopy (in most cases, it determines the source and makes it possible to simultaneously carry out treatment (electrocoagulation of a diseased vessel or other) and
Colonoscopy (examination of the upper sections).
Additional information is obtained by X-ray examination and scintigraphy using labeled erythrocytes.

The results of instrumental diagnostics are of decisive importance in the question of what to do with gastric or intestinal hemorrhage.

Treatment

In need of emergency hospitalization, victims of intestinal bleeding with signs of hemorrhagic shock (low blood pressure, tachycardia, cold extremities, cyanosis). An endoscopy is urgently performed, the source of blood loss is fixed, and measures are taken to stop the bleeding.

What endoscopy shows

The indicators of blood movement and its cellular composition are constantly assessed... The patient is injected with blood products.

But most often, the treatment is conservative in nature and is aimed at eliminating the focus of intestinal bleeding, revitalizing the hemostasis system and replacing blood to a normal volume.

Drugs are prescribed to stop the blood.

To lower the pressure in the portal vein, medications stimulate platelet activity... Given the scale of blood loss, plasma substitutes and donor blood are administered.

Rehabilitation

Blood loss entails a change in the structure of the affected tissues, and it takes time for them to heal. The first 2-3 days, nutrients are administered intravenously to the victim and gradually transferred to a standard diet in compliance with a strict diet.

The lesions heal for at least six months, and all this time the patient's diet should be given the utmost attention. After 6 months, the patient is re-examined by a gastroenterologist.

Video: Help with gastrointestinal bleeding.

Nutrition

Diet is one of the main conditions for the recovery of patients with intestinal bleeding.

In order not to injure the intestinal walls, they are prescribed:

Slimy cereal soups;
Liquid porridge;
Puree (meat, fish, vegetable);
Kissel and jelly;
Milk;
Weak tea;
Vegetable juices.

Excluded:

Solid;
Spicy food;
All that from which there is irritation of the mucous membrane.

More than 90% of cases of intestinal bleeding can be stopped with conservative methods.

If signs of internal blood flow remain, they resort to surgical intervention, the volume of which depends on the nature of the pathology.

Etiology
Classification
Symptoms
Diagnostics
Treatment
Complications
Prophylaxis

Why is there 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 account for up to 35% of all bleeding from the gastrointestinal tract. Risk factors for the development of peptic ulcer diseases are frequent stress, drinking and smoking.

Important information: How to stop bleeding in a cut (bleeding wounds) and first aid for injuries and bleeding

In children, the most common causes of bleeding are volvulus (for infants) and intestinal polyposis (for preschoolers).

Some causes of intestinal bleeding (for example, hemorrhoids, anal fissures or polyps) provoke only scant spotting or small amounts of blood in the stool. With ulcers, vascular pathologies, tumors and ruptures of the walls of the gastrointestinal tract, blood flows abundantly, mixing with secretions (vomiting, feces) in an altered or unchanged form.

Diagnostic methods

With regard to the differential diagnosis of gastrointestinal bleeding, it offers a complete examination, which begins with anamnesis, assessment of feces and vomit, performing rectal digital examination. The color of the skin must be taken into account. The abdominal area is gently palpated in order to avoid strengthening the GIQ. It is necessary to review the coagulogram, determine the level of urea and creatine, kidney test.

X-ray methods are useful:

irrigoscopy;
celiacography;
X-ray and angiography.

The most effective and accurate diagnostic method is endoscopy (EGD, gastroscopy and colonoscopy, as well as esophagoscopy). These analyzes will help to establish the presence of a superficial defect on the mucous membrane, as well as the source of the fatty tissue.

Classification

Bleeding from the digestive tract is divided into groups depending on the etiology, source of hemorrhage and severity. According to the etiology of bleeding, they are divided:

on caused by diseases of the gastrointestinal tract (ulcerative and non-ulcer genesis);
on provoked by impaired blood circulation in the portal vein (portal hypertension);
for bleeding in vascular diseases;
on the hematopoietic system caused by pathologies, incl. hemorrhagic diathesis.

In accordance with the classification of bleeding by localization, the following types of this disorder are distinguished:

bleeding from the upper digestive tract (stomach, esophagus, duodenum 12);
bleeding from the lower digestive organs (small and large intestine, rectum, hemorrhoids).

Discharge of blood from the upper gastrointestinal tract develops most often. Esophageal, duodenal and gastric bleeding is diagnosed in 8-9 out of 10 patients with bleeding in the digestive tract.

Classification of bleeding by severity

The severity of the pathology	Decreased circulating blood volume	External manifestations	Systolic blood pressure and pulse rate	Blood indicators
Easy	Less than 20%	The patient's condition is satisfactory: the patient has normal urine output (diuresis), slight weakness and dizziness are possible. The patient is awake.	BP - 110 mm Hg. Heart rate - no more than 80 bpm	The concentration of erythrocytes is above 3.5 * 1012, the level of hemoglobin is more than 100 g / l, the hematocrit is at least 30%.
Average	20-30%	The patient's skin turns pale, there is severe sweating (cold sweat), urine output is moderately reduced. The patient is conscious.	BP - 100-110 mm Hg Heart rate - 80-100 bpm	The concentration of erythrocytes is above 2.5 * 1012, the hemoglobin level is 80-100 g / l, the hematocrit is 25-30%.
Heavy	Over 30%	The patient's condition is serious: he has a breakdown, dizziness, severe muscle weakness, pronounced pallor of the skin, sweating, a decrease in the volume of urine excreted (until complete anuria). The patient's reactions are inhibited, loss of consciousness may occur.	BP is below 100 mm Hg. Heart rate - more than 100 bpm	The concentration of erythrocytes is below 2.5 * 1012, the hemoglobin level is less than 80 g / l, the hematocrit is less than 25%.

Some experts also identify the fourth, most severe stage of bleeding. It is characterized by complete loss of consciousness in the patient and the development of a coma.

Massive internal bleeding accompanied by severe blood loss is called profuse.

Additionally, bleeding in the gastrointestinal tract can be classified according to the following criteria:

duration of bleeding (acute or chronic bleeding);
the presence of external manifestations of pathology (latent or explicit);
the frequency and number of cases of blood loss (single or repeated, recurrent).

Intestinal bleeding treatment

After the patient is transported to the hospital, procedures are started. If the loss of biological fluid is significant, then drip administration of plasma or blood is prescribed.

Transfusion volumes:

Plasma: 50-10 ml, rarely 400 ml.
Blood: 90-150 ml.
If the bleeding is profuse: 300-1000 ml.

In addition to drip transfusion, intramuscular injection of blood protein is used, an indication for such procedures is arterial hypertension. With a high level of blood pressure, blood transfusion in a drip manner is impractical.

the patient needs complete rest;
compliance with bed rest.

The patient should be in bed, not experiencing any emotional or physical stress that could worsen his condition.

The introduction of homeostatic drugs that can stop or slow down the loss of biological fluid is also practiced:

Atropine sulfate.
Benzohexonium solution.
Rutin, Vikasol.

A solution of Benzohexonium is administered only if the level of blood pressure is not lowered, it helps to reduce intestinal motility, reduce vascular tone, and stop blood loss.

Along with medicines, a person is allowed to swallow a hemostatic sponge, crushed into pieces.

If blood pressure has dropped sharply, drugs are used to increase its level: Caffeine, Cordiamine. If the pressure is below 50 mm, then the blood transfusion is stopped until the pressure level has stabilized.

What are the signs and symptoms

Early symptoms of gastrointestinal bleeding include:

general weakness, weakness;
dizziness, fainting, confusion, and loss of consciousness;
tinnitus, flickering of flies in the eyes;
nausea, vomiting;
discoloration of gastric and intestinal secretions (vomiting and feces);
sweating;
intense thirst;
increased heart rate;
pallor of the skin, cyanosis of the lips, blue discoloration and decreased temperature of the fingertips.

The severity of the symptoms of pathology depends on the intensity of bleeding, BCC and the amount of blood lost. Due to the larger initial volume of circulating blood, bleeding symptoms in adults can manifest later and less brightly than in children. Even minor blood loss in a young child may require immediate resuscitation.

Symptoms of internal bleeding in the stomach often occur simultaneously with signs of massive blood loss and a decrease in circulating blood volume. Against the background of manifestations of blood loss, there may be pain in the affected gastrointestinal tract, an increase in abdominal volume due to the accumulation of fluid (ascites), fever caused by intoxication, weight loss, a sharp change or loss of taste and other pathological phenomena indicating the cause of the GCC.

The main symptom of gastric bleeding is bloody vomiting, the nature of which may indicate the cause of the pathology and the duration of the bleeding.

Vomiting with various pathologies of the upper gastrointestinal tract, which lead to blood loss:

"Coffee grounds" is a product of the treatment of blood from the stomach with hydrochloric acid.

With ulcerative lesions during vomiting, stomach pains decrease. Bleeding is not accompanied by irritation of the peritoneum and muscle tension in the anterior abdominal wall. With massive blood loss and stomach cancer, the color of the stool also changes.

Repeated vomiting with blood 1-2 hours after the first episode indicates the continuation of bleeding, and vomiting after 4-6 hours indicates its relapse.

With gastric bleeding, the symptoms of blood loss in most cases are more pronounced than with bleeding in the intestine. This is due to the fact that frequent causes of damage to the walls of the small, colon and rectum are hemorrhoidal trauma, polyposis and small cracks in the mucous membrane. They can provoke prolonged, but insignificant blood loss, which is accompanied by a slight decrease in the concentration of hemoglobin and the development of compensatory tachycardia while maintaining normal blood pressure and the patient's well-being.

Symptoms of intestinal bleeding accompanied by massive blood loss may include:

black feces;
discharge of melena (loose tarry stools with a strong unpleasant odor);
weakness, loss of consciousness, pallor of the skin and other manifestations of acute blood loss.

Visual changes in the color and structure of feces are visible only with blood loss of more than 100 ml / day and damage to the rectum and colon (cracks, polyps, bleeding hemorrhoids). With a single outflow of blood (with stomach ulcers and pathologies of the lower digestive tract), blood is excreted in the stool unchanged. With prolonged massive bleeding, a tarry stool (dark feces with small clots) is released a few hours after its onset.

The nature of stool changes in various intestinal pathologies:

In the chronic course of the pathology, symptoms of anemia may occur:

weakness, fatigue;
decreased performance;
frequent dizziness;
inflammation of the mouth and tongue;
pallor of the mucous membranes and skin.

Types of internal bleeding of the digestive system

Intragastric bleeding may occur once and no longer disturb the person, or repeat from time to time. In the second case, we can talk about a recurrent condition. In this case, the patient needs a thorough examination, which will help to identify the whole complex of reasons that each time lead to blood loss.

Acute develops suddenly and rapidly, leading to the loss of large volumes of blood and a sharp deterioration in the general condition. The person needs urgent medical attention as there is a risk of losing a large volume of blood. Signs include vomiting of scarlet blood, confusion, low blood pressure (the top reading is below 100), and loss of consciousness.

Chronic symptoms can last for days or even weeks. For the patient, it often goes unnoticed, but iron deficiency anemia develops over time. Do not hope that after a while this state will pass by itself: examination and medical care are necessary to stabilize the condition.

Depending on the amount of blood loss, it can be:

Light - practically does not appear. A person may notice a small amount of blood in feces or vomit. Small vessels are usually affected and blood loss is negligible.
Secondary mild dizziness and a slight decrease in blood pressure.
Severe, in which a person can lose consciousness, not react to the environment.

A patient with intestinal bleeding should be provided with rest and medical advice. The more severe the condition, the faster the help of doctors is needed. If the state of health is satisfactory, it is still necessary to consult a therapist or gastroenterologist.

Diagnostics

Elucidation of the cause of gastrointestinal bleeding syndrome requires a thorough clinical examination, laboratory tests, and the use of hardware and instrumental diagnostic methods.

Clinical examination

With the initial diagnosis of internal bleeding in the stomach or intestines, a clinical examination of the patient is carried out, during which the following data are analyzed:

patient history;
list of medications taken;
the color and consistency of the discharge;
skin color (pallor, yellowness);
the presence of vascular "asterisks", 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 examination are performed with caution. Inaccurate procedure can significantly increase blood loss.

Laboratory research

Laboratory tests that are performed for bleeding in the stomach, esophagus and lower gastrointestinal tract include:

general blood analysis;
blood biochemistry (liver and kidney tests, markers of inflammatory processes, etc.);
coagulogram;
coprogram;
analysis of antibodies to double-stranded DNA, etc.

Instrumental methods

The most informative hardware diagnostic methods that are used when intragastric and intraintestinal hemorrhage is suspected are:

X-ray examination of the esophagus and stomach;
celiacography;
MR-angiography of the gastrointestinal tract vessels;
static and dynamic scintigraphy of the digestive tract;
CT scan of the abdominal organs;
X-ray of the nasopharynx, bronchi and lungs.

Most quickly, bleeding in the stomach can be diagnosed using endoscopy of the upper gastrointestinal tract. For pathologies of the lower parts of the tract, irrigoscopy, sigmoidoscopy and colonoscopy are used.

If it is impossible to establish the source of hemorrhage using endoscopy and hardware methods, diagnostic laparotomy is performed.

The factors for the development of the disease are multiple. It is necessary to identify the provocateur as quickly as possible. Even if it is possible to completely eliminate the pathological process, no one can guarantee that a relapse will not happen. It will most likely be so.

Among the main factors:

Stomach ulcer

According to studies prior to 2010, this point was considered a key point in etiology. As it turned out later, not everything is so simple. The risks are really growing, which is quite obvious.

The reason for gastric bleeding is as follows: the normal integrity of the mucous membrane is disrupted, the tissues of the organ are richly supplied with blood, therefore any destructive, structural changes with a high probability will lead to a violation of the state of the local vascular (vascular) network.

However, despite the possibility of high-quality treatment and breakthroughs in medicine, the statistics on gastric bleeding do not change. Doctors assume that there is a group of disorders. Among which the ulcer plays an important role, but this is not the only and not the exclusive cause of hemorrhage in the stomach.

Cancer violations

Tumors. Often we are talking about completely benign structures. These are the so-called polyps. In fact, their good quality in a broad sense is rather arbitrary.

They grow quite deep into the tissue, eventually causing disruption of the local circulatory network. Also, do not forget about the possibility of cancerous transformation.

Malignant tumors cause bleeding in the gastrointestinal tract almost from the first stages. But critically acute conditions are observed closer to the final phase of the disease. When active disintegration and infiltrative germination begins through all the walls and layers of the stomach.

Digestive tract injuries

Observed as a result of the influence of a mechanical factor. Mostly. We are talking about the consumption of inedible objects, sharp objects with perforation of the wall of a hollow organ, also about impact, the effect of direct kinetic force. For example, during an accident, fighting, when falling from a great height.

Against the background of this disorder, direct ruptures of the stomach are possible, which leads to the outflow of blood into the cavity of the organ or into the peritoneum.

Invasive interventions

Including diagnostic ones. There is an iatrogenic effect. In this case, the doctors are to blame. Medical procedures can provoke problems of this kind, even if they are performed correctly and technically correctly.

The question lies in the individual characteristics of the human body. Medical errors cannot be ruled out, this also occurs.

Liver pathology

Hepatitis, cirrhosis, tumor processes. Mainly in sub- and decompensation. In this organ, a number of coagulation factors are produced. Without normal functional activity, there is no way to ensure adequate coagulation. Therefore, violations begin. The more significant the problem, the more dangerous the pathological processes themselves.

Disorders from the hematopoietic system itself

From hemophilia to others. The entire list of diagnoses located in the classifier in the appropriate section, one way or another, can provoke gastric bleeding.

Hypocoagulation

The generalized name of the processes during which there is a decrease in coagulation. Usually this is not an independent diagnosis, but just a syndrome, a clinical finding. Read more about the causes of poor blood clotting in this article.

These are the main causes of intragastric bleeding. There are others. The list is incomplete.

How to stop bleeding

Stopping bleeding should be carried out by doctors of a medical institution or emergency medical team. Even before providing emergency care, it is necessary to call an ambulance, outlining the patient's condition and the nature of the discharge.

The algorithm for providing emergency first aid if bleeding is suspected includes the following actions:

lay the patient on his back, raising his legs with rolled clothes or a pillow;
do not give the victim to drink and eat;
put a compress of ice wrapped in a cloth on the painful area;
during the provision of first aid, monitor the nature of breathing and heart rate;
in case of loss of consciousness, bring the patient to life with a cotton swab dipped in ammonia;
when waiting for an ambulance for a long time, carry the patient on a stretcher towards the medical team.

During the provision of emergency care for gastric bleeding, it is forbidden to wash the stomach. If an intestinal pathology is suspected, an enema should not be given to the patient.

An attempt to stop the blood without the help of doctors can lead to the death of the patient.

Emergency Stomach Bleeding

What is the emergency treatment for stomach bleeding? All necessary actions are listed below:

Providing bed rest, which helps to reduce the rate of bleeding.
Setting up a cold compress (the algorithm will be discussed below).
Washing the stomach with ice water, the essence lies in the spasm of the bleeding vessels and the subsequent stop or slowdown of the blood flow.
Prescribing epinephrine or norepinephrine medications via a gastric tube. This group of hormones refers to stress factors that cause compensatory narrowing of the vascular lumen.
Replenishment of reserves of the total volume of circulating blood (BCC) by introducing hemostatic solutions intravenously.
Use as a replacement for lost donor blood, blood substitutes and frozen plasma.

Other therapy is carried out when indicated.

How to treat

With gastrointestinal bleeding, treatment is aimed at stopping it, eliminating the root cause of the pathology, restoring hemostasis of the body and normal blood volume.

The danger for the patient is not only the loss of erythrocytes that carry oxygen, but also a sharp decrease in the BCC, which leads to massive thrombosis of small vessels and the development of disseminated intravascular coagulation.

Conservative treatment

Conservative treatment of gastric bleeding and intestinal blood loss is performed as an adjunct to surgery. As the main method of therapy, it is used for the following indications:

hemorrhagic syndromes;
cardiovascular diseases;
inoperable malignant tumors;
congenital pathologies of the hematopoietic system.

In therapy, hemostatic agents, cytostatics, anti-inflammatory and other drugs can be used.

If a large volume of blood is lost, the patient is prescribed droppers with saline solutions and transfusions of blood components.

Surgery

If there is a suspicion of bleeding in the gastrointestinal tract, the patient is taken to the surgical department of clinics, where diagnostics and determination of therapy tactics take place.

Depending on the diagnosis, the patient can undergo the following operations:

endoscopic sclerosis, electrocoagulation and ligation of dilated vessels of the intestine, esophagus, etc.;
suturing of the ulcer and partial resection of the stomach;
suturing duodenal ulcer;
subtotal large intestine resection with stoma.

Diet

The tactics of treatment with diet therapy depends on the underlying disease. With pathologies of the stomach, the patient is assigned a table No. 1, No. 1a (immediately after stopping the bleeding), No. 1b or No. 2. For bowel 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 number 5 and its variations.

Prophylaxis

Specific preventive measures for such a disorder have not been developed; in order to avoid problems with hemorrhages in the gastrointestinal tract, it is necessary:

timely treat diseases that can lead to the appearance of such a complication;
undergo regular examination of an adult and a child by a gastroenterologist.

How to prevent the phenomenon

To prevent the development of this dangerous pathology, it is necessary to undergo regular medical examinations, follow the rules for taking medications and lead a healthy lifestyle.

Contacting a gastroenterologist at the first manifestations of ulcerative and vascular diseases (malaise, nausea, pain in the stomach, etc.) increases the likelihood of a favorable prognosis for the effectiveness of therapy.

To track intestinal bleeding in the early stages, it is recommended to regularly take a fecal occult blood test.

Cold compress

A relationship of trust must be established with the patient. He needs to understand the purpose and course of the cold compress. The algorithm of actions performed with his consent is as follows:

Recovery period: lifestyle and diet

After undergoing a course of drug treatment, the specialist strongly recommends that the patient change his lifestyle and diet. You should exclude intense physical activity for at least 4 weeks, avoid hypothermia, stress, do not go to saunas and baths, and ensure yourself a full night's sleep.

It is worth excluding from the diet:

fat meat,
salted and smoked fish,
canned vegetables, fruits, marinades,
seasonings,
alcohol,
strong coffee,
soda,
fast food,
confectionery, baked goods.

The portions should be small, the food is low-fat, pureed, and the meals should be at least 5 times a day at regular intervals. After 4-6 weeks of adherence to the diet, it is allowed to make it less strict, but only after consulting a doctor.

The patient's menu must include the following products:

scrambled eggs;
biscuit biscuits, crackers;
weak black tea;
cereals;
a small amount of potatoes;
steamed poultry, fish;
mashed soups;
a little butter, dairy products.

If the patient has undergone surgery to suture the stomach, the first day after the manipulation, he does not use anything. On the second day and over the next week, chicken breast broth without skin, as well as dried fruit compote, are poured into his nasal probe. The daily rate is 1 liter of each of these liquids. On the 7-10th day, they are allowed to start gradually taking food: mashed potatoes without butter, soft-boiled egg, grated soup without frying.

The patient's lifestyle after surgery plays an important role. The first 10 days, it is strictly forbidden to get up, after the specialist removes one or all of the tubes, the patient is allowed to get up for a short time. The recovery period lasts at least 6 weeks. Recommendations are similar to those given to patients after undergoing conservative treatment.

Indications for surgical treatment

Acute gastric bleeding is an indication for surgery when:

lack of positive results from previously conducted conservative and endoscopic measures;
unstable condition of the patient or severe, which may be complicated in the near future (for example, ischemic disease or stroke);
repeated bleeding.

First aid

With severe and prolonged bleeding, the patient may experience blue lips. Often, the patient has a feeling of lack of air. Vision may be severely impaired. The human condition is deteriorating sharply. Such symptoms clearly indicate acute gastric bleeding. An "emergency" must be called immediately. Any delay in time is fraught with serious consequences. Statistics show that more than 17% of patients die from gastric blood loss.

What to do before the arrival of the medical team? First aid for gastric bleeding is to provide the patient with complete rest. It is recommended to lay the patient horizontally. It is strictly forbidden to give him food or water. If possible, put cold on the stomach, in the upper region. It can be a bubble or an ice bag. Doing enemas, rinsing the stomach is impossible in any case!

It is necessary to closely monitor the general condition of the patient. If he loses consciousness, be sure to revive him. For such purposes, use a cotton swab dipped in ammonia.

A. Emergency colonoscopy

B. Emergency sigmoidoscopy

B. Irrigoscopy

D. Plain fluoroscopy of the abdominal organs

E. Control of passage through the gastrointestinal tract of barium administered per os

Features of the course in adults and children

Symptoms of the disease in an adult and a child are almost the same. But in the former, the disease often develops gradually, they do not pay attention to the first signs, therefore complications often develop. In children, GCC is always acute, but due to the rapid restoration of blood vessels and gastric mucosa, symptoms may appear for a short time and disappear. The kid becomes active again, plays and asks for food. You should not postpone the visit to the doctor, even if there were no repeated manifestations during the day.

Rehabilitation

The lesions heal for at least six months, and all this time the patient's diet should be given the utmost attention. After 6 months, the patient is re-examined by a gastroenterologist.

Rehabilitation measures after surgery

Day one - you can move your arms and legs.
Day two - the beginning of the introduction of breathing exercises.
Day three - you can try to get back on your feet.
Day eight - postoperative stitches are removed.
Day fourteen - discharge from the department with recommendations to limit physical activity for a month and the need to perform a set of physiotherapy exercises.

The need for surgical intervention

Surgical treatment of patients can be divided into 2 ways - active and expectant tactics. In the first case, doctors perform surgery at the level of hemorrhage.

Expectant treatment tactics include stopping the flow of blood using conservative means. Then the surgeons perform a planned operation.

Surgical treatment is carried out in the diagnosis of profuse bleeding, ulcers in the projection of the great vessels, with an unfavorable endoscopic examination.

The preparation of the patient takes about 2 hours and depends on the intensity of the hemorrhage. To stop gastroduodenal bleeding, the use of endotracheal anesthesia is appropriate.

If the patient does not have an ulcer or other pathological lesions of the walls of the stomach, then a longitudinal gastrotomy can be performed.

All bleeding vessels are sutured, ligated and diathermocoagulated.

The duration of the operation depends on the patient's condition and possible complications. If patients are in a difficult situation, then palliative surgery is urgently needed.

Doctors carefully suture the bleeding vessels and perform a wedge-shaped excision of the ulcer. Stitching of the stomach walls and placement of the serous-muscular ganglion may be required.

Possible complications

The main complications are:

the appearance of hemorrhagic shock from blood loss;
the development of acute iron deficiency anemia;
acute hepatic and renal failure.

A life-threatening situation is the development of multiple organ failure, when the function of several vital organs and systems suffers. In such a situation, patients need resuscitation measures to save life. Any attempts at self-treatment or lack of timely hospitalization often lead to the death of the patient.