home Audience 2 Bleeding from the digestive tract in children. Causes of gastrointestinal bleeding in children

Bleeding from the digestive tract in children. Causes of gastrointestinal bleeding in children

Ministry of Education of the Russian Federation

Penza State University

Medical Institute

Department of Therapy

"Bleeding in Children"

Penza

Plan

Introduction

1.Nose bleed

2.Bleeding from digestive tract

3.Pulmonary hemorrhage

4.Bleeding from the kidneys and urinary tract

Literature

Introduction

Bleeding and increased bleeding in children are quite common. The causes of bleeding in children are different: traumatic and non-traumatic (increased fragility of the vascular wall, dysfunction of platelets, coagulation and anticoagulation systems, etc.). According to clinical manifestations, bleeding can be divided into external and internal; depending on the nature of the vessels, it can be arterial, venous, mixed, capillary (parenchymal).

1. Nosebleed

Often occurs in children and can be a consequence of trauma (blow, damage to the mucous membrane with a finger, etc.) or a sign general disease(hemophilia, thrombocytopenia, Osler disease, von Willebrand-Jurgens disease, hemorrhagic vasculitis, hypovitaminosis C and K, circulatory failure, etc.). Nosebleeds can occur with infectious diseases(measles, whooping cough, ARVI, influenza, sepsis, etc.), local inflammatory and productive processes (polyps, adenoids, neoplasms, etc.), increased blood pressure.

If you are predisposed to nosebleeds, the resolving factor may be: overheating, sudden head tilts, straining, etc.

Symptoms depend on the nature of the nosebleed (profuse or only an admixture of blood), the location of the bleeding area (anterior, posterior). If the mucous membrane of the anterior parts of the nose is damaged, the blood pours out; if the back parts of the nose are damaged, it is swallowed, simulating gastric and (or) pulmonary hemorrhage. The color of the blood is bright red. If blood is swallowed, bloody vomiting may occur. In cases of heavy bleeding, pallor, lethargy, dizziness, and tinnitus appear.

Urgent Care. Absolute rest, in a half-sitting position with the head moderately thrown back. It is forbidden to blow your nose. Ice or gauze soaked in cold water is placed on the bridge of the nose. Tampons moistened with a solution of 3% hydrogen peroxide, thrombin, or hemostatic sponge and press them to the nasal septum. If the bleeding does not stop, anterior nasal tamponade is performed with a swab moistened with the same solutions. For persistent and prolonged bleeding, posterior tamponade is indicated. At the same time, a 10% solution of calcium chloride or calcium gluconate is prescribed orally (1-5 ml intravenously according to indications), rutin (up to 1 year - 0.0075 g, 1-2 years - 0.015 g, 3-4 years - 0.02 g ., 5–14 years – 0.03 g per day), vitamin C, Vicasol for 3 days, 3–15 mg per day. In case of heavy and persistent bleeding, blood transfusion (including direct) is indicated.

Hospitalization. If the above measures are ineffective, the child must be hospitalized in the otolaryngology department.

2. Bleeding from the digestive tract

The main unifying symptom of bleeding from the digestive tract is bloody vomiting or bloody stools, which are often combined. With minor bleeding and relatively long stay blood in the stomach vomit looks like coffee grounds, in cases of heavy bleeding they contain scarlet blood. After 8–10 and when blood is swallowed, tarry stools are detected. When bleeding from the lower intestines, the stool contains little changed blood. The nature and causes of bleeding from the digestive tract in children largely depend on the age of the child. So, by manifestation hemorrhagic syndrome serves as melena of newborns. In children 1–3 years of age, the most common cause of bleeding is intussusception, Meckel's diverticulum and duplication of the intestine, hernia hiatus diaphragm, from 3 to 7 years – colon polyposis, over 7 years – varicose veins veins, esophagus and stomach, peptic ulcer of the stomach and duodenum, erosive and allergic gastritis.

MELENA OF NEWBORNS is caused by diapedetic bleeding from the capillaries of the stomach or intestines; it is more common in children in the first week of life. It begins suddenly with vomiting of blood and blood in the crimson-colored stool. The general condition may not change, but in some cases melena is severe against the background of severe anemia, continuous bleeding from anus. Differentiate from false melena (swallowing of blood from cracks in the mother’s nipples or from the child’s mouth).

Urgent Care. 0.2 ml of a 1% solution of Vikasol is administered intramuscularly (no more than 4 mg per day), fresh blood is transfused or directly transfused in an amount of 10–15 ml/kg, depending on blood loss.

Hospitalization in all cases of melena is emergency in the neonatal department.

MECKEL'S DIVERTICULUM AND DUPLICATION OF THE INTESTINE. When the mucous membrane of Meckel's diverticulum is ulcerated, intestinal bleeding is observed, often profuse, occurring among full health, repeated at intervals of 3–4 months, which leads to anemia, pallor, tachycardia, and collapse. The first stools are usually dark in color, followed by dark (scarlet) blood without clots or mucus. Unlike gastrointestinal bleeding of other origins, Meckel's diverticulum does not cause bloody vomiting. The diagnosis is made by exclusion. When the intestine is doubled, bleeding from the intestine occurs in almost 1/3 of all cases. X-ray contrast study is required gastrointestinal tract with barium.

Urgent Care. The patient should not be fed. Vikasol is prescribed to children under 1 year 0.002–0.005 g, up to 2 years 0.006 g, 3–4 years – 0.008 g, 5–9 years – 0.01 g, 10–14 years – 0.015 g, 2 possible –3 times orally (1 tablet – 0.015 g) or intramuscularly 1% solution (1 ml – 10 mg); intravenously 1–5 ml of a 10% solution of calcium gluconate or calcium chloride with ascorbic acid (1–3 ml of a 5% solution).

Hospitalization in a surgical hospital (for trial laparotomy) in case of repeated and persistent bleeding.

HEAT HERNIA. This disease in children often manifests itself as persistent vomiting mixed with blood, iron deficiency anemia, the presence of blood in the stool (usually hidden) as a result of erosive-ulcerative esophagitis and gastritis. Constant dysphagic phenomena, pain behind the sternum, attacks of cyanosis, shortness of breath, cough, children are behind in physical development, pale. The diagnosis is helped by percussion detection of areas of tympanitis in the chest, displacement of the borders of the heart in the direction opposite to the hernia; with auscultation in the chest cavity, it is possible to listen to intestinal peristalsis and rumbling.

Urgent Care. Compliance with the diet, Vikasol (see doses above), ascorbic acid, calcium supplements (gluconag or calcium chloride orally or intravenously 1-5-10 ml of 10% solution), in case of severe anemia - blood transfusion.

Hospitalization in all cases of suspected diaphragmatic hernia to the surgical hospital. The diagnosis is confirmed by x-ray examination.

INTESTINAL POLYPOSIS. Occurs more often in children and age 36 years, localized in lower parts large intestine. Bleeding can range from mild to heavy, life-threatening patient (with spontaneous tearing off of the toe), occurs during or after the act of defecation. Even with a slight but constant discharge of blood, pallor appears skin, weakness, tachycardia, indicating anemia. The diagnosis is made when digital examination rectum, sigmoidoscopy and irrigography. With hereditary polyposis (Peutz-Jeghers syndrome) around the mouth and on the mucous membrane oral cavity pigmentation is detected.

Urgent Care. Maintaining a gentle diet, prescribing calcium chloride and ascorbic acid.

Hospitalization in a surgical hospital for any bleeding from the rectum.

VARICOSE VEINS OF THE ESOPHAGUS AND STOMACH. Occurs with portal hypertension. In children, the predominant extrahepatic form of portal hypertension is caused by developmental anomalies portal vein or vascular thrombosis portal system due to pylephlebitis; The causes of the intrahepatic form of portal hypertension in children can be cirrhosis and congenital fibrosis of the liver. Bleeding more often occurs in older children from the veins of the cardial part of the stomach, in these cases it is always threatening, since at the same time, due to liver damage, there are disorders of the blood coagulation system. There is a lot of dark blood in the vomit and stool. Diagnosis is helped by anamnesis (the presence of liver diseases), enlargement of the spleen (possible only in the anamnesis, since against the background of bleeding the spleen can decrease in size and then increase again), examination (dilation of the veins of the anterior abdominal wall, liver enlargement, erythema of the palmar surface of the hands, spider veins on the skin of the face, chest, icterus); in blood tests - the phenomenon of hypersplenism (decrease in the number of platelets, leukocytes, erythrocytes). Differentiated with portal hypertension due to umbilical sepsis, suppurative processes in the abdominal cavity, Chiari disease (suprahepatic portal hypertension), lymphogranulomatosis.

Urgent Care. Place the child in a position with the head elevated and turned to one side to prevent aspiration of vomit. It is necessary to adequately and quickly compensate for blood loss: with blood loss up to 15 ml/kg, you can transfuse donor blood (7–10 ml/kg), rheopolyglucin (10–15 ml/kg) in combination with saline solutions(10 ml/kg); for blood loss of 16–25 ml/kg - transfusion of plasma replacement solutions and donated blood in a ratio of 2:1, with blood loss of 26–35 ml/kg and above, their ratio is 1:1 or 1:2. The total volume of transfusions should exceed blood loss by an average of 20–30%. In the hospital, the veins of the esophagus are compressed using the Blakemore area, it is possible to administer sclerosing drugs (varicocid) through the esophagocope, they begin early introduction oxygen into the stomach and intestines through a probe until slight swelling of the epigastric region and tympanic percussion sound. If unsuccessful conservative treatment Surgery is indicated within 2 days.

Article publication date: 06/08/2017

Article updated date: 12/21/2018

From the article you will learn: what internal bleeding is, why it is dangerous and by what signs it is recognized. Types of internal bleeding and first aid algorithm.

Internal bleeding is an acute life-threatening condition in which, through a rupture in the vessel wall, blood flows from the bloodstream either into the lumen of a hollow organ (uterus, stomach, lungs) or into a cavity artificially created by the volume of leaked blood (for example, intermuscular space). Such bleeding is never an isolated independent disease - but only either a sign or a consequence of the underlying pathological condition.

This pathology often develops as a result of injury or chronic illness. Severe types of such bleeding with large blood loss (more than 1.5 liters) are very dangerous and can lead to fatal outcome. Bleeding with less blood loss (less than 1.5 liters) is still very serious. Spilled blood can compress nearby vessels, disrupting the function of internal organs, exit through the mouth, for example, when stomach bleeding, and be accompanied by other serious manifestations.

Internal bleeding is called because the spilled blood does not flow outside the body. Therefore, uterine, gastric or are not always interpreted as internal; although, given that blood sometimes does not immediately exit through physiological openings - mouth, anus, vagina - it is advisable to classify them as internal.

The general causes, symptoms and treatment of internal bleeding are the same in men and women.

The elimination is carried out by a gynecologist, intestinal - proctologist, pulmonary - thoracic surgeon, post-traumatic - a traumatologist, intracranial - a neurosurgeon.

Late provision of medical care when a person contacts doctors late or has difficulties with differential diagnosis increase the risk to his health, and even life.

Types of internal bleeding

Internal bleeding is classified into many types based on location, cause, time of occurrence, amount of blood loss, etc.

Bleeding categories	Types, description
By location	Intestinal – blood is flowing from intestinal vessels Gastric - into the lumen of the stomach Gastrointestinal – blood loss into the cavity of the esophagus or other hollow organ Hemopericardium - filling the pericardial sac with blood Hemothorax - between the layers of the pleura, i.e. in the slit-like space between the special membranes surrounding each lung Intracranial Hemarthrosis – in the joint
According to the area of blood accumulation	Interstitial - into tissues adjacent to the vessel Abdominal - into the cavity of the peritoneum, pleura
According to the signs and characteristics of detection	Hidden - hemorrhage into the cavitary organs and cavities that communicate with external environment, For example bladder or lungs. But there are no obvious symptoms of bleeding; it can only be detected with the help of special diagnostics Explicit – easily determined by visual inspection
By origin	Mechanical – with traumatic damage to tissues and blood vessels of internal organs Arrosive - when the vascular wall is damaged due to the germination or disintegration of a neoplasm, a destructive or necrotic process (with tissue death) Diapedetic - with blood leaking through vascular wall for scurvy, scarlet fever, malaria
By volume of leaked blood	Lung – blood loss no more than 500 ml Average – 0.5–1 l Severe – blood loss is no more than one and a half liters of blood Massive – up to 2.5 l Lethal - from 2.5 to 3 l Absolutely lethal - over 3–3.5 l
Taking into account the type of damaged vessel	Capillary - from capillaries Venous – when the vein wall ruptures Arterial - from an artery Mixed - from different vessels Parenchymal - blood pours out from the vessels of a parenchymal organ (these are the spleen, liver, lungs, pancreas, kidneys and others - these are internal organs built from solid tissue)
According to development period	Primary – immediately after injury Secondary – some time after the injury. In the first 1–5 days it is considered early, after 10–15 days – late

Hemothorax

Causes of internal bleeding

Each type of bleeding has its own causes, the most common of which are injuries and illnesses in acute or chronic form.

Hemorrhage is caused by:

Open and closed injuries abdomen and lumbar region with damage or rupture of internal organs, most often the spleen or liver, less often the intestines and pancreas. Massive bleeding in abdominal cavity cause a blow during a fight or during a car accident, compression - when pressed down heavy object and so on.
Fractured ribs lead to bleeding into the pleural cavity.
Traumatic brain injury. Bleeding inside the skull is life-threatening because the volume cranium limited. Any hematoma leads to compression of brain structures and serious consequences. It can develop not only immediately after an injury, but also several hours or days after it.
Chronic diseases of the digestive tract. Bleeding into the cavity of the corresponding organ occurs with erosive gastritis, cirrhosis of the liver, peptic ulcer, malignant tumor process, the formation of a through hole in an ulcer of the duodenum or stomach.
Gynecological diseases and pathological conditions– apoplexy (rupture) of the ovary, ectopic pregnancy, malignancy, rupture of an ovarian cyst. In obstetrics and gynecology uterine bleeding may cause abortion, breech presentation or premature detachment placenta. It can begin after childbirth due to rupture of the birth canal or uterus, late release of the placenta.
Hemophilia – hereditary disease men with a malfunction of the blood clotting process.

Symptoms

Symptoms depend on the amount of blood loss and its location. There are general signs and characteristic of a particular species.

General symptoms of blood loss

Common signs of internal bleeding are weakness, darkening or clouding of the eyes, drowsiness, dizziness, cold sweat, and thirst. Loss of consciousness is possible. The intensity of blood loss is determined by pulse rate, blood pressure and characteristic complaints of the patient.

Minor blood loss often does not manifest itself at all, but in some people the pulse increases slightly and decreases slightly arterial pressure(HELL).
Manifestations of moderate bleeding: heart rate up to 100 beats per minute, decrease in systolic pressure to 80 mmHg. Art., moderate shortness of breath, dry mouth, cold hands and feet, cold sweat, dizziness, severe weakness, slower reactions, fainting.
With severe blood loss, symptoms are more pronounced. A drop in blood pressure of more than 80 mmHg is noted. Art., tachycardia more than 110 beats per minute, shortness of breath, hand tremors, excruciating thirst against the background of a decrease in the volume of urine excreted, apathy. There may also be a sharp pallor of the mucous membranes and skin, cyanosis of the limbs and the area around the lips, clouding or loss of consciousness.
Among clinical manifestations massive hemorrhage, blueness of the skin and mucous membranes, confusion, and delirium are observed. They fall inside eyeballs, facial features become sharper, pulse reaches 160 beats per minute, blood pressure drops to 60 mm Hg. Art.
For fatal and absolutely fatal blood loss we're talking about already about a threat to life. The pupils dilate, convulsions appear, the number of heart beats (bradycardia) sharply decreases to 2–10 beats per minute, breathing becomes agonal, urine is spontaneously released and feces. The patient falls into a coma, his skin is dry, pale with a marbled pattern. The result is agony, death.

Signs of hemothorax

Hemothorax is the entry of blood into the pleural cavity. In addition to general symptoms, it manifests itself as sharp pain in the problem area, difficulty in breathing, cough with foamy bloody sputum. On x-ray, the mediastinum (the space in the middle of the chest cavity) is shifted towards the healthy lung.

Signs of uterine bleeding

Symptoms of internal bleeding in women can be pulling, bursting or sharp pains lower abdomen with irradiation to the lower back and anus, the urge to defecate, a feeling of swelling of the mucous membranes.

Signs of hemorrhage in the urinary and digestive organs

Tar-colored chair foul odor– melena – speaks of bleeding from upper section intestines or other digestive organs.
When there is a hemorrhage in the stomach, a person begins to vomit with bloody clots; into the lumen of the duodenum, it becomes the color of coffee grounds.
Bleeding from hemorrhoids appears bright bloody discharge from the anus.
Blood entering the kidney area urinary tract, comes out in the urine - hematuria.

First aid for internal bleeding

For any type of internal blood loss, you should immediately call an ambulance. Although with mild blood loss a person himself can reach medical institution and get help, but it’s better not to take risks, because it is unknown whether the bleeding has stopped, whether the general condition will worsen further or not.

From the correctness of rendering first aid often a person's life depends. Before the doctors arrive, the patient must be laid down; further actions must be carried out only after he has assumed a horizontal position, and in case of hemothorax, a semi-sitting position. Apply ice to the area of the suspected source of the problem, focusing on the complaints. Then, as quickly as possible, transport the victim in this position to the nearest medical facility. institutions or wait for the ambulance to arrive.

It is strictly forbidden to: heat the bleeding area, apply a pressure bandage, insert suppositories, use laxatives, do an enema (if intestinal bleeding), offer to drink painkillers and medications that stimulate the heart.

Neglecting the above steps can lead to increased blood loss and death.

Inpatient medical care

Based on symptoms and primary medical examination, presumably they find out which organ was damaged, and the patient is hospitalized in the appropriate department. If there are objective symptoms of large blood loss, go to intensive care.

Main goals of treatment:

Stopping bleeding.
Restoring the lost volume of blood constantly circulating in the body (BCV).
Normalization of microcirculation.

Often massive blood loss can be stopped by performing emergency surgery:

in case of a stomach ulcer, its resection is carried out - part of it is removed along with the ulcer;
for pneumothorax, a thoracotomy is performed - the chest is opened, the cause of bleeding is found and eliminated;
in case of a hematoma in the cranial cavity, trepanation is performed: through holes made in the bones of the skull, the neurosurgeon gains access to the structures of the brain and the resulting hematoma, from which the blood is sucked out;
in some cases, internal bleeding can be stopped by performing tamponade: for example, to tamponade the bronchus, a sterile gauze swab or foam sponge is inserted into it through a bronchoscope.

To replenish the bcc, intravenous drips are administered infusion solutions, blood substitutes, blood products. The remaining funds are used for their intended purpose.

The prognosis depends on the competent provision of pre-medical and timely medical care.

Bleeding in a child occurs due to dysfunction of blood clotting processes. There are whole groups and subgroups this state. There is bleeding that appears instantly or lasts a long time without visible signs. There are also bleedings that occur as a result of various diseases of the internal organs, internal hemorrhage occurs.

With blood diseases, some children have impaired clotting function. Spontaneous hemorrhages are observed, and also with ordinary injuries the bleeding does not stop for a long time. Required in fast deadlines stop the bleeding and find out the cause of the appearance, otherwise irreversible consequences may occur, which will lead to an unfavorable outcome.

In children, gastric or gastric symptoms are the least common, but the most common is discharge. There are several factors that cause nosebleeds:

Increased level of inhaled air temperature;
Specific location of the child's head;
Minor injuries to the nose during games;
Presence of infectious agents.
Body of foreign origin;
Violation of the mucous membrane of the nasal septum (telangiectasia);

Recently, cases in children have become more frequent, as a result of which nasal hemorrhages also occur. The child must be examined by a pediatrician to exclude such a pathology.

Internal

The most the most important reasons the appearance of internal bleeding in children:

Various injuries;
Infectious diseases;
Diathesis of hemorrhagic origin;
Heart pathologies;
Respiratory failure and other diseases lung tissue.

Most common cases internal bleeding in children they affect the respiratory and digestive systems.

Hemophilia

Bleeding is often inherited. Such a disease is hemophilia. But it should be taken into account that this pathology occurs exclusively in males, in boys. The female sex is a carrier, so girls do not suffer from this pathology.

There are many factors that can cause bleeding in hemophilia. These factors include:

Minor cuts or abrasions of the skin;
Trauma to the mucous membrane of the nasal and oral cavity;
Idiopathic blood from other parts of the body.

It should also be noted that there is another disease in which there is a high risk of bleeding - thrombopenic purpura. Blood can be released from the lungs from the lung tissue of a child.

Symptoms

Clinical manifestations of hemorrhage in children depend on the nature of blood loss, the cause of the disease, and the type. If this is a factor of injury, then the release of blood is temporary. In this case, it is enough to stop the bleeding (hemostasis).

Depending on the severity of the injury, bleeding can be arterial, venous or capillary in nature.

If your child is experiencing blood loss long time, the following symptoms may be observed:

Apathy;
Weakness;
Loss of consciousness;
Hemorrhagic shock.

Of all the blood losses, the most dangerous is recurrent bleeding. With this condition, the child experiences anemia, with further development. With frequent blood loss, the following is observed:

Deterioration general condition child;
Anemic state of the body;
Fatigue, weakness.

So, based on this, the most dangerous bleeding is something that is repeated again and again. In this case, you need to urgently contact medical care, to identify the etiology of the pathological process.

Diagnostics

In order to make a diagnosis, it is necessary to examine the child completely. When a doctor examines a baby, he pays attention to certain clinical signs. If there is an injury, there is bleeding.

If the cause of bleeding was the penetration of infection into the child’s body, then this process should be stopped. In order to identify infections in a child, it is enough to conduct some diagnostic tests:

General blood analysis;
Stool analysis;
General urine analysis.

If you need to check hereditary predisposition, then you need to carefully study the history of the child and parents. After all, in this way it is possible to clearly determine the history of the pathology that is observed in the baby.

At various diseases heart, you need to do a cardiogram. This method will make it possible to determine what is bothering the patient and what is the cause of the symptoms. An echogram is also needed for heart disease. In order to study a child’s blood pressure, it is necessary to use a tonometer, a simple and painless diagnostic method.

If a child is suspected of having thrombopenic purpura, a clinical study should be conducted. As a result of the disease you can observe:

A sharp decrease in platelets in the blood;
Enlargement of the spleen (splenomegaly).

There is a duration of bleeding according to Duque. If there is a violation in time, that is, more than 4 minutes, then this is already a violation of clotting.

If a child has a strong suspicion that blood in the cavity is due to tuberculosis, then the sputum needs to be examined. This is a 100% method that gives a positive or negative answer. If the doctor does not understand enough about baby's lungs, then you need to carry out X-ray examination lung tissue. This is necessary if pulmonary tuberculosis is suspected.

Treatment and first aid

How to stop bleeding? If your child is bleeding, here are some things you can do: It is necessary to calm the baby and create optimal condition for his general condition. At the same time, it is necessary to speed up the search for the origin this bleeding. It is also necessary to quickly stop bleeding in children.

If a child is diagnosed with bleeding from the nose, then you need to take Urgent measures. These actions include:

Place the baby in an elevated position;
Throw your head back;
Do not let the child blow his nose;
Avoid picking in the nasal cavity.

It is urgently necessary to plug the nasal passage with cotton. But under no circumstances should the cotton wool be dry. You need to wet the tampon with liquids such as table vinegar, hydrogen peroxide, and raw meat. If a child has a minor injury, the bleeding will normally stop quickly.

If observed strong discharge from the nose, you need to carefully press the nose towards the septum (press on the nasal wings).

Ingestion;
Cacl 10% taken orally;
Give your baby a drink containing salt and water.

If you give a solution table salt, a certain proportion should be adhered to. For one mug of water there is about one teaspoon of regular salt. You need to drink in doses, drink one tablespoon of this liquid every hour. As for a solution such as calcium gluconate, you need to drink 2 dessert spoons per day.

Gastrointestinal bleeding in children is quite common and can occur from mechanical damage Gastrointestinal tract inadvertently swallowed sharp objects and aggressive liquids, and can be a symptom of a very serious disease. The health and often the life of the baby depends on how quickly parents take action. Of course, self-medication is unacceptable here; you should immediately consult a doctor.

The causes of such bleeding may be different. In children under three years of age, the reasons may be:

intussusception is a type intestinal obstruction caused by the ingrowth of one section of the intestine into another;
Meckel's diverticulum is a protrusion of the intestine into weak point and the formation of the so-called “abnormal sac”;
doubling of the large intestine, which may be accompanied by doubling of other organs;
hiatal hernia in the diaphragm.

In children under seven years of age the reasons gastrointestinal bleeding there may be polyps in the intestines, usually they occur in the rectum and sigmoid colon.

In children over seven years of age, the reasons may be:

stomach ulcer, duodenal ulcer;
various types of gastritis;
ulcerative colitis;
bleeding from varicose veins in different parts of the gastrointestinal tract;
thermal ileitis or Crohn's disease, this is an inflammation of the ileum small intestine, accompanied by the appearance of ulcers and polyps and destruction of the mucous membrane.

In addition, in children of all ages, bleeding can occur if they swallow any hard or sharp objects, as well as aggressive liquids. It is also possible to contract dysentery or typhoid fever. Infants may have blood in their stool if the mother has cracks in her nipples and through them her blood enters the baby's intestines.

There are several blood diseases that are also characterized by bleeding in the gastrointestinal tract. There can be many reasons for bleeding and parents should not make a diagnosis themselves. Their task is to notice the beginning of bleeding in time.

Symptoms of stomach bleeding in children

Sometimes the warning signs of bleeding are sharp deterioration child's condition. All signs of blood loss occur: lethargy and weakness, the child feels dry mouth and extreme thirst, the skin and mucous membranes become pale, a rapid heartbeat appears, and blood pressure may decrease.

And if bloody vomiting appears, as well as bloody stools, or all together, then this is already acute stage diseases. Moreover, by the color of the blood you can understand in which part the bleeding occurred. If bloody vomiting occurs, the bleeding cannot be below the duodenum. There is red blood in the vomit, if the bleeding is in the esophagus or stomach, if it is dark, then the source of bleeding is further away.

If there is blood in the stool, then the bleeding has occurred in the lower gastrointestinal tract. Dark blood in the stool or even black stool indicates bleeding in the ileum or colon. If the blood in the stool is bright, this indicates that it entered the stool from the rectum or from the anal fissures.

Emergency care for gastric bleeding in children

If these signs appear, you should call an ambulance as soon as possible. Before her arrival, it is necessary to put the child to bed, apply ice to the site of suspected bleeding, and you can even let the child swallow pieces of ice. When vomiting, place the head on one side to prevent the child from choking. There is no need to water or feed the child; you also cannot rinse the stomach or give an enema.

Treatment

The doctor determines the child’s treatment after full examination patient, it is usually performed inpatiently. Depending on the intensity of the bleeding, treatment may be therapeutic for mild or surgical for severe. The operation allows you to identify the focus heavy bleeding and take measures to eliminate it. This can be ligation of veins, or the application of a sigmostoma (this is the removal of a piece of intestine outside), or resection of part of the stomach or intestines. In any case, the treatment is long and serious; restoring the child’s health after surgery requires great dedication from the parents.

Conservative treatment is more gentle and consists of a number of therapeutic measures:

for bleeding resulting from burns chemicals, perform gastric lavage with neutralizing substances;
administration of medications to help stop bleeding;
removing blood from the gastrointestinal tract using a probe or, if there is no danger, using enemas;
restoration of blood loss, usually carried out by transfusion of donor blood;
general support for the body. Since feeding the child on the first day is not recommended, therefore a mixture of glucose and saline is administered intravenously, starting from the second day they begin to feed carefully dietary food recommended by a doctor;

diagnosis and treatment of the disease. Usually this stage is long-term, treatment continues even after the child has been discharged from the hospital. Here, parents are required to strictly follow the recommended treatment.

Emergency care for children with bleeding

Blood is unique liquid tissue, the quantity of which is strictly limited. The blood volume of a newborn child is 500 ml, an adult’s is about 5 liters, and every drop of this volume is priceless. Any blood loss is not indifferent to a person: small bleeding is stress for the body, massive bleeding is a threat to life and health. Bleeding is especially difficult for children and adolescents - it is for them that even a relatively small loss of blood can turn into a big disaster. How not to miss bleeding in a child and stop it correctly? Let's find out...

The cause of bleeding is a violation of the integrity blood vessel– artery, vein or capillary. Moreover, damage to the vessel does not necessarily result from injury or injury - the cause of bleeding can be the rupture of a vessel under the influence of high blood pressure (nosebleeds), damage to blood vessels by a growing tumor, exposure to medicines(gastrointestinal bleeding). The amount of blood loss depends on the type and caliber of the vessel (bleeding from arteries is more abundant than bleeding from veins and capillaries), as well as on the duration of blood loss. Sometimes damage to a relatively small vessel leads to the development of anemia and other severe complications due to late detection of bleeding. The nature of first aid for bleeding depends on the location of the bleeding vessel (external or internal bleeding), the type of vessel (artery, vein, capillary, vessels of internal organs) and the intensity of blood loss. It is always easier to recognize and stop external bleeding than internal bleeding, since with internal bleeding, blood is usually not visible, only symptoms of blood loss are visible.

Capillary bleeding . The most common reason capillary bleeding minor injuries occur - cuts, scratches and abrasions. For an adult, such an injury and the associated bleeding are insignificant, and they are not always paid attention to. But for a child’s body there are no insignificant injuries and bleeding - therefore, even in such a “frivolous situation”, first aid should be provided to the victim.

First aid.

Regardless of the location, the abrasion is washed with hydrogen peroxide, the skin around the wound is treated with an antiseptic (iodine, brilliant green) and a sterile napkin is pressed against the wound for a while to stop bleeding. If the abrasion is localized on the skin of the abdomen, chest or head, it is necessary to exclude internal bleeding, damage to the brain and internal organs - for this, the child must be shown to a specialist.

Venous bleeding . As the name suggests, this type of bleeding occurs when the veins are damaged. For those who don’t know: veins are vessels that carry blood from internal organs and different parts body to heart. Venous blood is oxygen-poor and rich in carbon dioxide, so its color is dark red. The blood pressure in a vein is relatively low (much less than the pressure in an artery), so deoxygenated blood relatively slowly flows out of the vessel, spreading over the skin. However, this does not mean that venous bleeding is harmless - if a large vein is damaged, blood loss can reach life-threatening levels within a few minutes.

First aid.

The most in a simple way stopping venous bleeding is pressure on the damaged vessel - as a result, the vein is pinched, the bleeding decreases or stops. You need to apply pressure to the bleeding vein and, accordingly, the wound, with a sterile napkin or a roll of a sterile bandage; in the absence of which, you can use a clean handkerchief or any other piece of clean cloth. If there is no other way out, you can apply pressure to the wound with your palm or fingers. Pressing the vessel to stop bleeding can only be used as a temporary measure - a pressure bandage should be applied to the wound as soon as possible.

Starting to apply a pressure bandage, take several sterile napkins or a roll of sterile bandage, press them tightly to the wound and, without releasing the pressure, firmly bandage it to the body with several tight rounds of bandage. If the bandage is applied correctly, bleeding significantly decreases or stops.

As additional measures To stop venous bleeding from the vessels of the limb, temporary clamping of the vessel below (!) the wound and elevated position of the limb are used.

If the veins of the neck are damaged, applying a conventional pressure bandage is impossible, since such a measure threatens suffocation. In this situation, the child’s hand on the side opposite to the location of the wound is tilted upward, towards the head, and a pressure bandage is applied to the neck, grabbing the hand on the healthy side and using it as a support.

Even if actions to stop venous bleeding are completely successful, the child must be shown to a doctor. To prevent wound infection and recurrent bleeding, the doctor will clean the wound and apply stitches.

Arterial bleeding . Arterial bleeding is the most dangerous look bleeding. It is characterized by the bright scarlet color of the blood, the release of blood from the wound under pressure (a pulsating stream or fountain), rapid rates of blood loss and a high risk of developing shock. Most often, arterial bleeding accompanies injuries to the extremities, including limb avulsion.

First aid.

You need to act quickly and clearly - the rate of blood loss during arterial bleeding They don't give you time for a second try. The first step is to lift and strongly squeeze the limb above (!) the wound - you will have to press really hard, since the arteries are located deep in the tissues and are protected by muscles. If you are injured in the lower leg, foot, forearm or hand, maximum flexion of the leg or arm at the knee or elbow joint and fixing the limb in this position. While continuing to apply pressure on the artery, apply a pressure bandage according to the same rules as for venous bleeding(usually the second rescuer applies the bandage).

After the bandage is applied, we gradually reduce the pressure on the vessel and see what happens. If the bandage remains dry or the amount of blood on it does not increase, measures to stop the bleeding were successful; further actions are up to the doctor. If after applying a pressure bandage the bleeding does not stop, it is necessary to apply a hemostatic tourniquet. The purpose of applying a tourniquet is to press the affected vessel to the bone, so the tourniquet is applied to that part of the limb where there is one bone - femur, shoulder. There is no point in applying a tourniquet to the lower leg or forearm - the vessel will not be crushed and bleeding will continue.

When an artery is injured, a tourniquet is always applied above the injury site. The pressure must be sufficient, but not excessive, otherwise there will be traumatic injury nerves, and as a result, dysfunction of the limb. The tourniquet on the limb is tightened until the pulse disappears in the wrist or foot (provided that you can determine the pulse) or until bleeding from the damaged vessel stops. Any long, strong and elastic object can act as a tourniquet - a wide rope, a trouser belt, a belt, a tie, a headscarf. It is not recommended to apply a tourniquet to a naked body - be sure to place any cloth, towel, or piece of clothing under it. After applying the tourniquet, record the time of application - the time factor in this case is very important. The tourniquet should not compress the limb for a long time, as this can lead to irreversible changes in the tissues of the limb. in winter safe period does not exceed 30 minutes, in summer – 1.5 hours. In this case, regardless of the time of year, every 15 minutes the pressure of the tourniquet must be slightly loosened until blood circulation is restored, and then tightened again.

Typically, the application of a hemostatic tourniquet is required in following situations: traumatic amputation (severance) of a limb; a large number of victims and there is no time to use other methods to stop bleeding; the injury to the limb is so significant that it is impossible to determine the type of bleeding; other methods of stopping bleeding are ineffective.

After the bleeding has stopped, while waiting for the ambulance to arrive, the victim must be laid down, if he is conscious, calmed down, warmed up and given hot tea. To maintain normal blood supply to the brain and internal organs, it is recommended that victims with a large volume of blood loss be placed on their back, without a pillow, with their legs elevated 115-20 cm. If your arm is injured, make sure that the injured limb is also in an elevated position.

Let's say a few words about the features of providing assistance to a child with life-threatening traumatic amputation (severance) of a limb or some part of the body. First aid measures in such a situation boil down to stopping the bleeding using any available methods: compression of large vessels supplying blood to the affected area of the body, application of a pressure bandage or hemostatic tourniquet. A sterile bandage is applied to the wound, and the limb is fixed. After the patient’s condition ceases to cause concern, it is imperative to find the severed part of the body so that microsurgeons can subsequently sew it back (this is especially important for children and adolescents). The severed body part (amputee) must be cleaned of visible contaminants or washed, and applied to the place where it was torn off. sterile bandage, put the amputee in a plastic bag, which must be placed in another bag filled with ice, snow, cold water. Such measures will keep the tissue viable for approximately 18 hours. Be sure to include a note in the first bag indicating the exact time of injury and the start of cooling. Do not freeze the rejected part in the refrigerator or freezer.

Internal bleeding, bleeding from internal organs . Internal bleeding can be caused by damage to vessels located outside the organs or damage to the internal organs themselves. Most often, internal bleeding accompanies injuries to the abdomen, lower back, chest and head, but can also be a complication of certain diseases - erosive gastritis, peptic ulcer of the stomach and duodenum (gastrointestinal bleeding), pulmonary tuberculosis (pulmonary bleeding). General symptoms internal bleeding are weakness, rapid heartbeat, cold sticky sweat, impaired consciousness, pallor, pain at the site of the damaged vessel (not always). When bleeding into the abdominal cavity, the child takes a forced position - lying on his side with his knees bent and his legs pressed to his stomach. When bleeding into the lumen of the gastrointestinal tract, vomiting blood appears (vomit may be red or brown due to contact of blood with gastric juice) And bloody diarrhea(usually black). Bleeding into the pleural cavity is accompanied by compression of the lung, which is manifested by shortness of breath, blue lips, the child tries to take a sitting or semi-sitting position. A symptom suspicious for kidney damage is the appearance of blood in the urine.

First aid.

First of all, the child must be ensured peace - try not to move the victim unless absolutely necessary. If there is a chest injury, help the child take a semi-sitting position; if there is an abdominal injury and gastrointestinal bleeding is suspected, help the child take a supine position. Place cold on the site of injury - chest, abdomen or lower back - and do not give water or food to the child. Provide access fresh air and at the same time, keep the baby warm. Ambulance should be called immediately after injury - than more like a child will receive qualified assistance, the greater his chances of recovery.

Nose bleed . The causes of nosebleeds are injuries, diseases of the nose (deviated nasal septum, polyps, tumors) and systemic diseases (arterial hypertension). Nosebleeds often occur suddenly and can vary in intensity and duration.

First aid.

The child must be seated, tilt his head forward, press his nostrils with his fingers, put cold on the bridge of his nose and leave in this position for 10 minutes. You cannot force a child to throw back his head - blood from the nose can get into the larynx and trachea, which is undesirable. If the above measures did not stop the nosebleed or the bleeding recurred after some time, immediately show the child to the doctor.

Hemoptysis . Hemoptysis is the release of blood with or without sputum during a cough. The most common reasons hemoptysis are pulmonary tuberculosis, bronchitis, pneumonia, tumors of the respiratory system, foreign bodies, caught in respiratory system. The basis of hemoptysis is pulmonary hemorrhage, so hemoptysis is often accompanied by typical signs blood loss: weakness, drowsiness, pale skin, cold sweat, rapid heartbeat, shortness of breath.

First aid.

When helping a child with hemoptysis, it is necessary to sit him down, calm him down, and provide access to fresh air. A heating pad with ice should be placed on the chest, and at the same time the child should be given small sips to drink. cold water or swallow very small pieces of ice. In this case, an early consultation with a doctor is vital.

Finally

Heavy bleeding is the most dangerous situation, which only a child can get into, and all hope in this case is on the adult closest to the place of injury. Massive external bleeding usually makes a strong impression on others, and despite this, it is necessary to act quickly and clearly. Do not panic under any circumstances and remember that the life of a wounded child depends on your actions in the next few minutes. Take care of your health!