Gastric bleeding

Bleeding from the stomach or intestines is one of the main reasons for emergency hospitalization of patients, they are found predominantly in adults with a frequency of 170 cases per 100 thousand people. These are the most dangerous consequences of quite a number of diseases, which seriously threaten not only health but also patients' lives. Not without reason with profuse( abundant, literally flowing) bleeding, when in a short time a large number of blood vessels of the organ are damaged, the account goes for minutes, during which it is necessary to stop the blood loss immediately. It should also be noted that mortality( the frequency of death outcomes) in such situations can reach, unfortunately, 25 percent.

Stomach is a hollow organ. Its mucous membrane lining the stomach from the inside, most often all other structures are affected by various pathological processes. First of all, it is destroyed under the influence of certain food products or beverages, as well as many chemicals, which include drugs. The larger the area and depth of destruction of the walls of the stomach, the more the vessels are injured and the more pronounced the hemorrhage into the cavity of the organ. In some cases, blood can be removed together with gastric contents during vomiting, in others - further pass through the gastrointestinal tract( GIT) and change the characteristics of stool.

According to clinical signs it can be difficult to determine exactly whether intestinal or gastric bleeding has occurred. However, each person should represent what signs are accompanied by such a dangerous situation, in order to be able to help the patient. It is also important to know what pathologies and provoking factors can cause gastric bleeding, which directly threatens life, so as not to allow their impact on their bodies.

Stomach ulcer very often begins to bleed

Types

The stomach is perfectly blood supply, all its structures are permeated with a capillary network. The venous system of the organ is also developed, which, for example, forms a pronounced venous plexus at the site of the esophagus into the stomach. And capillaries, and veins, and even small arteries can be traumatized or destroyed by various pathological processes, as a result of which the flow of blood into the stomach cavity begins.

It can occur quickly or slowly, with the loss of a small or significant amount of blood. Also, bleeding in the stomach may be accompanied by other prominent signs of the pathology or leak almost unnoticeably.

Based on the various characteristics of this process, the following classification of gastric bleeding is created:

• acute( requiring emergency medical care) or chronic( occurring over a long time);
• obvious( having a characteristic clinical picture) or hidden, that is, proceeding practically without changing the patient's condition;
• is mild, moderate, severe( each degree of severity is characterized by certain clinical and laboratory indicators);
• ulcerative( complicating peptic ulcer disease) or non-ulcer, which are formed against the background of other diseases.

Determination of the type of hemorrhage occurs when a patient seeks medical help and is reflected in the formulation of the diagnosis. This is extremely important for the development of therapeutic tactics, as well as for further prognosis.

The main causes of

In recent years, despite the development of medicine, the frequency of gastric bleeding does not decrease. At the same time, the occurrence of the main provoking factor, namely, ulcerative lesion, decreased somewhat, but other reasons related to the lifestyle and occupations of patients, the presence of various background diseases and the need to regularly take certain groups of medicines begin to play an increasing role.

Non-steroidal anti-inflammatory drugs negatively affect the mucosa of the digestive tract

All causes of gastric bleeding are very diverse and numerous, but they can be grouped into the following groups:

• formation of ulcerative lesions of the mucous membrane and deeper layers of the stomach caused by various factors( "aggression" of hydrochloric acid of gastric juice, rupture or thrombosis of blood vessels, the impact of acute or chronic stress, the influence of drugs, especially non-steroidal anti-inflammatory drugs);
• malignant neoplasms and benign( gastric cancer with tumor disintegration, polyposis accompanied by trauma or ischemia of polyps);
• diverticulosis of the stomach, that is, the presence of "outgrowths" on the wall of the stomach in its lumen( bleeding is possible with injuries or inflammation of diverticula);
• Mellory-Weiss syndrome, characterized by rupture of the blood vessels of the mucous membrane of the upper part of the stomach and esophagus, which leads to severe bleeding. This phenomenon is provoked by a sharp increase in intra-abdominal pressure, for example, during vomiting, severe coughing, when struck in the stomach;
• diaphragmatic hernia, that is, protrusion of the upper stomach into the thoracic cavity through an inconsistent diaphragm( damage to the blood vessels and further bleeding occurs as a result of the action of gastric juice on the lower part of the esophagus or ulcer formation);
• vascular pathologies( varicose veins, systemic vasculitis, hypertension, atherosclerosis);
• blood pathology, affecting, above all, the indices of its coagulability( leukemia, hemophilia, thrombocytopenia, hemorrhagic diathesis).

It should be noted that the pathologies of blood vessels or blood often become the consequences of very many diseases. For example, varicose disease of the esophagus, often leading to bleeding, can form with liver pathologies( tumors, cirrhosis), with thrombosis or compression of the portal vein. Often, hemorrhage begins with cardiovascular and endocrine diseases, sepsis, chronic renal failure. Reduction of blood clotting can be hereditary or acquired, which leads to bleeding in the stomach even in childhood.

Drop in blood pressure may indicate significant blood loss

Symptoms of

Symptoms of gastric bleeding depend on how quickly there is blood loss and what is the area of ​​the mucosal lesion. Of course, the more blood is poured out from the common vascular bed into the cavity of the stomach or intestine for a certain period of time, the more intense the manifestations of pathology. Therefore, gastrointestinal bleeding in the clinical picture is divided into acute and chronic.

Acute hemorrhage is most dangerous, since the body loses an impressive amount of blood in a short time. This is especially true for deep and extensive stomach ulcers, as well as for the decay of the tumor. As a result of a sharp decrease in blood volume, the patient develops hemorrhagic shock with internal hemorrhage, which is manifested by the following symptoms:

• weakness and lethargy are quickly replaced by inhibition, confusion and loss of consciousness;
• skin and mucous membranes abruptly turn pale, acquiring a cyanotic( cyanotic) hue;
• rapidly drops blood pressure;
• pulse becomes frequent and weak, characterized as "filiform".

These symptoms of internal bleeding appear and build up very quickly, literally in a matter of minutes. It is very important that in such a short period of time a person is given urgent medical assistance.

In addition to these manifestations of acute internal blood loss, other symptoms are added. Quickly accumulating blood in the stomach does not have time to be oxidized with digestive juice, so the vomit will contain scarlet, practically unchanged blood. Vomiting often occurs profusely, that is, a "fountain".The cavity of the stomach, freed from blood, fails to quickly fill it up again, which leads to a fatal outcome due to significant blood loss incompatible with life.

In cases where blood loss is not so rapid, hemoglobin begins to be exposed to hydrochloric acid. The color of the blood masses from red becomes brown, and vomiting occurs in the so-called "coffee grounds".For a doctor, this is a sign of gastric bleeding of moderate severity and a more positive further prediction, since it means that there is still time to save a person.

The more the pulse with bleeding in the stomach, the greater the loss of blood

With moderate bleeding, part of the blood penetrates into the duodenum and then into the digestive tract. Under the influence of a complex of enzymes, hemoglobin decomposes, and the fecal masses become more liquid and black. This chair is called "melena" and serves as a diagnostic criterion of blood loss throughout the gastrointestinal tract, not only in the stomach( except for the terminal parts of the large intestine).If fresh blood is found in the feces, then it becomes evidence of a pathological focus in the sigmoid or rectum, as well as a sign of exacerbation of hemorrhoids.

Many diseases can be characterized by chronic loss of blood in the stomach, occurring in small volumes. In such cases, the deficit of blood volume is quickly compensated by the body, but patients still note the presence of weakness, dizziness, increased sleepiness, loss of efficiency. Skin pale;Vomiting is not typical, but the feces become a "melena" type. If blood loss is negligible, the stool does not visually change, and the detection of hemoglobin in it is carried out by means of Gregersen's reaction( analysis of feces for latent blood).

Degrees of severity are characterized by certain clinical parameters:

• mild severity: the patient is in clear consciousness, may complain of dizziness and weakness, pulse 70-80 beats per minute, blood pressure not lower than 110 mm Hg. Art.
• moderate severity: severe weakness and dizziness, cold sweat, pale skin, pulse 90-100, pressure 90-100 mm Hg. Art.
• severe condition: confusion or loss of consciousness, sharp pallor with cyanosis of the skin and mucous membranes, pulse more often 100, pressure below 90.

Finding an adult patient or child in a satisfactory condition, with confirmed blood loss, also requires a very careful attitude. Easy blood loss can very quickly become severe, which will worsen the further prognosis.

In severe cases, patients are urgently hospitalized

Diagnostic features of

When a patient enters a hospital, if he is conscious, the doctor clarifies complaints, the presence of provoking factors, examines the patient. According to clinical data, gastric or intestinal bleeding can be suspected, but its exact source can only be determined by further examination. For this, gastroscopy is performed with the help of endoscopic equipment, during which a varicose esophagus, ulcers in the stomach, polyps or diverticula, mucosal ruptures can be detected.

The clinical and biochemical blood test, the determination of coagulability and the number of platelets are mandatory, the feces are analyzed for the Gregersen reaction. If necessary, ultrasound of the abdominal cavity, diaphragm, chest, x-ray of the stomach, angiography, radioisotope scanning, MRI.

The information obtained during the survey helps to make a differential diagnosis of bleeding in the stomach, that is, to eliminate intestinal or pulmonary foci of blood loss. In addition, it is necessary to pinpoint the pathologies leading to loss of blood.

Treatment methods

The therapeutic approach is always carried out individually and depends on the volume of blood loss and the severity of the patient's condition. If the bleeding is chronic or mild, then after the diagnostic activities in most cases, outpatient conservative treatment is appointed, under the supervision of a therapist or gastroenterologist. It will include the following directions:

• strict bed rest;
• "cold" on the abdominal area( these first two measures are also ways to provide first aid for suspected bleeding in the gastrointestinal tract);
• gastric lavage by means of instruments( at home it is practically not performed, only in a hospital);
• haemostatic drugs( help stop bleeding);
• correction of posthemorrhagic anemia( iron-containing agents).

If blood loss is significant, but surgical intervention is not required, these items are supplemented by transfusion of blood or blood substitutes performed in a hospital. Simultaneously, the therapy of background pathologies, which became the cause of blood loss, is conducted.

If necessary, bleeding in the stomach is stopped by surgical methods.

Treatment of gastric bleeding in an operative way is necessary in cases where conservative methods are not effective. Methods of surgical interventions are very different and depend on the size and depth of the pathological focus, on the rate of blood flow into the stomach cavity. With moderate blood loss, endoscopic methods( coagulation, needle threading, glue application) are often very effective. Cavity operations of modern surgery are carried out in severe cases and represent a suturing of the stomach wall, resection of part of the organ, organ plastic surgery on blood vessels or nerve trunks.

After surgery, a recovery period follows, the duration of which depends on the diagnosis and mode of operation. The patient is given special nutrition( two-day fasting is gradually replaced by a normal diet), respiratory gymnastics, exercise therapy, supporting courses of medicines.

The prognosis is extremely serious with acute gastric bleeding. Light and moderate chronic blood loss, with adequate therapy of the underlying diseases, in most cases end up favorably.