From this article you will learn about the causes, manifestations, methods of detection and therapy of a terrible complication of various pathological conditions of the gastrointestinal tract - bleeding. Depending on the location, there is bleeding gastric, intestinal, esophagic.
Contents of the article:
- Types of gastric bleeding
- Causes of occurrence
- Characteristic symptoms
- Diagnostic methods
- Treatment
- First aid
- Complications
- Forecast
Gastric bleeding is the expiration in the lumen of the stomach of blood. The exact source of bloody discharge can only be established by applying special methods of investigation, therefore the term "gastrointestinal bleeding" is used.
The gastrointestinal tract is conditionally divided into two sections: upper and lower. The upper include: the esophagus, stomach, duodenum.
This article is devoted to bleeding in the stomach, as here occurs 80-90% of all bloody secretions of the digestive system. About half of them are gastric.
Bleeding begins due to the destruction of the surface of the mucous membrane of the organ, or rupture, or the arrosion( corrosive tissue) of the vessel wall. Sometimes the cause of bleeding can be eliminated completely, sometimes - only to maintain a satisfactory state of the patient.
To which doctor to contact:
- Acute profuse bleeding requires emergency hospitalization and treatment in a surgical hospital. Also, the surgeon is treated with spotting from the rectum.
- Symptoms of digestive system diseases are treated by a therapist or gastroenterologist.
- The presence of bleeding, bruising, petechia( spots on the skin caused by a capillary hemorrhage) is an occasion to consult a hematologist( blood specialist).
- The emergence of common oncological signs - extreme exhaustion, pain, changes in appetite - requires examination from an oncologist.
Any internal bleeding is dangerous. Lack of or delayed treatment can lead to death.
Types of gastric bleeding
| Symptom classification | Types |
|---|---|
| bleeding Due to the emergence | Ulcerative( the most common) |
| ulcerative | |
| By the nature of bleeding | Acute |
| Chronic | |
| According to clinical manifestations | Explicit |
| Hidden | |
| Adrift and duration | Single |
| Recurrent |
Causes, resulting in bleeding of the stomach
Possible processes and pathologies leading to the destruction of the walls of blood vessels, more than 100.
Basicss 4 groups:
1. Diseases of the gastrointestinal tract
- stomach ulcer and duodenal ulcer;
- diverticula and diverticulitis;
- Malignant neoplasm of stomach;
- benign polyps;
- chronic esophagitis;
- gastroesophageal reflux;
- erosive gastritis;
- course receiving medication( salicylates, glucocorticosteroids, non-steroidal anti-inflammatory drugs);
- psychoemotional stress;
- Zollinger-Ellison syndrome( hormone-active pancreatic tumor);
- postoperative;
- diaphragmatic hernia;
- Mallory-Weiss syndrome( mucosal rupture with repeated vomiting).
2. Hemorrhages due to portal hypertension
- Chronic hepatitis;
- cirrhosis;
- occlusion of portal or hepatic veins;
- decrease in the cross-section of veins due to the action of tumors, scars.
3. Damage to blood vessels
- Varicose disease of the esophagus, upper third of the stomach;
- hemorrhagic vasculitis;
- atherosclerosis;
- autoimmune diseases( systemic lupus erythematosus);
- scleroderma;
- cardiovascular pathology.
4. Pathology of blood and hematopoiesis
- Aplastic anemia;
- hemophilia;
- thrombocytopenia;
- leukemia;
- hemorrhagic diathesis.
Click on the picture to enlarge Often there is a combination of two or more factors.
Symptoms of gastric bleeding
The type of symptoms that occur when there is open blood flow in the stomach and the power of their manifestation are determined by the size of the open wound and the duration of the process.
Common symptoms of gastric bleeding are associated with decreased blood supply to organs. Nonspecific signs, characteristic of internal hemorrhage in any body cavity:
- weakness, sluggish response to what is happening, until fainting with massive bleeding;
- pallor of the skin, cyanosis( blueing) of the fingers, nose, nasolabial triangle;
- excessive sweating - hyperhidrosis;
- dizziness, unsteadiness of gait;
- flickering "flies", tinnitus.
The pulse rate increases, the filling and tension fall, the tonometer captures the pressure drop.
Vomiting with blood, as well as changes in stool, the most characteristic external manifestations of the described traumatized state of the circulatory system of the gastrointestinal tract.
Vomiting more often with coagulated blood - "coffee grounds", because it acts hydrochloric acid of the stomach. The appearance of scarlet blood can indicate either bleeding from the esophagus, or profuse( abundant) gastric.
The patient's chair becomes black or very dark in color - melena, due to coagulated and partially digested blood.
In addition to these symptoms, there are manifestations of the disease or condition that led to the occurrence of blood loss.
Diagnostic methods
Examination of a patient with suspected or obvious signs of bleeding from the gastrointestinal tract begins with the collection of complaints and anamnesis data.
The administration of a preliminary diagnosis is influenced by a person's intake of medications, food, concomitant diseases.
Laboratory tests help to estimate the degree of blood loss:
- general clinical blood test - the number of shaped elements, the presence of anemia;
- biochemical blood test - evaluation of liver function, kidney function;
- occult blood feces analysis;
- coagulogram - indicators of the blood coagulation system.
The most informative are instrumental examination methods:
- PHAGS - examination of the mucosa of the upper gastrointestinal tract with the use of an endoscope;
- contrast radiography of the stomach;
- computed tomography without and with contrast;
- magnetic resonance imaging;
- angiography of vessels using contrast medium;
- radioisotope scanning - if previous research methods fail.
When examining a patient with symptoms of internal bleeding, it is necessary to exclude another pathology: myocardial infarction, ectopic pregnancy in women, nosebleeds and hemoptysis.
Treatment of bleeding from the stomach
Medical tactics, the amount of manipulation depends on the intensity of bleeding and the condition that led to it.
Minor chronic blood loss can be treated conservatively by the specialist whose competence includes the disease that is the cause of this condition.
Abundant vomiting with blood, confusion and unconsciousness require immediate calling of the "First Aid" and hospitalization of the patient.
Conservative
- A person is prescribed a strict bed rest, a cold on the epigastric region( an ice bubble).
- Apply gastric lavage with cold water followed by adrenaline injection. This contributes to vasospasm and the stopping of bleeding.
- Simultaneously, intravenous injection of haemostatic( haemostatic) agents and infusion of solutions to maintain the volume of circulating blood are started.
- Assign iron preparations to correct anemia.
- With massive blood loss, blood transfusion is used - fresh frozen plasma, erythrocyte mass.
- Perform symptomatic treatment according to indications.
Endoscopic
A favorable method of minimally invasive intervention is endoscopic manipulation. They can serve as a diagnostic procedure and, at the same time, they can provide a therapeutic effect.
- When carrying out PHAGS and detecting a bleeding ulcer, the latter is cut off with solutions of epinephrine or norepinephrine.
- Small lesions of the gastric mucosa are cauterized by laser or electrocoagulation.
- More extensive lesions are stitched with surgical threads or metal clips.
Such manipulations are easier to tolerate by patients, prevent additional loss of blood in open operations, but can be used only with minor bleeding.
Surgical
| When surgical | is used What types of interventions are most commonly used |
|---|---|
| Abundant bleeding threatens the patient's life Conservative tactics did not bring the expected effect The patient has a combined severe pathology Relapse after the newly performed treatment | Restoration of mucosal integrity by suturing or clipping Resection of the stomach or whole organ of the Endovascular embolization of the vessel( occlusion of the lumen by the embolus) Agodomy - the intersection of branches of the vagus nerve, which stimulate the stomach |
The surgeon chooses open or laparoscopic access, based on the goals of the operation and the general condition of the patient.
After the surgical treatment, the patient is prescribed a gentle diet, which is gradually expanded.
First aid
If you have symptoms of bleeding from the digestive tract, emergency medical attention is required. It should be borne in mind that with hidden loss of blood in the gastrointestinal tract, pain in the region of the stomach does not occur in 90% of cases.
Before the ambulance arrives, the following actions should be taken to alleviate the patient's condition:
- Lay the patient back on a hard or relatively hard surface. When the patient is on the floor - leave in place, do not move the bed.
- When vomiting, monitor the turning of the head to the side to exclude choking with vomit.
- Provide a cold to the area of the stomach( ice bladder or, as a tool, frozen food, a bottle of cold water).When using ice or frozen food, monitor the temperature of the cooled area to prevent frostbite.
- Absolutely eliminate food and liquid intake. In case of an irresistible thirst, offer an ice cube
- . If there is a tonometer, monitor the pressure reading. The fall in blood pressure is below 100 mm Hg.st may indicate the passage of blood loss from a satisfactory to a more severe phase, requiring initial infusion therapy.
Upon arrival, inform about symptoms, blood pressure readings and provide a list of medications the patient took to monitor the presence of anticoagulants and non-steroidal anti-inflammatory drugs prescribed for the treatment of joints.
If necessary, the team of doctors on the site will perform all necessary manipulations to stabilize the patient's condition and carry out its transportation in a horizontal position to the medical facility where all the required assistance will be provided, corresponding to the condition and preliminary diagnosis of the patient.
Complications of gastric bleeding
Abundant bleeding in the stomach can cause disruption of the functioning of the whole organism as a whole.
To frequent complications include:
- development of hemorrhagic shock;
- marked anemia;
- acute renal failure;
- multiple organ failure.
Preventing complications can promptly seek medical help. Delay in some cases is worth the patient's life.
Forecast for bleeding from the gastrointestinal tract
The prognosis is determined by the amount of blood loss and the causes of this condition.
- With minor changes and correction of the underlying disease, the prognosis is favorable.
- Abundant blood flow, malignant process have an unfavorable prognosis.
Prevention of gastric bleeding is the only one: adequate treatment of the underlying disease and compliance with the recommendations of the treating doctor.
