home Audience 2 How to treat internal non-ulcer bleeding of the gastrointestinal tract (GIT) in adults and what are the symptoms of blood in the intestines. Stomach bleeding

How to treat internal non-ulcer bleeding of the gastrointestinal tract (GIT) in adults and what are the symptoms of blood in the intestines. Stomach bleeding

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

General information

Gastrointestinal bleeding serves as the most common complication of a wide range of acute or chronic diseases digestive organs, which pose a potential danger to the patient’s life. The source of bleeding can be any part of the gastrointestinal tract - the esophagus, stomach, small and colon. 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 may be accompanied by gastrointestinal bleeding. All hemorrhages can be divided into 4 groups: bleeding due to damage to 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, hernia hiatus diaphragm, Crohn's disease, ulcerative colitis, hemorrhoids, anal fissure, helminthiasis, injuries, foreign bodies etc. Bleeding due to portal hypertension usually occurs when chronic hepatitis and cirrhosis of the liver, thrombosis of the hepatic veins or system portal vein, constrictive pericarditis, compression of the portal vein by tumors or scars.

Bleeding that develops as a result of vascular damage can be etiologically and pathogenetically associated with varicose veins of the esophagus and stomach, periarteritis nodosa, systemic lupus erythematosus, scleroderma, rheumatism, septic endocarditis, vitamin deficiency C, atherosclerosis, Randu-Osler disease, thrombosis of mesenteric vessels, etc.

Bleeding often occurs in diseases of the blood system: hemophilia, acute and chronic leukemia, hemorrhagic diathesis, vitamin deficiency K, hypoprothrombinemia, etc. Factors that directly provoke pathology may include taking aspirin, NSAIDs, corticosteroids, alcohol intoxication, vomiting, contact with chemicals, physical tension, stress, etc.

Pathogenesis

The mechanism of gastrointestinal bleeding may be due to a violation of the integrity of blood vessels (with their erosion, rupture of walls, sclerotic changes, embolism, thrombosis, rupture of aneurysms or varicose nodes, increased permeability and fragility of capillaries) or changes in the hemostatic system (with thrombocytopathy and thrombocytopenia, 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 part of the digestive tract that is the source of hemorrhage, bleeding is distinguished from the upper parts (esophageal, gastric, duodenal) and lower parts of the gastrointestinal tract (small intestinal, colonic, hemorrhoidal). The flow 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 distinguished.

According to duration, acute and chronic bleeding are distinguished; by severity clinical signs– obvious and hidden; by the number of episodes – one-time and recurrent. There are three degrees of bleeding based on the severity of blood loss. 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, slight dizziness, normal diuresis. Blood parameters: Er - above 3.5x1012/l, Hb - above 100 g/l, Ht - more than 30%; BCC deficit – no more than 20%.

When bleeding moderate severity Heart rate is 100 beats per minute, 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 is determined to 2.5x1012/l, Hb - to 100-80 g/l, Ht - to 30-25%. The BCC deficit is 20-30%. A severe degree should be considered when the heart rate is more than 100 beats. per minute 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 red blood cells in the blood is less than 2.5x1012/l, the Hb level is below 80 g/l, Ht is less than 25% with a BCC deficiency of 30% and above. Bleeding with massive blood loss is called profuse.

Symptoms

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

To others characteristic feature Acute hemorrhages from the gastrointestinal tract are caused by tarry stools (melena). The presence of clots or streaks of scarlet blood in the stool indicates bleeding from the colon, rectum or anal canal. Symptoms of hemorrhage are combined with signs of the underlying disease. In this case, there may be pain in various departments Gastrointestinal tract, ascites, symptoms of intoxication, nausea, dysphagia, belching, etc. Hidden bleeding can only be detected based on laboratory signs- anemia and positive reaction feces on occult blood.

Diagnostics

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

Laboratory indicators include counting of red blood cells, hemoglobin, hematocrit number, platelets; coagulogram study, determination of creatinine, urea, liver tests. Depending on the suspected source of hemorrhage, various radiological methods can be used in diagnosis: radiography of the esophagus, radiography 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 makes it possible to detect even superficial defects of the mucous membrane and the direct source of gastrointestinal bleeding.

To confirm bleeding and identify its exact location, radioisotope studies are used (scintigraphy of the gastrointestinal tract with labeled red blood cells, dynamic scintigraphy of the esophagus and stomach, static scintigraphy of the intestine, etc.), MSCT of the abdominal organs. The 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 location, causes and intensity of bleeding, it is determined therapeutic tactics. In case of massive blood loss, blood transfusion, infusion and hemostatic therapy are carried out. Conservative tactics are justified in the case of hemorrhage that develops due to impaired hemostasis; the presence of severe intercurrent diseases (heart failure, heart defects, etc.), inoperable cancer processes, severe leukemia.

When bleeding from varicose veins of the esophagus can be stopped endoscopically by ligating or sclerosing the altered vessels. According to indications, they resort to endoscopic control of gastroduodenal bleeding, colonoscopy with electrocoagulation or puncture of bleeding vessels. In some cases, surgical stopping of gastrointestinal bleeding is required.

So, in case of a stomach ulcer, the bleeding defect is sutured or an economical gastric resection is performed. For duodenal ulcers complicated by bleeding, suturing of the ulcer is supplemented with truncal vagotomy and pyloroplasty or anthrumectomy. If the bleeding is caused by nonspecific ulcerative colitis, a subtotal resection of the colon is performed with the imposition of an ileo- and sigmostoma.

Prognosis and prevention

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

Gastrointestinal bleeding(GIB) is the leakage of blood from disease-damaged blood vessels into organ cavities gastrointestinal tract. Gastrointestinal bleeding is common and serious complication a wide range of pathologies of the gastrointestinal tract, posing a threat to the health and even life of the patient. The volume of blood loss can reach 3-4 liters, so such bleeding requires emergency medical care.

In gastroenterology, gastrointestinal bleeding ranks 5th in prevalence after strangulation.

The source of bleeding can be any part of the gastrointestinal tract. In this regard, bleeding occurs from the upper gastrointestinal tract (esophagus, stomach, duodenum) and lower gastrointestinal tract (small and large intestine, rectum).

Bleeding from the upper sections accounts for 80-90%, from the lower sections – 10-20% of cases. If we look in more detail, the stomach accounts for 50% of bleeding, the duodenum - 30%, the colon and rectum - 10%, the esophagus - 5% and the small intestine - 1%. With and, a complication such as bleeding occurs in 25% of cases.

By etiological sign distinguish between ulcerative and non-ulcerative gastrointestinal tract infections, according to the nature of the bleeding itself - acute and chronic, according to clinical picture- obvious and hidden, in duration - one-time and recurrent.

Men are at risk age group 45-60 years old. 9% of people delivered to surgical departments ambulance service, they are admitted there with gastrointestinal bleeding. Quantity of it possible reasons(diseases and pathological conditions) exceeds 100.

Causes of stomach bleeding

All gastrointestinal bleeding is divided into four groups:

Bleeding due to diseases and damage to the gastrointestinal tract (peptic ulcer, diverticula, hernia, etc.);

Bleeding due to portal hypertension (cicatricial strictures, etc.);

Bleeding due to vascular damage (varicose veins of the esophagus, etc.);

Bleeding due to blood diseases (aplastic, hemophilia, thrombocythemia, etc.).

Bleeding due to diseases and damage to the gastrointestinal tract

In the first group, ulcerative and non-ulcerative gastrointestinal tracts are distinguished. Ulcerative pathologies include:

Stomach ulcer;

Duodenal ulcer;

Chronic esophagitis (inflammation of the esophageal mucosa);

Gastroesophageal reflux disease of the esophagus (develops as a result of systematic spontaneous reflux of stomach contents into the esophagus);

Erosive hemorrhagic gastritis;

Infectious lesions intestines (,).

Bleeding due to portal hypertension

The cause of gastrointestinal bleeding of the second group can be:

Chronic hepatitis;

Bleeding due to blood diseases

The fourth group is gastrointestinal intestinal bleeding associated with blood diseases such as:

Hemophilia and von Willebrand disease are genetically determined bleeding disorders);

Thrombocytopenia (deficiency of platelets - blood cells responsible for blood clotting);

Spicy and chronic leukemia;

Hemorrhagic diathesis(thrombasthenia, fibrinolytic purpura, etc. - tendency to recurrent bleeding and hemorrhage);

Aplastic anemia (impaired bone marrow hematopoietic function).

Consequently, gastrointestinal bleeding can occur both due to a violation of the integrity of blood vessels (with their ruptures, thrombosis, sclerosis) and due to hemostatic disorders. Often both factors are combined.

With ulcers of the stomach and duodenum, bleeding begins as a result of melting vascular wall. This usually occurs during the next exacerbation of a chronic disease. But sometimes there are so-called silent ulcers that do not make themselves known until they bleed.

In infants, intestinal bleeding is often caused by intestinal volvulus. Bleeding with it is quite scanty, the main symptoms are more pronounced: acute attack abdominal pain, constipation, failure to pass gas. In children under three years of age, such bleeding is more often caused by abnormalities in intestinal development, the presence of neoplasms, diaphragmatic hernia. Older children are more likely to have colon polyps: in this case, a little blood is released at the end of a bowel movement.

Signs and symptoms of stomach bleeding

General symptoms gastrointestinal bleeding are as follows:

Weakness;

The severity of these symptoms can vary widely: from mild malaise and dizziness to deep and coma, depending on the rate and volume of blood loss. With slow, weak bleeding, their manifestations are insignificant; there is a slight normal pressure, since partial compensation of blood loss has time to occur.

Gastrointestinal tract symptoms are usually accompanied by signs of the underlying disease. In this case, pain in different parts of the gastrointestinal tract, ascites, and signs of intoxication may be observed.

In case of acute blood loss, short-term fainting is possible due to sharp drop pressure. Symptoms of acute bleeding:

Weakness, drowsiness, severe dizziness;

Darkening and “floaters” in the eyes;

Shortness of breath, severe tachycardia;

Cold feet and hands;

Weak pulse and low blood pressure.

Symptoms of chronic bleeding are similar to those of anemia:

Deterioration of general condition, high fatigue, decreased performance;

Paleness of the skin and mucous membranes;

Dizziness;

The most characteristic symptom GI fluid is an admixture of blood in vomit and stool. Blood in vomit may be present in unchanged form (in case of bleeding from the esophagus in the case of its veins and erosions) or in an altered form (in case of gastric and duodenal ulcers, as well as Mallory-Weiss syndrome). In the latter case, the vomit has the color of “coffee grounds”, due to the mixing and interaction of blood with hydrochloric acid contents gastric juice. Blood in vomit is bright red in profuse (massive) bleeding. If bloody vomiting occurs again after 1-2 hours, most likely, bleeding continues, if after 4-5 hours, this is more indicative of re-bleeding. With bleeding from the lower gastrointestinal tract, vomiting is not observed.

In the stool, blood is present unchanged in case of a single blood loss exceeding 100 ml (with bleeding from the lower part of the gastrointestinal tract and with a stomach ulcer). In an altered form, blood is present in the stool during prolonged bleeding. In this case, 4-10 hours after the bleeding began, tarry, dark, almost black stools (melena) appear. If less than 100 ml of blood enters the gastrointestinal tract during the day, visual changes in stool are not noticeable.

If the source of bleeding is in the stomach or small intestine, blood, as a rule, is evenly mixed with feces; when flowing from the rectum, the blood looks like separate clots on top of the feces. The discharge of scarlet blood indicates the presence of chronic hemorrhoids or anal fissure.

It must be taken into account that the stool may have dark color when eating blueberries, chokeberries, beets, buckwheat porridge, taking activated carbon, iron and bismuth preparations. Also, the cause of tarry stools can be the ingestion of blood during pulmonary or nasal bleeding.

Gastric and duodenal ulcers are characterized by a decrease in ulcer pain during bleeding. At heavy bleeding the stool becomes black (melena) and loose. During bleeding, abdominal muscle tension does not occur and other signs of peritoneal irritation do not appear.

multiple organ failure (stress response of the body, consisting in the cumulative failure of several functional systems).

Untimely hospitalization and attempts at self-medication can lead to death.

Diagnosis of gastric bleeding

Gastrointestinal bleeding must be distinguished from pulmonary nasopharyngeal bleeding, in which blood can be swallowed and end up in the gastrointestinal tract. Likewise, vomiting can cause blood to enter the respiratory tract.

Differences between hematemesis and hemoptysis:

Blood leaves with vomiting, and with hemoptysis - during;

When vomiting, blood has alkaline reaction and has a bright red color, with hemoptysis - an acidic reaction and has a dark burgundy color;

With hemoptysis, the blood may foam, but with vomiting this does not happen;

Vomiting is profuse and short-lived, hemoptysis can last several hours or days;

Vomiting is accompanied by dark stools, but this is not the case with hemoptysis.

Profuse GIBs must be differentiated from myocardial infarction. In case of bleeding, the decisive sign is the presence of nausea and vomiting, and in case of bleeding, chest pain. Among women reproductive age It is necessary to exclude intra-abdominal bleeding due to ectopic pregnancy.

The diagnosis of gastrointestinal tract is established on the basis of:

History of life and history of the underlying disease;

Clinical and rectal examination;

General analysis blood and coagulograms;

Instrumental Research, among which the main role belongs to endoscopic examination.

When analyzing the anamnesis, information is obtained about past and existing diseases, the use of certain medications(Aspirin, NSAIDs, corticosteroids), which could provoke bleeding, the presence/absence of alcohol intoxication (which is common cause Mallory-Weiss syndrome), possible influence harmful working conditions.

Clinical examination

Clinical examination includes examination of the skin (coloring, presence of hematomas and telangiectasia), digital examination of the rectum, assessment of the nature of vomit and feces. The condition of the lymph nodes, the size of the liver and spleen, the presence of ascites, tumor neoplasms and postoperative scars are analyzed. abdominal wall. Palpation of the abdomen is carried out extremely carefully so that the bleeding does not increase. For bleeding of non-ulcer origin, there is no pain reaction upon palpation of the abdomen. Enlarged lymph nodes are a sign of a malignant tumor or systemic disease blood.

Yellowness of the skin in combination with may indicate a pathology of the biliary system and allows us to consider varicose veins of the esophagus as a possible source of bleeding. Hematomas, spider veins and other types of skin hemorrhages indicate the possibility of hemorrhagic diathesis.

Upon examination, it is impossible to determine the cause of bleeding, but the degree of blood loss and the severity of the condition can be approximately determined. Lethargy, dizziness, “floaters before the eyes,” acute vascular insufficiency indicate brain hypoxia.

Examination of the rectum with a finger is important, as it helps to analyze the condition of not only the intestine itself, but also nearby organs. Painful sensations upon examination, the presence of polyps or bleeding hemorrhoids allows us to consider these formations as the most likely sources of bleeding. In this case, after a manual examination, an instrumental examination (rectoscopy) is performed.

Laboratory methods include:

Various diseases of the digestive system are widespread today. The reason for this lies in human nutrition. Most people snack on the go, without paying attention to the food they eat. As a result, discord in digestive system. Sometimes such problems can even cause stomach bleeding. This is a serious danger for a person, because what is happening inside, unfortunately, is not visible.

Main reasons

Any pathology that is not visible at first glance is quite dangerous for a person. The consequence of one of them is gastric bleeding. Causes this phenomenon may be different. But its main source is a stomach ulcer.

Doctors identify several factors that can provoke this problem:

Stomach diseases. Among them, the most important place belongs, as previously mentioned, to ulcers. Erosion of the mucous membrane, gastritis, and various neoplasms (benign, malignant) can lead to bleeding.
Medicines. Some drugs damage the gastric mucosa. The following medications can serve as a provoking factor: Aspirin, Butadione, Reopirin, Hydrocortisone. Analogues of these drugs are no less dangerous.
Ailments of other organs. In most cases, these are hemophilia, hemorrhagic vasculitis, leukemia, mediastinal tumor, ruptured aortic aneurysm, Werlhof's disease, scurvy.

Stomach bleeding, the reasons for which lie in a number of various pathologies, begins as a result of a rupture blood vessel. At the same time, it differs in quite specific symptoms. The signs appear so clearly that it is simply impossible to ignore them.

Symptoms of the phenomenon

So, what are the signs of stomach bleeding? There are many of them, and they can testify to various diseases. But the most important symptom indicating this problem is bloody vomiting. Based on its intensity, the doctor is able to guess about the localization of the problem. Color and consistency give an idea of the rate of bleeding. Thus, a scarlet or dark cherry hue signals a rapid internal flow. If the vomiting of blood resembles coffee grounds, then the rate is low.

Often this sign is accompanied by the following symptoms of gastric bleeding:

dizziness;
black stool (tarry);
pain coming from the chest;
weakness, lethargy;
pale skin;
cold and clammy extremities;
increased heart rate;
clouding of consciousness, possible fainting;
decrease in pressure;
sticky cold sweat;
reduced orientation in space.

Severity of the condition

This criterion is determined by the amount of blood that the patient has lost. Depending on this, gastric bleeding can have three forms of severity:

Mild degree. The patient's condition is relatively satisfactory. The person is fully conscious. There is slight dizziness. The pressure does not exceed 110 mm. rt. Art., and the pulse is 80 beats in one minute.
Average degree. With this form, there is pallor of the skin, with the presence of cold sweat. The patient is experiencing dizziness. Blood pressure measurement shows results from 90 to 110 mm. rt. Art. The pulse increases to 100 beats per minute.
Severe degree. The patient is very pale, there is severe lethargy. Answers questions late. Usually such people do not even react to their surroundings. The pulse exceeds 100 beats, and the pressure drops below 80 mm. rt. Art.

First aid

In case of severe and prolonged bleeding The patient may experience blue lips. Often the patient has a feeling of lack of air. Vision may be significantly reduced. The person's condition deteriorates sharply. Such symptoms clearly indicate acute gastric bleeding. "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 medical team arrives? First aid for gastric bleeding is to ensure complete rest for the patient. It is recommended to lay the patient horizontally. It is strictly forbidden to give him food or water. On the stomach, in upper area, if possible, you should put it cold. This could be a bubble or an ice bag. Under no circumstances should you do enemas or rinse your stomach!

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

Chronic bleeding

Sometimes patients may not even realize that they have this pathology. They go to the doctor about the symptoms that bother them, completely unaware that these are signs of stomach bleeding.

As a rule, with discomfort and pain in the upper abdomen, digestive disorders, and nausea, patients are referred to a therapist or gastroenterologist. If there are many bruises on the body or bleeding increases, the patient goes to a hematologist. Any of these doctors will order an examination. During which gastric bleeding is determined.

If we're talking about O chronic form, the main symptom of this condition is tarry black stools. It is in the presence of this characteristic you should immediately contact a surgeon.

Diagnosis of the condition

If the patient’s condition allows, the doctor collects important information during the examination and conversation. After all, bleeding can occur not only from the stomach, but also from other organs. However, to make a diagnosis, even if the patient has some symptoms of gastric bleeding, the patient must undergo examination.

Typically, the following studies are used:

Fibrogastroduodenoscopy. This examination allows you to examine the esophagus, stomach, and duodenum. As a result of the study, the source of bleeding, as well as its location, is clearly established.
X-ray of the stomach. It is used to assess the condition of the stomach walls, identify tumors, ulcers, and diaphragmatic hernia.
Angiography. X-ray contrast examination of blood vessels. This study is used if there is a suspicion that bleeding is caused by vascular disorders. For example, atherosclerosis.
Radioisotope scanning. If the location of the bleeding cannot be identified by other methods, this examination is used. Red blood cells labeled with a special substance are injected into the patient’s blood. They accumulate in the problem area.
Blood analysis.
Magnetic resonance imaging.
Coagulogram. Examination for blood clotting.

Treatment methods

The patient who is found to have gastric bleeding must be hospitalized. If possible, emergency assistance is provided by the ambulance team and the patient is taken to the hospital. IN medical practice There are two tactics for treating these conditions:

conservative method (without surgery);
surgical intervention.

The decision about what measures to resort to is made only by the doctor. After a thorough examination of the patient, establishing the severity of the disease and the location of the bleeding, the most suitable efficient scheme treatment.

Conservative tactics

The patient is strictly assigned to bed rest. It is in this position that gastric bleeding subsides. If the patient continues to move, the problem may worsen.

Cold is applied to the epigastric region. This procedure promotes vasoconstriction. As a result, bleeding also stops. For the same purposes, washing is sometimes performed cold water.

The following medications are injected into the stomach through a tube: “Adrenaline”, “Norepinephrine”. They can cause vasospasm, thereby stopping bleeding. Such drugs are referred to as “stress hormones”.

Of course, hemostatic medications are prescribed. The most accessible drugs are “Ditsinon”, “Etamzilat”, “Vikasol”. Sometimes calcium chloride is used.

If necessary, if the patient has lost a lot of blood, doctors resort to transfusion.

Endoscopic treatment

This method is used if the patient has slight stomach bleeding. Treatment is carried out in several ways. To do this, special endoscopic instruments are inserted through the mouth.

Treatment methods:

Injection of solutions of “Norepinephrine” and “Adrenaline” into the bleeding area. The procedure causes, as mentioned above, vasospasm.
Laser coagulation. Bleeding areas of the mucous membrane are cauterized. At this method laser is used.
Electrocoagulation. Another cauterization method.
Stitching. With this method, threads or special metal clips are used.
Application. In this case, medical special glue is used.

Surgical intervention

Unfortunately, the above-described help with gastric bleeding is not always effective. Under some factors, the patient requires only surgical intervention.

The decision on the need for surgery is made in the following cases:

The patient is experiencing severe bleeding. At the same time, the pressure decreased significantly.
If attempts to stop bleeding using conservative methods have not given a positive result.
If the patient has severe disorders that can provoke a deterioration of the condition (impaired blood flow in the brain, cardiac ischemia).
In case of repeated bleeding.

Operations are performed through an incision or laparoscopically. In the latter case, punctures are made in the peritoneum. The doctor chooses the appropriate method for surgical intervention.

Conclusion

A very small percentage of people carefully monitor their health. At the same time, based on statistical studies, doctors say that every fifth patient who is diagnosed with an ulcer, unfortunately untreated, ends up in the hospital with stomach bleeding. Is it necessary to risk your well-being like that? After all, health must be protected.

Bleeding varying degrees intensity can come from arteries, veins, capillaries. Gastrointestinal bleeding can be hidden (occult), manifested by secondary hypochromic anemia, or obvious.

Hidden symptoms the phenomena are often chronic and originate from the capillaries, accompanied by iron deficiency anemia, weakness, and a decrease in hemoglobin and red blood cells. Hidden pathology can be detected by examining stool or gastric contents for the presence of blood (benzidine or guaiac tests).

Symptoms of developing gastrointestinal bleeding

The patient's reaction depends on

volume and rate of gastrointestinal bleeding,
degree of loss of fluid and electrolytes,
patient's age,
concomitant diseases, especially cardiovascular diseases.

Symptoms of minor gastrointestinal bleeding

In case of acute minor bleeding (less than 50 ml), formalized feces have a black color. The patient's general condition remains satisfactory. Obvious symptoms of profuse bleeding include bloody vomiting and bloody stools.

Signs of massive gastrointestinal bleeding

Early manifestations of bleeding are sudden weakness, dizziness, tachycardia, hypotension, and sometimes fainting. Later, bloody vomiting occurs (when the stomach is full of blood), and then melena.

Melena is the release of altered blood with feces (tarry stools), observed with bleeding from the duodenum and massive gastrointestinal bleeding with blood loss reaching 500 ml or more.

The loss of about 500 ml of blood (10-15% of circulating blood volume) during gastrointestinal bleeding is usually not accompanied by a noticeable reaction from the cardiovascular system. Loss 25% BCC causes a decrease in systolic blood pressure to 90-85 mm Hg. Art., diastolic - up to 45-40 mm Hg. Art.

Massive bleeding with such significant blood loss causes:

hypovolemic shock;

acute renal failure caused by decreased filtration, hypoxia, necrosis of convoluted tubules of the kidneys;

liver failure due to a decrease in hepatic blood flow, hypoxia, degeneration of hepatocytes;

heart failure caused by gastrointestinal oxygen bleeding and myocardial starvation;

cerebral edema due to hypoxia;

disseminated intravascular coagulation;

intoxication with hydrolysis products of blood spilled into the intestines. All these signs of bleeding mean that the patient has developed multiple organ failure.

Acute bleeding, the main symptom of which is only melena, has a more favorable prognosis than bleeding, manifested primarily by profuse repeated hematemesis. The highest probability of an unfavorable prognosis is with the simultaneous appearance of hematemesis and melena.

Diagnosis of massive gastrointestinal bleeding

They can be the first sign of a stomach or duodenal ulcer, which was previously asymptomatic (about 10%), or a manifestation of an acute ulcer (stress ulcer).

When examining, pay attention to:

patient's fear and anxiety.

Skin pale or cyanotic, moist, cold.

Pulse is increased; arterial pressure may be normal or reduced.

Breathing is rapid.

With significant gastrointestinal bleeding, the patient experiences thirst and notes dryness of the mucous membranes of the oral cavity.

An approximate assessment of the severity of gastrointestinal bleeding is possible based on the external symptoms of gastrointestinal bleeding, determining the shock index by heart rate (see " Acute stomach"), blood pressure, measuring the amount of blood released through vomiting and loose stools, as well as during aspiration of contents from the stomach.

Indicators of hemoglobin, hematocrit, central venous pressure (CVP), circulating blood volume (CBV), hourly diuresis allow a more accurate assessment of the severity of blood loss and the effectiveness of treatment. When examining blood early (several hours) after the onset of acute gastrointestinal bleeding, the number of red blood cells and hemoglobin content may remain at normal level. This is due to the fact that during the first hours red blood cells are released from the depot.

Degrees of gastrointestinal bleeding and their symptoms

Taking into account the above data, four degrees of severity of the phenomenon can be distinguished.

I degree. Its symptoms are chronic occult (hidden) bleeding, the hemoglobin content in the blood is slightly reduced, and there are no signs of hemodynamic disturbances.

II degree. Its signs are acute minor bleeding, heart rate and blood pressure are stable, hemoglobin content is 100 g/l or more.

III degree. Its symptoms are acute blood loss of moderate severity (tachycardia, slight decrease in blood pressure, shock index more than 1, hemoglobin content less than 100 g/l.

IV degree - massive heavy bleeding. Its manifestations are blood pressure below 80 mm Hg. Art., heart rate over 120 per minute, shock index about 1.5, hemoglobin content less than 80 g/l, hematocrit less than 30, oliguria - diuresis less than 40 ml/h.

Differential diagnosis of massive bleeding

Gastrointestinal bleeding should be differentiated from pulmonary hemorrhage, in which bloody vomiting is foamy in nature, accompanied by coughing, and moist rales of various sizes are often heard in the lungs.

Features of the treatment of gastrointestinal bleeding

Examination and treatment of patients is carried out in the intensive care unit, where the following priority measures are carried out:

catheterization of the subclavian vein or several peripheral veins to quickly replenish the deficit of blood volume, measurement of central venous pressure;

probing the stomach to lavage it and monitor for possible resumption of bleeding;

emergency esophagogastroduodenoscopy of a patient with gastrointestinal bleeding and a simultaneous attempt to stop the bleeding by puncturing a bleeding ulcer or coagulating a bleeding vessel;

permanent catheterization Bladder to control diuresis (it should be at least 50-60 ml/h);

determination of the degree of blood loss;

6) oxygen therapy;

hemostatic therapy in the treatment of gastrointestinal bleeding;

autotransfusion (foot bandaging);

cleansing enemas to remove blood spilled into the intestines.

Probing of the stomach in the treatment of massive blood loss

Probing the stomach and rinsing it with cold water (3-4 l) (removing spilled blood and clots) is done to prepare for endoscopic examination and stop bleeding. Cold water means water at a temperature of 4°C, stored in the refrigerator or cooled to the specified temperature by adding pieces of ice. Inserting a probe into the stomach during bleeding and aspirating the contents at certain time intervals allows one to monitor the dynamics of bleeding.

Conservative therapy for the treatment of gastrointestinal bleeding

When choosing a treatment method, it is necessary to take into account endoscopy data (bleeding stage at the time of endoscopy according to Forrest), the intensity of bleeding, its duration, relapses, general state and the patient's age.

Treatment methods for bleeding from the stomach and intestines

Conservative measures should be aimed at the prevention and treatment of shock, suppression of the production of hydrochloric acid and pepsin by intravenous administration of H 2 receptor blockers - Ranitidine (and its analogues - Gistak, Ranital), Famotidine (Quatemal).

If it is possible to take drugs orally, it is advisable to prescribe blockers that are more effective for bleeding ulcers proton pump- Omeprazole, anticholinergics (Gastrocepin), antacids and drugs that reduce blood supply to the mucous membrane (Vasopressin, Pituitrin, Somatostatin).

During endoscopy, gastrointestinal bleeding can be stopped by introducing into the submucosa near the ulcer substances that help stop bleeding (liquid Fibrinogen, Decinon, etc.), applying Thrombin or medical glue, coagulating the bleeding vessel (diathermocoagulation, laser photo coagulation).

In most cases (about 90%), acute gastrointestinal bleeding can be stopped with conservative measures.

Infusion therapy for gastrointestinal bleeding

Infusion therapy is carried out to normalize hemodynamics and ensure adequate tissue perfusion. It includes replenishing blood volume, improving microcirculation, preventing intravascular aggregation, microthrombosis, maintaining plasma oncotic pressure, correcting water-electrolyte balance and acid-base status, and detoxification.

In the infusion treatment of gastrointestinal bleeding, they strive to achieve moderate hemodilution (hemoglobin content should be at least 100 g/l, and the hematocrit should be within 30%), which improves the rheological properties of blood, microcirculation, reduces peripheral vascular resistance to blood flow, and facilitates the work of the heart. .

Infusion treatment should begin with the transfusion of rheological solutions that improve microcirculation. For mild blood loss, an infusion of Reopoliglyukin, Hemodez is performed in a volume of up to 400-600 ml with the addition of saline and glucose-containing solutions.

For moderate blood loss, plasma replacement solutions and components are administered donated blood. The total volume of infusions should be 30-40 ml per 1 kg of patient body weight. The ratio of plasma replacement solutions and blood in this case should be equal to 2:1. For the treatment of gastrointestinal bleeding, Polyglyukin and Reopoliglyukin are prescribed up to 800 ml, and the dose of saline and glucose-containing solutions is increased.

In case of severe blood loss and hemorrhagic shock the ratio of transfused solutions and blood is 1: 1 or 1: 2. The total dose of drugs for infusion treatment of gastrointestinal bleeding should exceed the amount of lost blood by an average of 200-250%.

To maintain oncotic blood pressure, intravenous administration of Albumin, Protein, and Plasma is used. The approximate volume of infusions can be determined by the value of central venous pressure and hourly diuresis (after therapy it should be more than 50 ml/h). Correction of hypovolemia improves central hemodynamics and adequate tissue perfusion, provided that the deficiency in blood oxygen capacity is eliminated.

Conservative treatment bleeding with erosive gastritis

Diagnosis is made by clinical and typical endoscopic findings. Treatment of gastrointestinal bleeding with erosive gastritis is usually conservative. Antisecretory drugs are prescribed: Omeprazole, H2 receptor inhibitors (Ranitidine, Famotidine), Sucralfate, antacids, agents that reduce blood flow to the mucous membrane (Secretin, Octapressin), Adrenaline solution orally for local action on the capillaries.

Stomach on background erosive gastritis washed periodically with cold water (at a temperature of about 4°C) to remove blood clots and stop bleeding. The full program is carried out intensive care. Bleeding erosions and ulcers are coagulated through an endoscope.

The success rate of treatment for erosive gastritis is 90%. The need for surgery is rare.

Surgical relief of gastrointestinal bleeding

IN surgical treatment apply

selective proximal vagotomy,
sometimes suturing defects,
ligation of the arteries supplying the stomach,
and very rarely - gastric resection.

Emergency surgery is indicated for patients with active bleeding (Forrest 1), which cannot be controlled by endoscopic and other methods; it must be carried out early after the onset of bleeding, since the prognosis with late interventions worsens sharply.

In case of hemorrhagic shock and ongoing bleeding, the operation is performed against the background of massive blood transfusion, plasma-substituting solutions and other anti-shock measures. Urgent surgery is indicated for patients in whom conservative measures and blood transfusion (up to 1500 ml per 24 hours) did not stabilize the patient's condition.

After stopping the bleeding (Forrest 2-3), surgery is indicated for patients with a long history of ulcers, recurrent bleeding, callous and stenosing ulcers, and when the patient is over 50 years old. It is necessary to decide on the choice of surgical option taking into account concomitant diseases, which can increase the risk of both early and late surgical intervention.

Treatment of bleeding in Mallory-Weiss syndrome

For Mallory-Weiss syndrome, gastrointestinal bleeding is treated in the form of tamponade with a Blakemore probe. If tamponade is unsuccessful, a gastrotomy operation is performed with suturing of the mucosal defect.

Causes of gastrointestinal bleeding

The source of bleeding that occurs during an exacerbation in young people is often a duodenal ulcer, in patients over 40 years old - a stomach ulcer. Before bleeding, the pain often intensifies, and from the moment the bleeding begins, it decreases or disappears (Bergmann's symptom). Reduction or elimination of peptic pain is due to the fact that the blood neutralizes hydrochloric acid.

So, the most common sources of bleeding are:

stomach or duodenal ulcers,

stress ulcers,

acute erosion of the mucous membrane (erosive gastritis).

Erosive gastritis as a cause of bleeding

Bleeding from erosions (erosive gastritis) and stress ulcers can be threatening. Erosions, which are small superficial multiple defects of the mucous membrane measuring 2-3 mm, are located mainly in the proximal part of the stomach. The appearance of erosions and stress ulcers is preceded by severe mechanical trauma, extensive burns, shock, hypoxia, severe surgical trauma, exogenous and endogenous intoxication. The main cause of erosive gastritis is hypoxia of the mucous membrane, caused by impaired microcirculation, increased capillary permeability and ischemia of the stomach wall. The mucous membrane is edematous, usually covered with multiple petechiae and hemorrhages. Against the background of weakening of the protective mucous-bicarbonate barrier, damage to the mucous membrane occurs with hydrochloric acid and pepsin. Reverse diffusion of hydrogen ions plays an important role in disruption of microcirculation and damage to the mucous membrane.

Other causes of gastrointestinal bleeding

Less commonly, symptoms of the disease are observed in Mallory-Weiss syndrome (longitudinal rupture of the mucous membrane of the cardial part of the stomach, which occurs with repeated vomiting). Gastrointestinal bleeding is also very rare with a simple Dieulafoy ulcer (a small round ulcer on the anterior or posterior wall of the stomach, located above a relatively large-diameter artery in the wall of the stomach), which is relatively rare (0.7-2.2%), but represents great danger, since bleeding usually occurs from a large vessel that has undergone erosion, is usually massive and often recurrent. To stop it you need surgical treatment- transgastric ligation of a bleeding vessel or excision of a bleeding ulcer.

In 3-10% of patients, bleeding occurs from varicose veins of the esophagus with portal hypertension. Rarely, the source of bleeding can be telangiectasia in Osler-Rendu syndrome, vessels of benign and malignant tumors of the stomach, diverticula of the duodenum and stomach, hiatal hernias.

Gastrointestinal bleeding from peptic ulcer disease is a dangerous complication. It occurs due to arrosion of branches gastric arteries(right or left). With a duodenal ulcer, the source of bleeding is aa. pancreaticoduodenales in the area of the bottom of the ulcer.

Bleeding in the stomach area is an internal outpouring of blood and blood clots into the stomach cavity. The maximum volume of hemorrhage is 4 liters. The causes of bleeding can be a variety of factors: from an incorrectly selected diet to Mallory-Weiss syndrome. Mortality from gastric bleeding is high and amounts to 9% of known cases.

Causes of stomach bleeding

Factors that influence bleeding include:

long-term disruption of the normal psycho-emotional state;
lack of physical activity;
improperly selected diet;
uncontrolled reception medications;
drinking alcohol and tobacco products in large quantities;
infectious and bacterial diseases abdominal organs: duodenal ulcer/stomach ulcer/inflammatory processes in the intestines, intestines, stomach.

Experts use a special classification of causes of bleeding:

Bleeding from an ulcer

Erosion of mucous membranes, their superficial changes.
Formation of a stress ulcer (due to severe trauma, surgery, mechanical damage internal organs).
Drug ulcer. It is formed due to prolonged uncontrolled use of medications (mainly analgesic and anti-inflammatory in nature).
Mallory-Weiss syndrome. Mallory-Weiss syndrome is a superficial rupture of the mucous membrane of the esophagus and one of the gastric sections. Such damage occurs due to incessant vomiting, which is accompanied by hemorrhage. The reason for the formation of Mallory-Weiss syndrome is uncontrolled consumption of alcohol and large amounts of carbohydrate fatty foods.

Intestinal inflammation

Development of rectal hemorrhoids.
Anal fissure.
Formation of tumors in the intestines.
Mechanical injuries of the abdominal cavity.
Infectious diseases (dysentery).

Symptoms and signs

Early symptoms of the disease are as follows:

pronounced weakness of the body appears (the reason for this is an imbalance and blood circulation);
dizziness/blurred consciousness;
the occurrence of shortness of breath, darkening of the eyes;
stuffy ears;
the patient breaks out in a cold sweat;
a sharp drop in blood pressure;
manifestation of tachycardia;
heart rate increases;
loss of consciousness is possible.

One of early symptoms illness - loss of consciousness.

There are also specific symptoms that can vary depending on the cause and type of blood loss:

discharge of vomit with blood particles (can take on a scarlet or dark brown color, scarlet clots indicate the presence of a wound in the esophagus, dark brown clots indicate a wound in the stomach);
the formation of bloody stools, particles of blood that are released along with stool may turn black (with prolonged blood loss);
vomiting mixed with black flakes (a black cotton clot indicates hidden bleeding);
increasing anemia.

Symptoms of the condition depend on the amount of blood lost. The most reliable signs of bleeding are vomiting and stool containing blood clots. Symptoms also include some specific signs:

the appearance of fear and anxiety (which makes the patient even more vulnerable to illness and disorders of the psycho-emotional state);
pallor of the epithelial covers;
the skin becomes moist and cold;
a sharp jump in heart rate;
increased breathing;
a sharp decrease in blood pressure;
constant feeling of thirst, dry mouth.

Classification

Depending on the location of the bleeding:
1. Upper section (stomach and esophagus area).
2. Lower section (intestinal area).
According to the form of bleeding:
1. Spicy.
2. Chronic.
Based on the bleeding time frame:
1. One-time (manifests in episodes).
2. Recurrent (cyclical manifestation depending on external and other factors).
3. Chronic (permanent).
According to the nature of the bleeding:
1. Hidden.
2. Explicit.

Diagnostics

Primary diagnosis of bleeding is possible only from the words of the victim. The patient independently determines the symptoms, consults a specialist, after which a thorough and quickest diagnosis of his condition follows. If bleeding is suspected, the patient is prescribed bed rest and is prohibited from using food products at the time of diagnosis and determination.

One of the most common and effective diagnostic methods for bleeding is EGDS (esophagogastroduodenoscopy). During endoscopy, a specialist examines the esophagus, stomach, duodenum using a special medical device. The location of the bleeding, its size and shape are visually highlighted. An additional analysis of the condition of the abdominal organs and the degree of damage to the body is carried out. Before starting EGD, the patient is prohibited from consuming food and liquid. On top part a cold heating pad (or other cold object) is placed in the abdomen, the patient is placed in a lying position and the examination begins.

If, after determining the required data, the doctor is unable to stop the bleeding, they resort to surgery. In some cases, specialists resort to surgery immediately, without an initial examination. Such actions are appropriate when there is large blood loss and there is a risk to the patient’s life.

First aid

In case of stomach bleeding, urgently call an ambulance

The provision of primary non-skilled actions to maintain the patient’s viability depends on the following factors:

nature of bleeding;
profuse blood loss;
the well-being of the victim (symptoms indicated by the patient);
the possibility of providing qualified medical care.

The primary action is to call an ambulance. Before the ambulance arrives, you should perform several mandatory actions:

help the victim take a lying position;
help prevent food, liquids, and medications from entering the patient’s body;
apply a cold object to the abdominal cavity;
increase inflow fresh air if you are indoors;
pack your things and Required documents patient for prompt examination and transfer to a medical center.

Therapy and patient care

Treatment of the patient depends on a list of factors (primarily on signs of psychological health and physical indicators). If the patient's condition is not critical, before starting treatment comprehensive diagnostics, which helps determine the general condition of the patient’s body, subsequent therapy, possible complications and consequences. If there is no time for preparatory actions, the only effective method The treatment is surgery.

Conservative treatment

Conservative treatment of the disease consists of drug therapy.

Conservative treatment consists of drug therapy without resorting to surgical intervention. Treatment consists of following bed rest, which will help reduce blood loss. The victim should be provided with complete emotional and physical rest (muscle contractions can increase blood flow). The abdominal cavity is fixed, a cold object is applied to it, which slows down the outflow of blood and promotes vasoconstriction.

After carrying out the required diagnostic measures (blood in the stomach, food debris, dead tissue must be removed from the organ). The procedure is carried out with cold water through the mouth or nasal passage using a special tube. After lavage, a probe is inserted into the stomach, through which it is introduced into the body. medicinal substance– adrenaline, norepinephrine. The medication causes muscle contraction, constriction of blood vessels and helps stop bleeding. It is possible to administer intravenously medications that promote rapid blood clotting.