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Acute gastrointestinal bleeding (clinic, diagnosis, therapy). Gastrointestinal bleeding

Gastrointestinal bleeding is not an independent disease, but a complication of many diseases gastrointestinal tract. Assistance for gastrointestinal bleeding should be provided as quickly and fully as possible, since this is a serious complication, especially severe cases it can lead to fatal outcome.

Causes of gastrointestinal bleeding

The cause of gastrointestinal intestinal bleeding is damage to the wall of the gastrointestinal tract involving a blood vessel or small capillaries in any of its sections. The most common causes of gastrointestinal bleeding are the following diseases:

Stomach and duodenal ulcers;
Haemorrhoids;
Tumors, both benign (polyposis) and malignant (cancer) in any part of the gastrointestinal tract;
Varicose veins of the esophagus;
Cracks in the mucous membrane of the esophagus;
Anal fissures;

Gastrointestinal bleeding in children is most often caused by trauma to the esophagus or stomach, including chemical burns, as well as hemorrhagic disease of the newborn.

Types of gastrointestinal bleeding

Gastrointestinal bleeding is distinguished from the upper part of the gastrointestinal tract, which includes the esophagus and stomach, and the lower part, consisting of the intestines.

Gastrointestinal bleeding in duration can be:

One-time (episodic);
Recurrent (periodically renewed);
Chronic (permanent).

By form:

Sharp;
Chronic.

By nature of manifestation:

Hidden;
Explicit.

Symptoms of gastrointestinal bleeding

General symptoms of gastrointestinal bleeding are similar to symptoms of blood loss in general. These include pallor skin, weakness, tinnitus, cold sweat, tachycardia, shortness of breath, dizziness, spots before the eyes, decreased blood pressure. Pain, or an increase in existing pain, is not characteristic of gastrointestinal bleeding.

The nature of the released blood itself depends on which particular part of the gastrointestinal tract the integrity of the blood vessel was violated, and on whether the bleeding is hidden or obvious.

First, let's focus on obvious gastrointestinal bleeding.

Gastrointestinal bleeding from the upper gastrointestinal tract manifest themselves by bloody vomiting (hematemesis). Vomiting may contain unchanged blood, which is typical for bleeding from the esophagus, or may look like coffee grounds if the bleeding occurred in the stomach, characteristic appearance it is given by blood that has coagulated under the influence of hydrochloric acid. However, gastric arterial bleeding significant force may also have the form of vomiting with unchanged blood, since the blood does not have time to coagulate.

Gastrointestinal bleeding from the small intestine and colon may manifest itself either as “coffee grounds” vomiting or as melena – bloody diarrhea, having a tar-like consistency and black color. Melena may continue for several days after bleeding in the upper gastrointestinal tract has stopped, and tarry stool will be released as the contents move through the intestines.

If bleeding occurs in the lower gastrointestinal tract ( colon, rectum, anus), then it manifests itself as bloody stool (hematochezia). In this case, the feces contain an admixture of constant scarlet blood, sometimes in significant quantities. However, sometimes bloody stools can occur when there is significant bleeding in the small intestine, when due to large quantity blood moves the contents of the small intestine very quickly.

Hidden gastrointestinal bleeding is detected when laboratory research feces and gastric juice. Hidden bleeding from upper sections The gastrointestinal tract may look like an admixture of black flakes in the vomit; in all other cases, it is invisible to the naked eye, and only manifests itself common features increasing anemia.

There is no particular difference in the manifestation of gastrointestinal bleeding in children and adults, only anemia in children develops much faster, and due to the body’s lower compensatory capabilities, the consequences can be more dangerous.

First aid for gastrointestinal bleeding

If acute bleeding occurs, first aid for gastrointestinal bleeding is as follows:

Call as soon as possible ambulance;
Immediately put the patient to bed;
Avoid the entry of any substances into the gastrointestinal tract, including water, medications and food;
Place an ice pack on your stomach;
Provide access fresh air to the room where the patient is lying;
Ensure constant monitoring of him until the ambulance arrives, without leaving him alone.

First aid for gastrointestinal bleeding in children does not differ from that in adults. It is important to provide peace for the child, which is somewhat more difficult than for an adult, especially if the child is small. If gastrointestinal bleeding in children is suspected to be caused by trauma, it is necessary to try to determine the traumatic factor (sharp object, chemical substance) as accurately as possible.

Emergency medical assistance for gastrointestinal bleeding depends primarily on the severity of the bleeding and its nature, as well as on the condition of the patient. In the event that the bleeding is significant, with scarlet (arterial) blood, and it cannot be stopped within a certain time by conventional means, the patient is taken to the emergency surgery department.

Treatment of gastrointestinal bleeding

Treatment of gastrointestinal bleeding, depending on its nature, is carried out with surgical or conservative means.

In case of significant bleeding, if it is not possible to stop the blood loss, resort to resuscitation techniques and emergency surgery. Before surgery, it is desirable to at least partially replenish the volume of lost blood, for which purpose infusion therapy, by intravenous infusion of blood products or blood substitutes. In case of a threat to life, emergency surgery without such preparation is possible. The operation can be performed either classically, open method, and endoscopic (FGS, laparoscopy, sigmoidoscopy, colonoscopy), depending on the indications. Surgical treatment of gastrointestinal bleeding consists of ligating the veins of the esophagus and stomach, applying a sigmostoma, resection of a section of the stomach or intestine, coagulation of the damaged vessel, etc.

Conservative treatment gastrointestinal bleeding consists of the following activities:

Administration of hemostatic agents;
Evacuation of blood from the gastrointestinal tract by introducing a nasogastric tube and cleansing enemas (if the bleeding is not from the lower gastrointestinal tract);
Replenishment of blood loss;
Support of vital body systems;
Treatment of the underlying disease that led to bleeding.

Video from YouTube on the topic of the article:

Gastric or gastrointestinal bleeding is commonly called pathological condition, accompanied by a violation of the integrity of the choroid plexuses of the mucous membrane of pathologically changed areas of the stomach or intestines with the leakage of blood beyond the bloodstream into the lumen of these organs. Similar condition is very dangerous as it can be fatal. This is due to the rich blood supply to the gastric and intestinal walls, high intensity of blood flow and pressure in the vessels. When their integrity is compromised, this can lead to intense bleeding and large blood loss.

Danger of blood loss

When blood begins to leave the vascular bed, they go along with it vitality and energy. The faster this happens, the worse the prognosis for the patient. After all, the symptoms of gastric bleeding completely depend on several factors:

Localization of the source of bleeding;
Diameter and number of bleeding vessels;
General blood pressure level;
Disease that caused bleeding;
The general condition of the patient, his age and concomitant diseases.

During bleeding, the body loses a certain volume of circulating blood. In this case, both red blood cells and blood plasma are lost. This affects the supply of blood, oxygen and nutrients all organs and tissues. Arises oxygen starvation, first of all, sensitive systems - nervous and cardiovascular. Centralization of blood circulation occurs, during which all small vessels skin, limbs and secondary organs. Thus, the body tries to maintain blood circulation in the most vital important systems(heart and brain). If the bleeding is not stopped in time, this will inevitably lead to the gradual death of the body.

In the case of chronic blood loss, there is a loss not so much of the volume of circulating blood, but of red blood cells. This condition is not dangerous with an immediate threat to life, but provokes the development of posthemorrhagic anemia (decrease in the amount of hemoglobin and red blood cells), which impairs normal functioning all organs and the general condition of the body. The more pronounced its degree, the brighter the clinical manifestations.

Signs of stomach bleeding

The main thing with any type of gastric bleeding is their timely detection. With massive, acute bleeding, there are no problems with diagnosis. Their manifestations are so vivid that they immediately indicate correct diagnosis as soon as they arise. The situation is completely different with chronic bleeding. At the same time, the person long time may not notice secondary symptoms until it breaks general state.

Symptoms on the basis of which gastrointestinal bleeding can be suspected look like this:

Vomiting of blood, clots, brown matter like coffee grounds;
Nausea preceding vomiting;
Formed stool is black (tarry);
Liquid, bloody or dark cherry-colored stool (melena);
Falling blood pressure numbers (arterial hypotension);
Frequent heartbeat and pulse (tachycardia);
Pale skin and mucous membranes;
Dizziness and general weakness;
Fainting and confusion are the most dangerous signs.

It is important to remember that bleeding into the lumen of the gastrointestinal tube differs from internal bleeding in that when last blood flows into abdominal cavity. In this case, there is no direct contact of blood with air. Therefore, it can be reinfused into the patient by intravenous infusion. With stomach bleeding this is not possible. They usually begin involuntarily, without any previous symptoms. If a large vessel is involved, then vomiting and a disturbance in the general condition develop simultaneously. If the bleeding is gradual, then signs of blood appearing in the cavity of the digestive tract come to the fore. The general condition deteriorates with increasing anemia.

The main symptoms of any gastric bleeding consist of the appearance of bloody contents during vomiting or stool. The more active the bleeding, the more severe these symptoms are.

Peptic ulcer of the stomach and duodenum - main reason stomach bleeding

Causes of stomach bleeding

Gastrointestinal bleeding is rarely an independent disease. They usually complicate the course of various pathological processes in the stomach and intestines. They are the direct causes of bleeding into the cavity of the gastrointestinal tract. Such diseases include lesions of the abdominal organs, listed in the table.

Pathology of the esophagus	Ruptures of the mucous membrane (Mallory-Weiss syndrome); Tumors; Varicose veins due to severe liver disease (cirrhosis); Erosive esophagitis (inflammation with the formation of small ulcers);
Stomach diseases	Stomach ulcer; Erosive and hemorrhagic gastritis; Bleeding polyps and cancerous tumors;
Damage to the duodenum	Duodenal ulcers; Erosive duodenitis; Pancreatic cancer growing duodenum;
Small intestinal pathology	Acute stress ulcers of the small intestine; Autoimmune diseases accompanied by hemorrhagic vasculitis with damage to the small intestinal vessels; Diverticulitis is inflammation of additional protrusions in the small intestinal wall;
Damage to the large intestine and rectum	Ulcerative colitis; Crohn's disease; Severe infectious and inflammatory bowel diseases; Tumor diseases; Haemorrhoids.

Regardless of the cause of gastrointestinal bleeding, you need to remember the most important thing - this condition is a complication. Therefore, having identified it, you must definitely look for primary cause. This is the only way to fully eliminate the problem and prevent its recurrence.

Diagnostics

All additional methods The studies that the patient must go through consist of a diagnostic complex that will help exclude internal bleeding:

Constant monitoring of blood pressure and pulse;
General clinical blood test. Important indicators are hemoglobin, red blood cells and hematocrit (the percentage of the liquid part of the blood to the formed elements);
. Determination of the hepatic-renal complex is indicated to exclude problems with these organs as the cause of bleeding;
Fibrogastroscopy is a visual examination of the mucous membrane of the esophagus, stomach and duodenum. It is the gold standard for diagnosing gastric bleeding and can be both diagnostic and therapeutic. In this case, a bleeding vessel can be detected and attempts can be made to endoscopically stop the bleeding;
Sigmoidoscopy and fibrocolonoscopy are visual diagnostics of the lumen of the rectum and large intestine. It is performed by analogy with fibrogastroscopy if there is a suspicion of colonic bleeding.

Useful video about gastrointestinal bleeding:

Treatment tactics

On prehospital stage the following actions must be taken:

Place the patient in a horizontal position;
Apply cold to the stomach;
Transport a patient with bleeding in this position to the nearest medical institution.

You should not experiment with treating stomach bleeding at home. This could result in dire consequences.

All further assistance measures should be provided in a surgical or intensive care unit under the supervision of specialists. They can be presented:

Emergency surgical treatment. Indicated in cases of ongoing active bleeding that cannot be controlled medication stop or initially in serious condition sick;
Conservative therapy. It includes intravenous infusions saline solutions, blood substitutes and blood components (erythrocyte mass and plasma);
Administration of hemostatic drugs and parallel treatment of the disease that caused the bleeding.

Gastric bleeding is the leakage of blood into the lumen of the stomach from damaged vessels. This pathological condition occupies a leading position among all causes of emergency hospitalization in surgical hospitals.

Source: cardio-life.ru

More than a hundred pathologies are known that can lead to the development of gastric bleeding. The most common of these is gastric ulcer - bleeding occurs in approximately 20% of patients with a history of gastric ulcer in the absence of adequate treatment.

In case of heavy gastric bleeding, hospitalization in the intensive care unit is required. intensive care.

The stomach is a hollow muscular organ located between the esophagus and the duodenum. The function of the stomach is the accumulation of food mass, its mechanical and chemical treatment, absorption of certain substances, movement further along the digestive tract. In addition, the stomach produces hormones and biologically active substances, performs protective and excretory functions. Volume empty stomach is approximately 0.5 liters; after eating, the stomach can stretch to 1–4 liters. The size of the organ varies depending on the degree of its filling, as well as on the person’s body type. The wall of the stomach is formed by serous, muscular, submucosal and mucous membranes. The stomach consists of the inlet section, the fundus of the stomach, the body of the stomach, and the pylorus. The venous plexus is located at the junction of the esophagus and the stomach. For some pathological processes the veins dilate and are easily injured, which causes bleeding, sometimes quite significant.

Causes of stomach bleeding and risk factors

In addition to gastric ulcers, the main causes of gastric bleeding include non-ulcerative lesions of the gastric mucosa, chronic renal failure, chronic stress, irrational intake of certain medicines. More rare causal factors are: ischemia of the gastric mucosa against the background of cardiovascular vascular pathology, malignant tumors, cirrhosis of the liver, tuberculosis and syphilis of the stomach, thermal and chemical burns gastric mucosa.

Source: econet.ru

Risk factors include:

endocrine diseases;
states of shock;
hypotension (especially a combination of low blood pressure and tachycardia);
stomach polyps, lipomas;
general hypothermia;
age over 60 years;
vitamin deficiency (especially vitamin K).

Treatment of mild and moderate gastric bleeding, in which there is no significant deterioration in the patient’s condition, is carried out in outpatient setting or in the gastroenterology department.

Gastric bleeding is divided into two main types:

spicy– develop quickly, the patient requires emergency medical care;
chronic– develop more slowly, gradually leading to anemia in the patient.

Depending on the degree of expression, they can be obvious or hidden.

Depending on the severity of blood loss, gastric bleeding can be:

light(condition is satisfactory, patient is conscious);
medium-heavy(the patient is worried about dizziness);
heavy(the patient is very inhibited and does not react to the environment).

Depending on the etiological factor, ulcerative and non-ulcerative gastric bleeding is distinguished.

Source: gastrit-yazva.ru

Symptoms of stomach bleeding

The presence of certain signs of gastric bleeding depends on its duration and intensity.

If gastric bleeding occurs from small blood vessels stomach, and the volume of blood loss does not exceed 20% of the total volume of circulating blood, the patient’s condition can remain satisfactory for a long period.

Mild short-term gastric bleeding can be manifested by weakness, fatigue, decreased performance, dizziness when changing body position, flashing spots before the eyes, pale skin, and cold sticky sweat.

With the development of moderate gastric bleeding, blood accumulates in the stomach cavity, which partially enters the duodenum. Hemoglobin is converted into hematin under the influence of gastric juice. When a certain volume of blood accumulates, the patient vomits bloody contents, the color of which, due to the admixture of hematin, resembles coffee grounds.

At pronounced signs blood loss, the patient is transported on a stretcher with the head end down.

With intense gastric bleeding, the stomach cavity fills with blood quickly, while hemoglobin does not have time to oxidize and a large amount of unchanged scarlet blood is present in the vomit. Blood that enters the duodenum and passes through digestive tract, turns stool black. Patients experience a decrease in blood pressure, dry mucous membranes, tinnitus, frequent weak pulse, and lethargy. With heavy blood loss - disturbances of consciousness (including coma), hemorrhagic shock, impaired renal function. In case of profuse bleeding and/or delay in seeking medical help, there is a high risk of death.

Against the background of sepsis and/or shock, patients may develop stress gastric ulcers, in the pathogenesis of which the main role is played by ischemia of the mucous membrane, disruption of the gastric mucous barrier and increased secretion of hydrochloric acid. 4–15% of patients with stress gastric ulcers experience massive bleeding.

Diagnostics

Diagnosis of gastric bleeding is based on data obtained during the collection of complaints, anamnesis, objective examination, instrumental and laboratory studies.

If gastric bleeding is suspected, a general blood test is prescribed (a decrease in the number of red blood cells and platelets, a decrease in hemoglobin levels is determined), a fecal occult blood test, a coagulological blood test, and the nature of the vomit is studied.

Source: gastroprocto.ru

During fibrogastroduodenoscopy, the mucous membranes of the esophagus, stomach and duodenum are examined, this makes it possible to detect the source of bleeding. If it is impossible to carry out this procedure, it may be carried out to determine the etiological factor. X-ray examination stomach with contrast.

In elderly patients, even when surgical treatment gastric bleeding has a high risk of recurrence.

If vascular pathology is suspected, angiography is indicated. To confirm the diagnosis, radioisotope scanning may be needed (if it is impossible to detect the site of bleeding by other methods), as well as magnetic resonance imaging and ultrasound of the abdominal organs.

Treatment of stomach bleeding

Treatment of mild and moderate gastric bleeding, in which there is no significant deterioration in the patient's condition, is carried out on an outpatient basis or in the gastroenterology department. Patients are given strict bed rest; an ice pack is placed on the epigastric region. To stop bleeding, hemostatic drugs are prescribed. For this purpose, adrenaline and norepinephrine are injected into the stomach through a probe. For minor bleeding, apply medical glue to the affected area. To cleanse the intestines of bloody masses, cleansing enemas are indicated. To correct posthemorrhagic anemia, iron supplements are prescribed.

In case of heavy gastric bleeding, hospitalization in the intensive care unit is required. If there are significant signs of blood loss, the patient is transported on a stretcher with the head end down. The volume of circulating blood is restored by colloid, crystalloid solutions, and blood products that are administered intravenously. After relative stabilization of the patient’s condition, emergency stop gastric bleeding using clipping methods, ligation of affected vessels or suturing of bleeding gastric ulcers using gastroduodenoscopy.

Surgery is indicated in cases where it is not possible to stop the bleeding using other methods, with severe gastric bleeding accompanied by a significant decrease in blood pressure, repeated bleeding, development of complications.

More than a hundred pathologies are known that can lead to the development of gastric bleeding.

According to indications, the following methods of surgical treatment of gastric bleeding are used:

suturing the affected area;
removal of part of the stomach;
plastic surgery of the junction of the stomach and duodenum;
intervention on the vagus nerve.

The operation can be performed by open or laparoscopic (preferred) approach.

The recovery time after surgical treatment of gastric bleeding varies depending on the method surgical intervention. Sutures are usually removed on the 8th day after surgery, and the patient is discharged from the hospital approximately on the 14th day. IN rehabilitation period the patient is prescribed a gentle diet, physiotherapy. Large physical exercise contraindicated for the next month.

Possible complications and consequences

Stomach bleeding may be complicated hemorrhagic shock, posthemorrhagic anemia. In elderly patients, even with surgical treatment of gastric bleeding, the risk of recurrence is high.

Forecast

The prognosis depends on the timeliness of diagnosis and treatment. In case of minor gastric bleeding, if the patient is treated in a timely manner medical care the prognosis is usually favorable. With the development of profuse bleeding, the prognosis worsens. The mortality rate for gastric bleeding is 4–25%.

Prevention

To prevent the development of gastric bleeding, it is recommended:

timely and adequate treatment diseases that can lead to gastric bleeding;
refusal of self-medication, uncontrolled use of medications;
rejection of bad habits;
avoiding hypothermia;
strengthening the immune system.

Video from YouTube on the topic of the article:

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;
consumption of 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- 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. Most reliable signs bleeding is vomiting and stool with 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, and 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. A cold heating pad (or other cold object) is placed on the upper 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 initial examination. Such actions are appropriate when there is large blood loss and there is a risk to the patient’s life.

First aid

At stomach bleeding urgently need to 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 the flow of fresh air if you are indoors;
collect the patient’s belongings and necessary documents for prompt examination and transfer to the medical center.

Therapy and patient care

Treatment of the patient depends on a list of factors (primarily the signs 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 treatment becomes surgical intervention.

Conservative treatment

Conservative treatment of the disease consists of drug therapy.

Conservative treatment consists of drug therapy without resorting to surgery. 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 cold water through the oral or nasal passage using a special tube. After lavage, a probe is inserted into the stomach, through which a medicinal substance is introduced into the body - 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.

Gastrointestinal bleeding is the leakage of blood into the cavity of the stomach and intestines, followed by its release only with feces or with feces and vomiting. It is not an independent disease, but a complication of many – more than a hundred – different pathologies.

Gastrointestinal bleeding (GIB) is dangerous symptom, indicating that it is urgent to find the cause of the bleeding and eliminate it. Even if a very small amount of blood is released (and there are even situations where the blood is not visible without special tests), this may be the result of a very small, but rapidly growing and extremely malignant tumor.

Note! Gastrointestinal bleeding and internal bleeding are not the same thing. In both cases, the source of bleeding can be the stomach or various parts of the intestine, but with gastrointestinal tract bleeding, blood is released into the cavity of the intestinal tube, and with internal bleeding, into the abdominal cavity. Gastrointestinal bleeding can in some cases be treated conservatively, while internal bleeding (after injury, blunt trauma and so on) can only be treated surgically.

What happens when you lose more than 300 ml of blood

Massive bleeding from the gastrointestinal tract causes the following changes in the body:

Causes of gastrointestinal condition

There are so many causes of acute gastrointestinal bleeding that they are divided into two classifications. One of the classifications designates the type of causes, the second - the causes depending on the location in the gastrointestinal “tube”.

So, depending on the type of reasons, gastrointestinal tract can be caused by:

Inflammatory, erosive and ulcerative formations of the gastrointestinal tract, as a result of which the vessels feeding one or another structure are “corroded”. Not all of these pathologies occur due to poor diet or Helicobacter pylori infection. Erosive-ulcerative lesions occur with any serious illness (this is called stress ulcers). They are caused by burns from strong alcoholic drinks, acids and alkalis, drunk by mistake or intentionally. Erosion and ulcers also often occur as a result of taking painkillers and glucocorticoid hormones.
Tumors of the gastrointestinal tract of any degree of malignancy.
Wounds and injuries of the gastrointestinal tract.
Blood clotting diseases.
Increased pressure in the vessels of the gastrointestinal tract. This mainly happens only with the syndrome portal hypertension caused by cirrhosis, blood clots in the portal vein or compression from the outside.

Depending on the location, bleeding from the upper sections (up to the end of the duodenum) and bleeding from the lower sections (starting from the small intestine) of the gastrointestinal tract are distinguished. The upper sections suffer more often: they account for about 90% of gastrointestinal tract infections, while the lower sections, accordingly, account for a little more than 10% of cases.

If we consider the frequency of damage to individual organs, then bleeding from the stomach is every second gastrointestinal tract, bleeding from the duodenum occurs in every third case. The colon and rectum are every 10th bleeding, the esophagus is every twentieth. The small intestine in adults rarely bleeds - in 1% of cases.

The causes of gastrointestinal tract from the upper gastrointestinal tract are:

erosive esophagitis, whose main cause is ingestion of acids or alkalis;
erosive and hemorrhagic gastritis, including those that occurred when taking painkillers;
peptic ulcer of the gastric or duodenal localization;
increased pressure in the veins of the esophagus (portal hypertension syndrome). It develops with cirrhosis of the liver, blood clots in the hepatic or other veins communicating with the portal vein, compression portal vein at the level of the heart - with constrictive pericarditis or at any other level - with tumors and scars of nearby tissues;
penetrating wounds chest or upper abdomen;
Mallory-Weiss syndrome;
stomach polyps;
trauma to the esophagus or stomach due to foreign bodies or hard (metal) medical equipment during the examination;
bleeding from diverticula (“pockets”) and tumors of the esophagus, stomach or duodenum;
hernia hiatus diaphragms;
aorto-intestinal fistulas;
injuries biliary tract(mainly during operations and manipulations), during which blood, along with bile, enters the duodenum.

The causes of gastrointestinal bleeding from the lower sections are:

blunt abdominal trauma;
abdominal wounds;
tumors;
thrombosis of mesenteric vessels;
infection with worms;
increased pressure in the veins of the rectum, which is caused by portal hypertension, which has the same reasons as in the case of the esophagus;
nonspecific ulcerative colitis;
Crohn's disease;
anal fissures;
haemorrhoids;
diverticula;
infectious colitis;
intestinal tuberculosis.

The causes of gastrointestinal bleeding, which can cause bleeding from any part of the gastrointestinal tract, are vascular damage due to:

systemic lupus erythematosus;
vitamin C deficiency;
periarteritis nodosa;
atherosclerosis;
Rendu-Osler disease;
rheumatism;
congenital malformations, telangiectasias and other vascular malformations,

coagulation disorders (eg, hemophilia);
decreased platelet levels or abnormalities in their structure (thrombocytopathy)

In addition to acute bleeding, there are gastrointestinal bleeding chronic. This means that in specific localization there are damaged vessels of small caliber, from which small, non- life threatening, blood volumes. The main causes of chronic bleeding are stomach and duodenal ulcers, polyps and tumors.

How to recognize gastrointestinal bleeding

The first signs of bleeding are weakness, which increases with at different speeds(depending on the rate of blood loss), dizziness, sweating, feeling of rapid heartbeat. With severe blood loss, a person becomes inadequate, and then gradually falls asleep, turning pale. If blood is lost quickly, the person experiences strong feeling, fear, turns pale, loses consciousness.

These symptoms are typical for any acute bleeding with a loss of more than 300 ml of blood, as well as for any conditions that may result in shock (intoxication, taking antibiotics against the background of significant bacterial infection, taking an allergen product or medication).

It is about the gastrointestinal tract that you should think about based on the existing symptoms:

cirrhosis or thrombosis of the hepatic veins. This yellow dry skin, weight loss in the arms and legs with an enlarged abdomen, in which fluid accumulates, redness of the palms and feet, bleeding;
clotting diseases. This is bleeding when brushing teeth, bleeding from injection sites, and so on;
gastritis, duodenitis and peptic ulcer. These are pain in the upper abdomen immediately after eating (typical of stomach lesions) or 2-4 hours after it (typical of duodenal lesions), nausea, belching;
infectious bowel disease. These are fever, nausea, vomiting, chills, weakness. In this case, a person may remember that he ate something “dangerous”: raw water, belyash at the bus station, three-day salad with mayonnaise, cake or pastry with cream. It must be said that infectious gastroenterocolitis will not cause profuse gastrointestinal bleeding, unless it is dysentery, in which (but not at the very beginning of the disease) lower sections ulcers form in the intestines.

Most tumors, diverticula or polyps of the gastrointestinal tract have no manifestations. Therefore, if gastrointestinal bleeding develops acutely, against the background full health(or you can only remember alternating constipation and diarrhea, unexplained weight loss), you need to think about this.

Why don’t we immediately describe the appearance of blood, since gastrointestinal tract infections are necessarily accompanied by it? Yes, indeed, blood has a laxative effect; it will not remain in the lumen of the gastrointestinal tract and will not be absorbed back. She will not stagnate, unless the gastrointestinal tract coincides with an acute intestinal obstruction(for example, blocking of the intestine by a tumor), which can happen extremely rarely

But in order for the blood to “appear” outside, time must pass until it covers the distance from the damaged vessel to the rectum or to the mouth. You can immediately describe the appearance of blood only when bleeding from the sigmoid or rectum. Then the first symptoms will not be weakness and dizziness, but defecation, when scarlet blood is found in the stool (most often it is hemorrhoids or anal fissure, so defecation will be painful)

Further symptoms of gastrointestinal bleeding vary depending on which section of the vessel is damaged.

So, if the source of bleeding is in the upper parts of the stomach, and the volume of blood lost exceeds 500 ml, then there will be vomiting of blood:

scarlet blood - if the source is an artery in the esophagus;
similar to coffee grounds (brown) - when the source is in the stomach or duodenum, and the blood was able to mix with gastric juice and oxidize;
dark (venous) blood - if the source is the dilated vein of the esophagus.

In addition, with any amount of blood loss from the upper section, the stool will also be stained with blood: it will acquire more dark color. The more blood is lost, the blacker and more liquid the stool will be. The greater the amount of bleeding, the sooner this stool will appear.

Gastrointestinal bleeding from the upper gastrointestinal tract must be distinguished from conditions when blood entered from the respiratory tract. You need to remember: blood from the respiratory tract will be released with a cough; it contains a lot of foam. The stool practically does not darken.

There are also conditions where the source of bleeding was in the mouth, nose or upper respiratory tract, the blood was swallowed, after which vomiting was observed. Then the victim needs to remember whether there was an injury to the nose, lips or teeth, whether it was swallowed foreign body whether there was a frequent cough.

For bleeding from the small and large intestines, vomiting blood is not typical. They are characterized only by darkening and thinning of the stool. If bleeding:

from the rectum or anal sphincter - scarlet blood will appear on the surface of the stool;
from the cecum or ascending colon - stool can be either dark or look like brown stool mixed with dark red blood;
from the descending colon, sigmoid or rectum - feces regular color, veins or blood clots are visible in it.

Severity of gastrointestinal tract infections

To know how to provide assistance with gastrointestinal bleeding in a particular case, a classification has been developed that takes into account several indicators, their changes are divided into 4 degrees. To determine, you need to know the pulse, arterial pressure, and using blood tests to determine hemoglobin and ( percentage liquid part of the blood and its cells), according to which the circulating blood deficiency (CBD) is calculated:

The number of heartbeats is within 100 per minute, blood pressure is normal, hemoglobin is more than 100 g/l, DCV is 5% of normal. The person is conscious, scared, but adequate;
The number of heartbeats is 100-120 per minute, the “upper” pressure is 90 mm Hg, hemoglobin is 100-80 g/l, DCV is 15%. The person is conscious, but lethargic, pale, and dizzy. The skin is pale.
Pulse is more often than 120 per minute, difficult to palpate. “Upper” pressure 60 mm Hg. Consciousness is confused, the patient constantly asks for a drink. The skin is pale and covered in cold sweat.
The pulse is not palpable, the pressure is not determined or is palpated once within 20-30 mm Hg. DCC 30% or more.

Bleeding in children

Bleeding in children is very serious reason to contact a medical facility. It will not go away on its own, even if the child vomits blood, and after that behaves normally, plays and asks for food. Before applying, remember if he could have eaten chocolate, hematogen or foods that are colored red (beets, cakes with red dye). Also rule out injuries in the mouth and nose (they are visible to the naked eye).

There are quite a few causes of gastrointestinal tract problems in children. When looking for a diagnosis, doctors first of all pay attention to the age of the child: there are diseases that are most typical for a particular age period:

Age	Diseases
2-5 days of life	Hemorrhagic disease of newborns - vitamin K deficiency. Characterized by dark, profuse stools 3-4 times a day
Up to 28 days of life	Ulcers of the stomach (more often), duodenal ulcers (less often), ulcerative necrotizing colitis of newborns
From 14 days to 1 year of life	Duodenal ulcers (more often), stomach ulcers (less often)
1.5-4 months	Intussusception
1-3 years	Juvenile intestinal polyps, Meckel's diverticulum, Dieulafoy's disease, familial colon polyposis (in 5% of untreated children it transforms into cancer by age 5)
Over 3 years old	Esophageal varices
5-10 years	Portal hypertension syndrome, ulcerative colitis
10-15 years	Peutz-Jeghers syndrome, when many small polyps are found in the intestines. At the same time, the skin, lips, eyelids have characteristic feature– multiple brown spots

At any age of a child, starting from the neonatal period, the following may occur:

gastritis: the cause may be serious disease, hypoxia (for example, in newborns);
esophagitis. Most often it occurs in children with shortened esophagus, achalasia cardia, hiatal hernia;
doubling of the stomach;
duplication of the small intestine;
Mallory-Weiss syndrome;
hiatal hernia;
eosinophilic gastroenteropathy;
vascular malformations of the gastrointestinal tract: hemangiomas and vascular malformations.

Diagnostics and urgent Care Children are treated on the same principle as adults.

First aid

The algorithm for gastrointestinal bleeding is as follows:

Call an ambulance.
Lay the patient down, raise his legs, returning the maximum possible amount of blood from the depot in the veins into the bloodstream.
Provide fresh air flow.
Put cold on your stomach. Be sure to put it on your clothes to avoid frostbite. Keep it on for 15-20 minutes, remove it for 10 minutes, then put it back on.
As for medications, you can give only 50 ml of aminocaproic acid solution and/or 1-2 tsp. calcium chloride.
Do not give anything to drink or eat: this may further increase bleeding.
To go to the toilet - use a bedpan, a diaper or some kind of container so that he doesn’t have to get up. At the same time, you should not be allowed to push.

What are they doing in the hospital

From the moment of admission, the patient is given assistance: colloidal solutions of blood substitutes (gelatin or starch solutions) are infused; after determining the blood type, blood and plasma are transfused (if necessary). This is explained by the fact that if surgery is necessary, go to the operating room, even in emergency, you need to take only a prepared patient. Such a patient has a better chance of survival.

Hemostatic drugs (“Tranexam”, “Tugina”, “Vikasol”, “Etamzilat”) are necessarily injected into a vein, and “Aminocaproic acid” is given by mouth. If erosive and ulcerative lesions are detected, drugs that reduce acidity (Contraloc, Kvamatel or Ranitidine) are also injected into the vein.

All this time he is examined in the emergency department or intensive care unit (the second option is if the patient was brought in in very serious condition, with grade 3-4 bleeding):

take a general blood test from your finger or look only at “red blood” (red blood cells and hemoglobin);
take blood from a vein for hematocrit, determining the percentage of the liquid part of the blood and its shaped elements, and blood for coagulogram (state of the coagulation system;

These indicators are used to judge the degree of gastrointestinal tract disease and develop tactics for further action;

perform FEGDS - examination of the stomach and duodenum using fiber optic technology to determine the source of bleeding. If such a source is found in the esophagus, stomach or duodenum, they try to cauterize it directly during the procedure. If this is successful, no surgical intervention is undertaken;
if necessary, and if the patient’s condition allows, angiography can be performed if FEGDS is uninformative.

Next, they look at the results of the examination, prepare the patient for surgery as much as possible and perform it using one of the following methods: or open surgery, or by introducing a fragment blocking the vessel using the intravascular method, or by clipping (applying clips) under the control of an endoscope or laparoscope.

With portal hypertension syndrome, they try to stop bleeding conservative method: placement of a special Blackmore probe and intensive drug hemostatic therapy. If this does not help, shunt operations are performed - blood is sent from the veins with high pressure into veins with a lower