home Adviсe What to do with internal bleeding of the intestine. What are the symptoms of internal bleeding in the intestines?

What to do with internal bleeding of the intestine. What are the symptoms of internal bleeding in the intestines?

intestinal bleeding- the release of blood into the lumen of the large or small intestine is a symptom that requires prompt medical intervention. Its cause may be a pathological process in the intestine and associated organs, or trauma. If timely measures are not taken to stop, it may represent serious danger for the life of the patient.

Bleeding of the duodenum is the most common after gastric bleeding. It accounts for 30% of all cases of gastrointestinal hemorrhages (more than 50% for the gastric hemorrhage). 10% of the sources of damage are localized in the large intestine, and 1% in the small intestine.

It is rather difficult to distinguish profuse gastric bleeding from intestinal bleeding due to the similarity of their signs, the adjacent location of organs and belonging to a single system. The International Classification of Diseases of the Tenth Revision (ICD-10) combines hemorrhages of the stomach and intestines into one group K92.

Types of intestinal bleeding

According to the localization of blood loss:

Arising in the upper intestine (duodenum 12);
Arising in the lower intestine (small, large, rectum).

By way of manifestation:

Having clear signs of presence;
Hidden, invisible to the victim.

By the nature of the flow:

in acute form;
in a chronic form.

By duration:

One-time;
Recurrent.

Causes

A fairly wide range of pathologies can be accompanied by loss of blood in the intestine.

They are usually divided into 4 groups:

Diseases of ulcerative and non-ulcerative nature. Ulcerative lesions are the most common cause of intestinal bleeding (about 75% of all cases, and separately in men, the figure is higher).

These include:

duodenal ulcer that arose after resection of the stomach and other surgical interventions in the gastrointestinal tract;
Nonspecific ulcerative colitis;
Multiple ulcers of the large intestine accompanying Crohn's disease;
Bleeding ulcers resulting from a mucosal burn (due to poisoning with concentrated acid, mercury, lead, etc., prolonged use of medications);
Ulcers in places of mechanical injury of the gastrointestinal tract;
Formed against the background of stress or physical overstrain.

Non-ulcerative intestinal bleeding:

Intra-intestinal effusion in infants can provoke intestinal volvulus, intestinal obstruction.

The disease is expressed not so much by the release of blood as by constipation, gas formation, and sharp animal pains.

Another factor is congenital anomalies of the intestine and neoplasms.

In older children, the main culprits of intestinal bleeding are polyps. A common cause of hemorrhage in young children is foreign objects in the digestive tract that damage the mucous membrane.

Symptoms

When internal intestinal bleeding is strong enough, it is not difficult to diagnose it. It is determined by the presence of blood in the feces and vomiting.

If blood is present in the stool unchanged, then this indicates its one-time loss of more than 100 ml. This may be a profuse gastric effusion, or blood loss of the duodenum 12 as a result of an extensive ulcer. If the blood runs for a long time, it releases iron under the influence of enzymes and stains the stool black, tarry. With small secretions, changes in feces are not visually visible.

Not always dark color feces are a sign of intestinal bleeding. Sometimes this is a consequence of eating foods rich in iron, or certain medications. And sometimes - the result of swallowing blood by patients (this can happen, including if the nasopharynx or oral cavity is damaged).

When blood clots are visible on the surface of the feces, we can conclude that there are diseases of the lower part of the large intestine. In the case when blood mixes with the stool, forming streaks, the lesion is located in the upper sections. Liquid, fetid, with a characteristic sheen stool, most likely indicates defeat small intestine.

Another characteristic symptom- profuse vomiting. Against the background of intestinal bleeding, profuse vomiting is a profuse eruption of the contents of the gastrointestinal tract with blood impurities.

Sometimes, due to the reaction of the blood with acidic gastric juice, the vomit becomes a rich brown color.

Other symptoms of intestinal bleeding

Anemia. It occurs as a result of prolonged blood loss, when the body is not able to compensate for the lost red blood cells. Anemia, without resorting to medical tests, can be late for a weak, drowsy state, dizziness, fainting, excessive pallor, cyanosis, brittle hair and nails, tachycardia;
Miscellaneous disorders digestive process: nausea, vomiting, diarrhea or constipation, excessive gas, bloating;
Some of the victims of intestinal bleeding experience causeless anxiety, fear, followed by lethargy or a feeling of euphoria.
Intestinal pain. Depending on the disease that provoked intestinal bleeding, the nature of the pain syndrome may be different. Yes, an ulcer. duodenum accompanies a strong, sharp, pain in the abdomen, and it decreases when the bleeding opens. In cancer patients, the pain is aching, dull, and appears sporadically. With ulcerative colitis, it migrates, and in the case of dysentery, it accompanies the urge to defecate.

Portal hypertension, in addition to intestinal bleeding, is manifested by its typical symptoms:

Decreased body weight of the patient;
The appearance of spider veins;
Severe reddening of the palms (erythema).

In such patients, the anamnesis often reveals experienced hepatitis or long-term alcohol intake.

Blood clotting problems associated with cirrhosis are the cause of massive, persistent intestinal bleeding.

Nonspecific ulcerative colitis is accompanied by false urges to the toilet, and the stool itself is liquid, purulent, mucous, with blood impurities. For diseases inflammatory nature intestinal bleeding is observed against the background of high temperature.

Bowel cancer is characterized by small bleeding, tarry feces, coupled with typical symptoms for this disease: sudden weight loss, loss of appetite.

It should be remembered that sometimes a hemorrhage does not manifest itself in any way and is discovered by chance during a medical examination for other diseases, including those not related to the gastrointestinal tract.

Condition of victims of open intestinal bleeding

It happens:

Satisfactory: the person is conscious, his pressure, hemoglobin and red blood cell count are at a normal level, but the pulse is quickened;
Moderate: coagulability worsens, hemoglobin sharply decreases (up to half of normal), pressure decreases, tachycardia appears, cold sweat. The skin is pale;
Heavy: the face swells, hemoglobin is very low (up to 25% of the norm), the pressure is greatly reduced, the pulse is quickened. There is retardation in movement and speech. This condition often leads to coma and requires urgent resuscitation.

How to stop at home

If the intestines bleed, the first first aid consists in measures aimed at reducing blood loss:

The patient should be kept calm: lay him on his back and slightly raise his legs:
In no case do not stimulate the digestive tract. Drinking and eating with intestinal bleeding should be excluded;
Constrict the blood vessels as much as possible: put an ice heating pad or something cold on a possible lesion.

First aid at home should not include enemas and gastric lavage.

Diagnosis of intestinal bleeding

Examination of patients with bleeding is carried out by a gastroenterologist and an endoscopist. Assessed condition skin palpable abdomen. A digital examination of the rectum is carried out, the purpose of which is to identify polyps and hemorrhoidal cones, as well as assess the condition of organs located near the intestines.

To determine the severity, the patient's blood is urgently examined (clinical analysis and coagulogram), establishing the amount of hemoglobin and erythrocytes and the ability of the blood to clot.

Feces are given for occult blood. The patient is collected anamnesis, check the pressure and pulsation.

To determine the source of intestinal bleeding, instrumental techniques are used:

Endoscopy (in most cases, it determines the source and makes it possible to simultaneously carry out treatment (electrocoagulation of a diseased vessel or other) and
Colonoscopy (examination upper divisions).
Additional information is obtained by x-ray examination and scintigraphy using labeled erythrocytes.

results instrumental diagnostics are of decisive importance in the question of what to do with gastric or intestinal hemorrhage.

Treatment

In emergency hospitalization, victims of intestinal bleeding with signs of hemorrhagic shock(low blood pressure, tachycardia, cold extremities, blueness). An endoscopy is urgently performed, the source of blood loss is fixed, and measures are taken to stop the bleeding.

What does endoscopy show?

Blood flow indicators and its cellular composition are constantly assessed. The patient is given blood products.

But most often the treatment is conservative and is aimed at eliminating the source of intestinal bleeding, reviving the hemostasis system and replacing blood to a normal volume.

Drugs are prescribed to stop the bleeding.

To reduce pressure in the portal vein, drug stimulation of platelet activity. Given the scale of blood loss, plasma substitutes and donor blood are administered.

Rehabilitation

Blood loss entails a change in the structure of the affected tissues, and their healing takes time. For the first 2-3 days, nutrients are administered intravenously to the victim and gradually transferred to a standard diet with a strict diet.

The lesions heal for at least six months, and all this time the patient's diet should be given the closest attention. After 6 months, the patient is re-examined by a gastroenterologist.

Video: Help with gastrointestinal bleeding.

Nutrition

Diet is one of the main conditions for the recovery of patients with intestinal bleeding.

In order not to injure the intestinal walls, they are prescribed:

Excluded:

solid;
Spicy food;
All that from which there is irritation of the mucous membrane.

More than 90% of intestinal bleeding can be stopped conservative methods.

If signs of internal blood flow remain, they resort to surgical intervention, the volume of which depends on the nature of the pathology.

Intestinal bleeding is a type of internal current. A dangerous disorder occurs due to damage to the capillaries, venous vessels, arterial channels. The intensity of the bleeding process clearly correlates with the diameter of the vessels that have integral damage. Doctors say that bleeding in the gastrointestinal tract is a rather dangerous ailment for human life. As a result, the patient will need emergency medical care.

Loss of blood from lower divisions The gastrointestinal tract is referred to as intestinal bleeding. In most cases, the release of blood in the area of the suction organ concerns residents of urban conditions. It is they who lead a sedentary lifestyle without strict adherence to a balanced and rational diet. About 70% of these complications occur in the colon. Also, 20% of patients who suffer from intestinal bleeding have clear violations of the integrity of the ileum (mucosal areas). In other cases, the loss of liquid connective tissue is formed from other parts of the suction organ. Unlike gastric lesions, this pathological process in the intestine can last for a long time (latent form).

Internal bleeding is not an independent disorder, but a symptom of various other diseases. These ailments require prompt and timely treatment. Of particular note is the focus of blood loss. In practice, hemorrhoids, Crohn's disease, cancer-type tumors and other causes significantly affect the degree of exacerbation of the disease.

It is quite difficult to determine intestinal bleeding from the stomach. Diagnosis of the disease is complicated by a number of reasons: the similarity of clinical indications, the proximity of sources, the unity of all organs of the gastrointestinal tract (anatomical, functional).

The main cause of intestinal bleeding is damage to arterial vessels. Capillary and venous blood flows in practical medicine are quite rare. Science distinguishes several types of blood flow outside the vascular bed: hidden and obvious (explicit). Occult disorders are formed on the basis of ruptures of capillary channels. This disease refers to a chronic condition of the body, which is associated with reinforced concrete anemia. All intestinal bleeding is classified into:

Certainly not serious;
Potentially serious;
Undoubtedly serious.

Classification of the disorder

When the stomach is damaged, the blood gradually passes into the intestines. As a result, stool tests have impurities of blood structures. International classification bleeding data (ICD 10) has the following form: K 92.2. – unspecified gastrointestinal + K 92.1. - melena (copious black-type stools). So with ulcerative leakage of the 12th duodenum, the code K26 is assigned to the patient. With high localization (gastrojejunal) - K 28. With bleeding from the rectum - K 62.5.

Localization of sources of damage to the lower region of the digestive tract:

1st place: duodenum 12 (about 30% of the total mass of diseases);
2nd place: colon(rectum + transverse colon) - 10%;
3rd place: pathological disorder of the small intestine (1%).

To date medical science allocates acute and chronic types of internal bleeding. They vary greatly in the rate of development and the picture of clinical manifestations. So an acute loss of blood of a profuse type can significantly worsen the condition of a sick person in a few hours. In this case, the patient will need operative hospitalization. There is a possibility of developing anemia. When the process is stretched for a long period, it is transformed into chronic form ailment. The body stops generating red blood cells and reacts dynamically to the formation of iron deficiency anemia. This treatment requires the patient to be patient and patient.

Symptoms of the disease

The degree of damage to the vessel directly affects the scale of intestinal bleeding. The manifestation can be detected not immediately, but only after a while. The sick person has abrupt appearance pallor of the skin. The pulse becomes quickened. The aggravation of the situation occurs in the first week (with severe bleeding). With minor losses, the symptoms are delayed for several months and weeks.

Symptoms of a pathological disorder:

The presence of a chair with scarlet impurities of blood secretions;
Regular;
Prolonged constipation;
Diarrheal disorders + the presence of mucous feces;
In the event of a bloody stool, there may be a strong burning sensation in the anus (rectal duct).

Increased and heavy bleeding intestines (including capillary) affect:

Mild pulse of rapid type;
A sharp decrease in blood pressure;
The formation of severe headaches (migraines, seizures) + the formation of the effect of "flickering midges";
The process of dehydration of the body;
Development of tachycardia + cold sweat + frequent fainting;
The course of insufficiency of the cardiac and renal type;
Brain edema + hepoxia + hypovolemic shock.

The location of the outbreak

The length of the large intestine in an adult is about 150 cm. The most interesting thing is that bleeding can occur in various parts of the suction organ. mesenteric arteries(branch from the abdominal aorta) qualitatively carry out blood supply. The process of diversion of blood is carried out through the veins of the mesenteric type. Varicose lesions provoke slow and prolonged bleeding into the cavity of the large intestine (signs are indicated above).

Qualified specialists know that the lower the source of blood leakage, the more it will be in the patient's feces. Resinous pigmentation of decay products informs about bleeding in the upper parts of the organ.

Pain syndrome in most cases occurs with traumatic lesions of the intestine (its mucous membrane). To identify the source of injury, it is necessary to conduct a point diagnostic study.

Causes of the disease

Internal bleeding of the intestine is formed for a number of reasons. A common symptom of disorders is a violation of the integrity of the mucous and muscular layer of the membrane of the absorbing organ. The development of the disease is facilitated by the activity of various infections, helminths and poor-quality nutrition (spicy dishes). Consider the main reasons in more detail:

Bleeding in childhood

The lower digestive tract often occurs in childhood (up to 3 years). In newborns, genetic pathologies of the intestine are sometimes found:

Doubling of the small intestine;
Colon infarction due to volvulus and obstruction;
Necrotizing enterocolitis of the ulcerative type.

The baby experiences bloating, regurgitation, gag reflexes, green watery stools (mucus + blood) are observed.

First aid mechanism and treatment

First aid for internal bleeding of the intestine is as follows:

Compliance with the patient's bed rest;
An ice pack + heating pad should be placed on the abdomen cold water;
Doctors recommend the use of hemorrhoidal suppositories, which are placed in the anus.

In the event that the bleeding is small, then the patient should call an ambulance. Symptoms of acute anemia require prompt attention. With abundant current, drugs for blood clotting (Didicone, Vikasol, etc.)

The treatment process is carried out strictly in the surgical department. In emergency cases, fibrogastroscopy is performed. This method allows you to establish diseases of the stomach. The next step is the introduction of intravenous hemostatic drugs (aminocaproic acid, Fibrinogen, Etamsilat). If hemodynamics has various disorders (tachycardia, low blood pressure), Reopoliglyukin, a concentrated soda solution, blood plasma is taken. The decision on surgical (laparotomy) intervention in the body is decided in a planned manner. It all depends on the degree of bleeding.

IN stationary conditions The patient must fast for 3 days. Nutrients are introduced into the body through the veins drip (concentrated glucose + protein preparations). After that, for several days, the use of fatty milk, raw eggs, fruit jelly is allowed. Then the patient switches to the reception of grated cereals, cottage cheese, soufflé, boiled eggs, jelly. All products must be refrigerated and show signs of freshness.

After a dangerous pathological disorder, the patient needs time to restore the integrity of the suction organ. Various kinds of ulcers and cracks should heal. Compliance with a strict diet takes more than 6 months. Physical activity for a person is prohibited! After rehabilitation, the patient should be examined by a gastroenterologist. All doctor's recommendations must be followed. After all, a slight disregard for the recommendations of a doctor entails serious consequences for human health. For example, there may be various blood diseases that are difficult to treat.

In which blood is poured into the lumen of the stomach. In general, the term "gastrointestinal bleeding" is commonly used in medicine. It is more general and refers to all bleeding that occurs in the digestive tract (esophagus, stomach, small and large intestines, rectum).

Facts about stomach bleeding:

This condition is one of the most common reasons for hospitalization of patients in surgical hospitals.
Today, more than 100 diseases are known that may be accompanied by bleeding from the stomach and intestines.
Approximately three-quarters (75%) of all bleeding from the stomach or duodenum is due to an ulcer.
Bleeding develops in about one in five patients who suffered from a stomach or duodenal ulcer and did not receive treatment.

Features of the structure of the stomach

The human stomach is a hollow organ, a “bag” that takes food from the esophagus, partially digests it, mixes it and sends it further into the duodenum.

Anatomy of the stomach

Sections of the stomach:

input department (cardia)- the transition of the esophagus to the stomach and the area of the stomach immediately adjacent to this place;
fundus of the stomach – top part an organ that looks like a vault;
body of the stomach- the main part of the body;
exit part (pylorus)- the transition of the stomach into the duodenum and the area of \u200b\u200bthe stomach immediately adjacent to this place.

The stomach is located at the top of the abdominal cavity on the left. Its bottom is adjacent to the diaphragm. Nearby are the duodenum, pancreas. On the right is the liver and gallbladder.

The wall of the stomach is made up of three layers:

mucous membrane. It is very thin, as it consists of only one layer of cells. They produce stomach enzymes and hydrochloric acid.
muscles. Due muscle tissue the stomach can contract, churn, and push food into the intestines. At the junction of the esophagus to the stomach and the stomach to the duodenum, there are two muscle sphincter. The upper one prevents the contents of the stomach from entering the esophagus, and the lower one prevents the contents of the duodenum from entering the stomach.
outer shell is a thin film of connective tissue.

Normally, in an adult on an empty stomach, the stomach has a volume of 500 ml. After eating, it usually stretches to a volume of 1 liter. The maximum stomach can stretch up to 4 liters.

Functions of the stomach

In the stomach, food accumulates, mixes and is partially digested. The main components of gastric juice:

hydrochloric acid- destroys proteins, activates some digestive enzymes, promotes food disinfection;
pepsin- an enzyme that breaks down long protein molecules into shorter ones;
gelatinase- an enzyme that breaks down gelatin and collagen.

Blood supply to the stomach

The arteries supplying the stomach pass along its right and left edges (due to the curved shape of the organ, these edges are called the lesser and greater curvature). Numerous small ones branch off from the main arteries.

The venous plexus is located at the junction of the esophagus with the stomach. In some diseases, the veins of which it consists expand and are easily injured. This leads to heavy bleeding.

Types of stomach bleeding

Depending on the reason:

ulcerative- due to peptic ulcer, the most common;
non-ulcerative due to other reasons.

Depending on the duration of bleeding:

sharp- develop quickly, require emergency medical care;
chronic- less intense, last for a long time.

Depending on how severe the bleeding symptoms are:

explicit- appear brightly, all symptoms are present;
hidden- no symptoms, usually characteristic of chronic stomach bleeding- only pallor of the patient is noted.

Causes of stomach bleeding

Cause of stomach bleeding	Development mechanism	Features of manifestations
Diseases of the stomach itself
Stomach ulcer	Approximately 15% -20% of patients with gastric ulcer is complicated by bleeding. Causes of bleeding in gastric ulcer: direct damage to the vessel by gastric juice; development of complications occlusion of the vessel lumen by a thrombus, causing it to collapse.	The main symptoms of stomach ulcers: pain that occurs or becomes stronger immediately after eating; vomit, after which the patient becomes easier; heaviness in the stomach- due to the fact that food accumulates in the stomach and leaves it more slowly;
Malignant tumors of the stomach	Stomach cancer may occur on its own or be a complication of peptic ulcer disease. When the tumor begins to disintegrate, bleeding occurs.	The main symptoms of stomach cancer: most often the disease develops in elderly people; weakness, loss of appetite, weight loss, discomfort in the stomach; vomiting of eaten food; pain in the upper abdomen, especially on the left; a feeling of heaviness, a feeling of fullness in the stomach.
Diverticulum of the stomach	diverticulum is a bulge in the wall of the stomach. In order to understand what it looks like, one can imagine rubber surgical gloves: each "finger" is a "diverticulum". This disease is rare. Bleeding occurs as a result of damage to the vessel during inflammation of the wall of the diverticulum.	The main symptoms of a diverticulum of the stomach: often the diverticulum is asymptomatic and is detected only during the examination; belching, swallowing air while eating; an incomprehensible feeling of discomfort in the abdomen; dull weak pains; sometimes the diverticulum is shown by rather strong pains, pallor, weight loss.
Diaphragmatic hernia	Diaphragmatic hernia is a disease in which part of the stomach rises through a hole in the diaphragm into the chest cavity. Causes of bleeding in diaphragmatic hernia: damage to the lining of the esophagus gastric juice, which is thrown into it; Ulcer complicating diaphragmatic hernia.	Bleeding with diaphragmatic hernia develops in approximately 15%-20% of patients. In most cases, it is hidden, that is, it is not accompanied by any symptoms. But it can also be strong enough.
Polyps of the stomach	Polyps of the stomach- it's quite common benign tumors. Bleeding occurs as a result of: polyp ulceration under the influence of gastric juice; polyp injury; circulatory disorders(for example, if a large pedunculated polyp twists or "falls" into the duodenum and is strangulated).	Before bleeding, polyps usually do not manifest themselves in any way. If they have enough big sizes, then the passage of food through the stomach is disturbed.
Mallory-Weiss syndrome	Mallory-Weiss Syndrome - bleeding that occurs when the mucosa ruptures at the junction of the esophagus to the stomach. Causes: prolonged vomiting with alcohol poisoning, taking a large number food; a predisposing factor is a diaphragmatic hernia - a condition in which part of the stomach comes out through the diaphragmatic opening of the esophagus into the chest cavity.	Bleeding can be very intense, so much so that the patient may die if emergency medical care is not provided.
Hemorrhagic gastritis	A type of gastritis, in which erosions (superficial defects) appear on the gastric mucosa, there is a risk of bleeding.	Main symptoms: discomfort, pain in the upper abdomen after eating, especially spicy, sour, smoked, fried, etc .; decreased appetite and weight loss; heartburn, belching; nausea and vomiting; bloating, heaviness in the abdomen; the presence of blood in the vomit, in the stool.
stress ulcer	Stress renders Negative influence to many internal organs. A person who is often nervous has a higher likelihood of getting sick with various pathologies. During severe stress in an extreme situation, the adrenal cortex begins to produce hormones (glucocorticoids), which increase the secretion of gastric juice, cause circulatory disorders in the organ. This can lead to superficial ulcers and bleeding.	It is often very difficult to identify a stress ulcer, as it is not accompanied by pain and other pronounced symptoms. But the risk of bleeding is high. It can be so intense that it can lead to the death of the patient if emergency assistance is not provided.
Vascular diseases
Varicose veins of the esophagus and upper stomach.	The venous plexus is located at the junction of the esophagus with the stomach. This is the junction of the branches of the portal vein (collecting blood from the intestines) and the superior vena cava (collecting blood from the upper half of the body). When the pressure in these veins increases, they expand, are easily injured, and bleeding occurs. Causes of esophageal varicose veins: liver tumors; portal vein thrombosis; chronic lymphocytic leukemia; compression of the portal vein in various diseases.	There are no symptoms in the early stages. The patient does not suspect that he has varicose veins of the esophagus. Bleeding develops unexpectedly, against the background of a condition full health. It can be so strong that it quickly leads to death.
Systemic vasculitis: periarteritis nodosa; Schönlein-Henoch purpura.	Systemic vasculitis- this group autoimmune diseases in which vascular damage occurs. Their walls are affected, resulting in increased bleeding. Some of the systemic vasculitis manifests as gastrointestinal bleeding.	With systemic vasculitis, symptoms of gastric bleeding are combined with symptoms of the underlying disease.
atherosclerosis, increased arterial pressure.	With vascular damage and increased blood pressure there is a risk that the wall of one of the vessels during an injury or another pressure surge will burst and bleeding will develop.	Gastric bleeding is preceded by symptoms characteristic of arterial hypertension: headache; dizziness; "Tinnitus", "flies before the eyes"; weakness, increased fatigue; periodic reddening of the face, a feeling of heat; sometimes there are no symptoms; when measuring blood pressure with a tonometer, it turns out to be higher than 140 mm. rt. Art.
Blood clotting disorder
Hemophilia	A hereditary disease that manifests itself as a violation of blood clotting and severe complications in the form of hemorrhages. Only men suffer.
Acute and chronic leukemias	Leukemias are blood tumors in which hematopoiesis is disturbed in red bone marrow. The formation of platelets, platelets, which are necessary for normal clotting, is disrupted.
Hemorrhagic diathesis	This is a large group of diseases, some of which are inherited, while others occur during life. All of them are characterized by impaired blood clotting, increased bleeding.
Avitaminosis K	Vitamin K plays important role during the process of blood clotting. With its deficiency, there is increased bleeding, hemorrhages in various organs, internal bleeding.
Hypoprothrombinemia	A large number of different substances are involved in the process of blood clotting. One of them is prothrombin. Its insufficient content in the blood may be congenital or be associated with various acquired pathological conditions.

Symptoms of stomach bleeding

Symptom / group of symptoms	Description
Common symptoms of internal bleeding- develop with bleeding in any organ.	weakness, lethargy; pallor; cold sweat; lowering blood pressure; frequent weak pulse; dizziness and tinnitus; lethargy, confusion: the patient reacts sluggishly to the environment, belatedly answers questions; loss of consciousness. The more intense the bleeding, the faster these symptoms develop and increase. With severe acute bleeding, the patient's condition deteriorates very quickly. All symptoms increase within a short time. If you don't provide emergency assistance, death may occur. With chronic gastric bleeding, the patient may be disturbed for a long time by slight pallor, weakness and other symptoms.
Vomiting blood	The appearance of vomit and blood impurities depends on the source and intensity of bleeding.: Gastric bleeding is characterized by vomiting, resembling "coffee grounds". The vomit takes such appearance due to the fact that the blood entering the stomach is exposed to hydrochloric acid. If there is unchanged red blood in the vomit, then two options are possible: bleeding from the esophagus or intense arterial bleeding from the stomach, in which the blood does not have time to change under the action of hydrochloric acid. Scarlet blood with foam may indicate pulmonary hemorrhage. Only a specialist doctor can finally establish the source of bleeding, make a correct diagnosis and provide effective assistance!
Admixture of blood in the stool	For gastric bleeding, melena is characteristic - black, tarry stools. It acquires this appearance due to the fact that the blood is exposed to gastric juice containing hydrochloric acid. If there are streaks of fresh blood in the stool, then probably there is not gastric, but intestinal bleeding.

How severe can be the condition of a patient with gastric bleeding?

The severity of stomach bleeding is determined by the amount of blood lost. Depending on the degree of blood loss, there are three degrees of gastric bleeding:

Light degree. The patient's condition is satisfactory. He is conscious. Worried about mild dizziness. Pulse no more than 80 beats per minute. Blood pressure is not lower than 110 mm. rt. Art.
Moderate severity. The patient is pale, the skin is covered with cold sweat. Relieves dizziness. Pulse increased to 100 beats per minute. Arterial pressure - 100-110 mm. rt. Art.
Severe stomach bleeding. The patient is pale, severely retarded, answers questions belatedly, does not respond to the environment. Pulse more than 100 beats per minute. Blood pressure below 100 mm. rt. Art.

The patient's condition can only be adequately assessed by a doctor after examination and examination. Mild bleeding can become severe at any time!

Diagnosis of gastric bleeding

Which doctor should be consulted in case of stomach bleeding?

In chronic gastric bleeding, the patient often does not suspect that he has this pathological condition. Patients turn to specialized specialists about the symptoms of the underlying disease:

for pain and discomfort in the upper abdomen, nausea, indigestion - see a general practitioner, gastroenterologist;
with increased bleeding, the appearance of a large number of bruises on the body - to the therapist, hematologist.

The specialist prescribes an examination, during which gastric bleeding is detected.

The only symptom that can indicate the presence of chronic bleeding in the stomach is black, tarry stools. In this case, you should immediately contact the surgeon.

When do you need to call an ambulance?

With intense acute gastric bleeding, the patient's condition worsens very quickly. In such cases, you need to call the ambulance brigade:

Sharp weakness, pallor, lethargy, rapid deterioration.
Loss of consciousness.
Vomiting "coffee grounds".

If, with intense acute gastric bleeding, medical care is not provided on time, the patient may die from large blood loss!

The ambulance doctor will quickly examine the patient, perform necessary measures to stabilize his condition and take him to the hospital.

What questions can the doctor ask?

During the conversation and examination of the patient, the doctor has two tasks: to establish the presence and intensity of gastric bleeding, to make sure that the bleeding comes from the stomach, and not from other organs.

Questions you may be asked at the appointment:

What are the concerns about this moment? When did they arise? How has your condition changed since then?
Have you had gastrointestinal bleeding in the past? Have you been to doctors with similar problems?
Do you have a stomach or duodenal ulcer? If yes, for how long? What treatment did you receive?
Do you have the following symptoms: upper abdominal pain, nausea, vomiting, belching, heartburn, indigestion, bloating?
Have you had surgery for diseases of the stomach and abdominal veins? If so, on what occasion, when?
Do you suffer from any liver disease, bleeding disorder?
How often and how much do you drink alcohol?
Do you have nosebleeds?

How does a doctor examine a patient with stomach bleeding?

Usually the doctor asks the patient to undress to the waist and examines his skin. Then he feels the abdomen, doing it carefully so as not to increase the bleeding.

What examination can be ordered?

Study title	Description	How is it carried out?
Fibrogastroduodenoscopy	Endoscopic examination, during which the doctor examines the mucous membrane of the esophagus, stomach, duodenum. Most often, it is possible to establish the place and source of bleeding.	The study is carried out on an empty stomach. The patient lies on the couch on the left side. Anesthesia of the mucous membrane is carried out with a spray. A special mouthpiece is placed between the teeth. The doctor inserts a fibrogastroscope, a flexible tube with a miniature video camera at the end, into the patient's stomach through the mouth. At this time, the patient should breathe deeply through the nose. Usually the review does not take much time.
Radiography of the stomach	To identify the cause of gastric bleeding, x-rays with contrast are taken. The doctor can assess the condition of the walls of the organ, identify ulcers, tumors, diaphragmatic hernia, and others. pathological conditions.	The study is carried out on an empty stomach. The stomach must be empty, otherwise the contrast will not fill it evenly. The patient drinks a solution of barium sulfate, a substance that does not transmit x-rays. After that do x-rays in different positions: standing, lying. The images clearly show the contours of the stomach filled with contrast.
Angiography	X-ray contrast study of blood vessels. Performed when there is suspicion that stomach bleeding is due to atherosclerosis or other vascular disorders.	Through special catheter a contrast solution is injected into the desired vessel. Then X-rays are taken. The painted vessel is clearly visible on them.
radioisotope scanning	It is carried out according to indications when it is not possible to detect the place of bleeding in other ways. Red blood cells labeled with a special substance are injected into the patient's blood. They accumulate at the site of bleeding, after which they can be identified by taking pictures using a special apparatus.	A solution with labeled red blood cells is injected into the patient's vein, after which pictures are taken.
Magnetic resonance imaging	It is carried out according to indications, when additional information is needed to make a correct diagnosis. With the help of MRI, you can get pictures with layered sections or a three-dimensional image of a certain area of the body.	The study is performed in a specialized department using a special installation.
General blood analysis	Deviations that can be detected in the general blood test for gastric bleeding: a decrease in the number of erythrocytes (red blood cells) and hemoglobin (anemia associated with blood loss); a decrease in the number of platelets (platelets) - indicates a decrease in blood clotting.	Blood is taken in the usual way from a finger or from a vein.
Blood coagulation test - coagulogram	The study is used in cases where there is a suspicion that gastric bleeding is associated with a violation of blood clotting.	Blood is examined using a special apparatus. A number of indicators are evaluated, on the basis of which conclusions are drawn about the state of the coagulation system.

Treatment of stomach bleeding

A patient with gastric bleeding should be immediately admitted to the hospital.

There are two tactics for treating stomach bleeding:

without surgical intervention(conservative);
operation.

Only a doctor can make the right decision. He conducts an examination and examination, establishes the cause and place of bleeding, determines the degree of its severity. Based on this, a further course of action is selected.

Treatment without surgery

Event	Description	How is it carried out?
Strict bed rest	Rest helps to subside bleeding, and during movement it can intensify.
Cold in the epigastric region		The most commonly used is an ice pack wrapped in a cloth.
Gastric lavage with cold water	Under the influence of cold, vasoconstriction occurs, which helps to stop bleeding.	Gastric lavage is carried out using a probe - a tube that is inserted into the stomach through the mouth or through the nose.
Introduction to the stomach through a tube of adrenaline or norepinephrine	Adrenaline and noradrenaline are “stress hormones”. They cause vasospasm and stop bleeding.	A probe is inserted into the patient's stomach through which medications can be administered.
Intravenous administration hemostatic solutions	Special hemostatic solutions contain substances that increase blood clotting.	Medicines are administered intravenously using a dropper.
donated blood; blood substitutes; frozen plasma.	Transfusion of blood and blood substitutes is carried out in cases where the patient has lost a lot of blood as a result of gastric bleeding.
Other drugs designed to combat existing disorders in the body

Endoscopic treatment

Sometimes stomach bleeding can be stopped during endoscopy. To do this, special endoscopic instruments are inserted into the stomach through the mouth.

Methods of endoscopic treatment:

Injection of a bleeding stomach ulcer with solutions of adrenaline and norepinephrine which cause vasospasm and stop bleeding.
Electrocoagulation- cauterization of small bleeding areas of the mucous membrane.
Laser coagulation- cauterization with a laser.
stitching threads or metal clips.
Application of special medical glue.

These methods are mainly used for minor bleeding.

Surgery for stomach bleeding

Surgical treatment of gastric bleeding is necessary in the following cases:

attempts to stop bleeding without surgery do not work;
severe bleeding and a significant decrease in blood pressure;
severe disorders in the patient's body that can lead to deterioration of the condition: coronary heart disease, impaired blood flow in the brain;
repeated bleeding after they have already been stopped.

The most common types of operations for gastric bleeding:

Sewing up the bleeding area.
Removal of part of the stomach (or the entire organ, depending on the cause of bleeding).
Plastic surgery of the transition site of the stomach into the duodenum.
Surgery on the vagus nerve, which stimulates the secretion of gastric juice. As a result, the patient's condition improves with peptic ulcer reduces the risk of relapse.
Endovascular operations. The doctor makes a puncture in the inguinal region, inserts a probe through the femoral artery, reaches the bleeding loan and closes its lumen.

Stomach surgery can be performed through an incision or laparoscopically through incisions in the abdominal wall. The attending physician chooses the appropriate type surgical treatment and provides detailed information the patient, his relatives.

Rehabilitation after stomach surgery

Depending on the type of operation, its duration and volume may be different. Therefore, recovery times may vary.

In most cases rehabilitation measures carried out according to the scheme:

on the first day, the patient is allowed to move his arms and legs;
usually starts on the second day breathing exercises;
on the third day the patient can try to stand up;
on the eighth day, with a favorable course, the stitches are removed;
on the 14th day they are discharged from the hospital;
Subsequently, the patient is physical therapy, physical exercise banned for a month.

Diet in the postoperative period (if the operation was not very difficult, and there are no complications):

Day 1: It is forbidden to eat and drink water. You can only moisten your lips with water.
2nd day: you can only drink water, half a glass a day, teaspoons.
3rd day: you can take 500 ml of water, broth or strong tea.
4th day: you can take 4 glasses of liquid per day, dividing this amount into 8 or 12 doses, jelly, yogurt, mucous soups are allowed.
From the 5th day, you can use any amount of liquid soups, cottage cheese, semolina;
From the 7th day, boiled meat is added to the diet;
From the 9th day, the patient switches to the usual sparing diet, excluding irritating foods (spicy, etc.), products prepared on the basis of whole milk.
Subsequently, frequent meals in small portions are recommended - up to 7 times a day.

Prevention of stomach bleeding

The main measure for the prevention of gastric bleeding is the timely treatment of diseases that lead to them (see above - "causes of gastric bleeding").

Bleeding can occur anywhere in the gastrointestinal tract. The most dangerous and common is bleeding from the stomach. Intestinal bleeding is found much less frequently (about 10% of cases) and in most cases it stops on its own. Acute bleeding can be fatal, so require emergency treatment which can be conservative or operative.

Causes

Bleeding in the intestines or stomach can be triggered by:

pathologies of the gastrointestinal tract (ulcers, neoplasms, diverticula, Crohn's disease, ulcerative or bacterial colitis, helminths, hemorrhoids, injuries, foreign objects);
portal hypertension (hepatitis and cirrhosis of the liver, thrombosis of the portal or hepatic vein, compression or cavernous transformation of the portal vein, tumors, infiltrates);
damage to blood vessels (scleroderma, lupus, rheumatism, beriberi C, atherosclerosis, thrombosis or embolism of the mesenteric vessels);
blood diseases (thrombasthenia, aplastic anemia, leukemia, hemophilia, vitamin K deficiency, hypoprothrombinemia).

Acute gastrointestinal bleeding can be complications of various diseases and syndromes (more than 100 pathologies have been described that can provoke bleeding in the gastrointestinal tract). The source of blood is most often found in the upper part of the digestive tube (esophagus, stomach, duodenum).

Acute bleeding most often develops due to ulcers, portal hypertension syndrome, hemorrhagic erosive gastritis, tumors, Mallory-Weiss syndrome. In 15-20% of cases chronic ulcer the upper gastrointestinal tract (gastrointestinal tract) is complicated by bleeding. Blood from the wall of the stomach can also go with hypertension, atherosclerosis, esophageal hernia, Rendu-Osler disease, blood diseases, leiomyoma, lipoma, tuberculosis, syphilis, trauma or burns of the stomach, acute pancreatitis and other pathologies.

Blood from the wall of the duodenum can go with diverticulum, ruptured aortic aneurysm, pancreatic cancer, hysteria, hemobilia. Rarely, the cause of hemorrhage can be pancreatic adenoma, volvulus, inflammation of the appendix, sepsis, beriberi, food poisoning, radiation sickness, allergy, uremia, surgical intervention, an ulcer formed on the background of taking medications.

Bleeding from segments below the duodenal lean flexure is usually due to benign and malignant formations colon and rectum. Acute colonic bleeding occurs with cancer, colitis, dysentery, polyposis, cholera, intussusception, mesenteric thrombosis, intestinal tuberculosis and syphilis.

The rectal mucosa or anus can bleed with hemorrhoids, anal fissures, injuries, prolapse of the intestine, specific ulcers and NUC (ulcerative colitis), proctitis, paropractitis, after taking material for histology. In the digestive tube, blood can be found as a result of rupture of an aneurysm of the aorta, arteries of the stomach, intestines or spleen, hemobilia after a liver injury, liver abscesses, purulent pancreatitis, and also due to diseases of the circulatory and other body systems.

Bleeding in the gastrointestinal tract in 75% of cases has an ulcerative etiology

The provoking factor of hemorrhage may be taking corticosteroids, aspirin, non-steroidal anti-inflammatory drugs, alcohol intoxication, occupational hazards. In children, the cause of hemorrhage is more often in trauma to the intestinal wall. foreign body.

Symptoms

Depending on the rate of blood loss, bleeding is usually divided into obvious and latent, the determination of the latter is possible only during the analysis of feces for occult blood. Explicit acute are manifested by bloody vomiting and chalky, and hidden hemorrhages cause manifestations of anemia. Early signs intestinal hemorrhage are considered weakness, dizziness, fainting, palpitations, which is associated with the occurrence of anemia.

If the hemorrhage is severe, then hematemesis (due to the overflow of the stomach with blood) or melena (black semi-liquid stools with an unpleasant odor that is formed from blood and intestinal contents) may occur. With a small blood loss, there will be no bloody vomiting, since the blood has time to evacuate from the stomach into intestinal tract.

Blood appears in the vomit if the bleeding ulcer is in the duodenum and duodenal contents are thrown into the stomach. Repeated vomiting and melena occurs with massive bleeding. If vomiting is frequent, then this indicates ongoing bleeding in the high sections of the gastrointestinal tract, and if the intervals between urges are long, then most likely the bleeding resumes.

If the bleeding is not massive or chronic, then melena and vomiting can occur only a few days after the start of bleeding from the mucosal wall. Intestinal bleeding is more often manifested not by vomiting, but by the presence of blood in the stool. It can also be determined during a digital rectal examination, and the redder the blood, the closer to the anus the location of the damage.

If the blood loss is more than 100 ml, then, against the background of an accelerated passage of feces, the stool will contain liquid blood dark in color, and if the intestinal contents have advanced for more than 6 hours, then a tarry stool (melena) appears. You can determine the strength of the outpouring by the consistency of the feces. With the defeat of the small intestine, the feces are liquid, black, fetid.

If the bleeding opens above the rectosigmoid colon, then the blood has time to mix with the feces. When blood is isolated unchanged and unmixed with feces, hemorrhoidal bleeding or damage to the perianal region is suspected.

Most common cause intestinal bleeding - intestinal diverticulosis

Often, before acute bleeding, patients talk about increased pain in the epigastric region, and as soon as the ulcer begins to bleed, the pain becomes less intense or disappears altogether. This is because the blood dilutes the hydrochloric acid in the stomach. The skin with gastrointestinal bleeding becomes pale, cyanotic, cold, moist. The pulse is quickened, and blood pressure (blood pressure) is normal or low.

Intestinal bleeding is rarely acute, in most cases, patients only talk about the appearance of blood in the stool. If a lot of blood is poured out, then it irritates the intestinal walls and leads to an acceleration of the passage of feces through the digestive tube. Hence the liquid, black, fetid stool.

Acute blood loss (more than 0.5 liters of blood) leads to the following symptoms:

In young patients, bleeding from duodenal ulcers is more common, and in patients after 40 years, the pathology is more often localized in the stomach.

Signs of chronic hemorrhage:

pallor of the skin and mucous membranes;
glossitis, stomatitis;
decrease in working capacity;
dizziness;
anemia;
rarely tarry stools.

Inflammatory bowel pathologies cause pain in the lower abdomen, diarrhea, tenesmus (painful false urges to defecation). The blood is usually mixed with the stool because the source is above the rectosigmoid. Inflammation of the colon, which is provoked bacterial infection, can also cause bloody diarrhea, but blood loss is not significant.

Typhoid fever, for example, is manifested by intestinal bleeding, fever, increasing intoxication, rashes that turn pale when pressed, and coughing. Diagnosis is confirmed by sigmoidoscopy with biopsy and fecal analysis. With ischemia of the colon, colicky pain appears in the abdomen, more often on its left side. Bloody diarrhea is observed during the day.

Blood loss is usually minimal but can be massive. The diagnosis is established after x-ray examination and colonoscopy with biopsy. If hemorrhage occurs against the background of long-term low-grade fever, weight loss, chronic diarrhea and symptoms of intoxication, then intestinal tuberculosis can be assumed. If the outpouring of blood into the intestines is combined with systemic lesions of the skin, joints, eyes and other organs, then there is a high probability nonspecific colitis.

Diagnostic measures

You can guess the cause of intestinal bleeding by the accompanying symptoms. Diverticular bleeding is usually acute, painless, and appears as bright red blood in the stool, although melena may occur if the diverticulum is in the small intestine.

At internal hemorrhoids often pain syndrome is absent, and the patient notices blood on toilet paper, around feces. With anal fissures, the blood also does not mix with the stool, but there is pain. The same clinic occurs with rectal polyps and rectal carcinoma. At tumor processes on early stage rarely acute hemorrhage occurs, more often they cause chronic occult bleeding and iron deficiency.

Hidden blood loss, as a rule, accompanies ulcerative colitis, Crohn's disease, since large vessels are not damaged in these diseases.

Esophagogastroduodenoscopy is the most informative method diagnostics. With the help of the survey, it is possible not only to diagnose the disease, but also to predict the success of treatment with conservative methods. In conclusion, the endoscopist indicates whether the bleeding continues or has already ended, if it continues, then it is jet or drip, and if it has taken place, whether a blood clot or thrombosed vessels have formed only at the bottom of the ulcer (Forrest classification of bleeding).

The latter indicator is important for assessing the risk of recurrence, since if a blood clot has not formed, then the likelihood of re-opening of the ulcer is high.

During endoscopy, medical measures that stop bleeding (diathermocoagulation, laser coagulation, treatment with hemostatic or vasoconstrictor drugs, use of film-forming aerosols or biological adhesives).

To determine the degree of blood loss, it is necessary to ask how much blood the patient has lost, evaluate the color of the skin and mucous membranes, respiratory rate, pulse, and blood pressure. Lab tests will show deviations from the norm in the number of red blood cells, hemoglobin level, the value of the color index, the size of the specific gravity of blood and plasma.

If the bleeding is of non-ulcer etiology, then the following examinations may be required:

If chronic or non-intensive intestinal bleeding, then laboratory methods play an important role in the diagnosis. A clinical blood test allows you to determine the level of hemoglobin, blood cells, ESR (erythrocyte sedimentation rate), and the volume of circulating blood. With severe bleeding, these indicators change insignificantly in the first hours, so they cannot give an objective assessment of blood loss.

A coagulogram in acute hemorrhages shows an increase in blood clotting activity. Always with GCC, the level of urea increases, and the concentration of creatinine remains within the normal range. This can be detected by donating blood for biochemistry.

The benzidine test (Gregersen's reaction) even reveals the presence of occult blood in the feces, however, positive result can be obtained with bleeding gums, whipworm infection, after eating apples, nuts, plums, bananas, pineapples, fried meats, sausages, ham, tomatoes, certain drugs that contain iron or bismuth.

Differential Diagnosis carried out between the gastrointestinal, nasopharyngeal and pulmonary bleeding. The diagnosis is confirmed after studying the anamnesis, percussion and auscultation (tapping and listening) of the lungs, temperature, fluoroscopy results chest.

Treatment for acute and occult intestinal bleeding

Algorithm emergency care in case of acute bleeding from the upper gastrointestinal tract, it is supposed to put the patient on his back, turn his head to one side and put cold on his stomach. Further actions such as monitoring hemodynamics, temperature and frequency respiratory movements, oxygen therapy, intravenous infusions of saline, hydroxyethyl starch and other drugs are possible only medical workers.

First aid kit should include sterile gloves, ice, hemostatic drugs. Transportation of patients with acute hemorrhage is possible only in lying position. As soon as the pathology is diagnosed, it is necessary to start the infusion of blood substitutes. In the surgical department, simultaneously with diagnostic measures, correction of volemic disorders and hemostasis is carried out.

Upon admission, an anamnesis is taken, which can help in determining the cause of intestinal bleeding. Hemodynamic and hematological parameters are also determined, such as pulse, blood pressure, ECG, hemoglobin, creatinine, urea, electrolytes, blood group and Rh factor, acid-base state.

A patient with acute gastroduodenal bleeding should be treated in surgery

With severe gastroduodenal bleeding, the following measures should be taken immediately:

catheterization of the subclavian vein, restoration of circulating blood volume;
probing the stomach, washing the stomach with cold water to determine the localization of erosion and stop blood loss;
emergency esophagogastroduodenoscopy;
determination of the severity of blood loss;
oxygen therapy;
bladder catheterization.

Intestinal bleeding is less dangerous than bleeding from the upper gastrointestinal tract and in most cases it stops spontaneously. Only if the hemorrhage is abundant and does not stop on its own, then surgical intervention is prescribed.

With diverticular or angiodysplastic bleeding, intra-arterial administration of vasopressin, transcatheter embolization of intestinal arteries, endoscopic methods coagulation, sclerotherapy. For hemorrhoids, vasoconstriction therapy is recommended, oral administration 10% calcium chloride solution, and if the blood loss is significant, then rectal tamponade is used.

Low-intensity intestinal hemorrhages do not require hospitalization of the patient, to the department intensive care Only patients with symptoms of hemorrhagic shock are referred. Treatment of bleeding that occurred against the background of ischemia involves the restoration of blood flow. If intestinal infarction, peritonitis has developed, then it is necessary to remove the affected area. Hemorrhoidal bleeding is stopped by sclerosing or bandaging.

The patient must be prescribed a sparing diet, which excludes thermal, chemical and mechanical trauma to the digestive tract. Any spicy, fried, pickled, fatty foods should be excluded from the diet. Food temperature should be between 15-60°C. Nutritional recommendations will take into account the diagnosis and accompanying symptoms.

If the therapy of the disease that caused intestinal bleeding is not started on time, then, as a complication, intestinal perforation and peritonitis may occur, which require urgent surgical intervention. With the development of such serious complications, the chance for a favorable outcome of the disease is sharply reduced, therefore, as soon as the symptoms of intestinal bleeding have been noticed, one should seek medical help.

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

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

Pathogenesis

The mechanism of occurrence of gastrointestinal bleeding may be due to a violation of the integrity of the vessels (with their erosion, rupture of the walls, sclerotic changes, embolism, thrombosis, rupture of aneurysms or varicose veins, increased permeability and fragility of capillaries) or changes in the hemostasis system (with thrombocytopathy and thrombocytopenia, coagulation disorders). Often, both the vascular and hemostasiological components are involved in the mechanism of bleeding development.

Classification

Depending on the department of the digestive tract, which is the source of hemorrhage, there are bleeding from the upper sections (esophageal, gastric, duodenal) and lower sections of the gastrointestinal tract (small intestine, large intestine, hemorrhoidal). The outflow of blood from the upper parts of the digestive tract is 80-90%, from the lower - 10-20% of cases. In accordance with the etiopathogenetic mechanism, ulcerative and non-ulcerative gastrointestinal hemorrhages are distinguished.

According to the duration, acute and chronic bleeding are distinguished; by severity clinical signs- explicit and hidden; by the number of episodes - single and recurrent. According to the severity of blood loss, there are three degrees of bleeding. A mild degree is characterized by heart rate - 80 per minute, systolic blood pressure - not lower than 110 mm Hg. Art., satisfactory condition, safety of consciousness, slight dizziness, normal diuresis. Blood parameters: Er - above 3.5x1012 / l, Hb - above 100 g / l, Ht - more than 30%; BCC deficit - no more than 20%.

When bleeding moderate Heart rate is 100 beats per minute, systolic pressure is from 110 to 100 mm Hg. Art., consciousness is preserved, the skin is pale, covered with cold sweat, diuresis is moderately reduced. In the blood, a decrease in the amount of Er to 2.5x1012 / l, Hb - up to 100-80 g / l, Ht - up to 30-25%. The BCC deficit is 20-30%. A severe degree should be thought of with a heart rate of more than 100 beats. in min. weak filling and tension, systolic blood pressure less than 100 mm Hg. Art., lethargy of the patient, weakness, severe pallor, oliguria or anuria. The number of erythrocytes in the blood is less than 2.5x1012 / l, the level of Hb is below 80 g / l, Ht is less than 25% with a BCC deficiency of 30% or more. Bleeding with massive blood loss is called profuse.

Symptoms

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

Another characteristic sign of acute hemorrhages from the gastrointestinal tract is tarry stools (melena). The presence of clots or streaks of red blood in the stool indicates bleeding from the colon, rectum, or anal canal. Symptoms of hemorrhage are combined with signs of the underlying disease. In this case, there may be pain in various parts of the gastrointestinal tract, ascites, symptoms of intoxication, nausea, dysphagia, belching, etc. Hidden bleeding can be detected only on the basis of laboratory signs - anemia and positive reaction stool for occult blood.

Diagnostics

Examination of the patient is carried out by an abdominal surgeon, begins with a thorough clarification of the anamnesis, assessment of the nature of vomit and feces, and a digital rectal examination. Pay attention to the color of the skin: the presence of telangiectasias, petechiae and hematomas on the skin may indicate hemorrhagic diathesis; yellowness of the skin - about trouble in the hepatobiliary system or varicose veins veins of the esophagus. Palpation of the abdomen is carried out carefully, in order to avoid increased gastrointestinal bleeding.

From laboratory indicators, erythrocytes, hemoglobin, hematocrit, platelets are counted; study of coagulogram, determination of the level of creatinine, urea, liver tests. Depending on the suspected source of hemorrhage, various radiological methods can be used in the diagnosis: radiography of the esophagus, radiography of the stomach, irrigoscopy, angiography of mesenteric vessels, celiacography. The fastest and most accurate method for examining the gastrointestinal tract is endoscopy (esophagoscopy, gastroscopy, colonoscopy), which allows you to detect even superficial mucosal defects and the direct source of gastrointestinal bleeding.

To confirm bleeding and identify its exact localization, radioisotope research(scintigraphy of the gastrointestinal tract with labeled erythrocytes, dynamic scintigraphy of the esophagus and stomach, static scintigraphy of the intestine, etc.), MSCT of the abdominal organs. Pathology must be differentiated from pulmonary and nasopharyngeal bleeding, for which X-ray and endoscopic examination of the bronchi and nasopharynx is used.

Treatment of gastrointestinal bleeding

Patients are subject to immediate hospitalization surgery department. After clarifying the localization, causes and intensity of bleeding, treatment tactics are determined. With massive blood loss, blood transfusion, infusion and hemostatic therapy is carried out. Conservative tactics is justified in the case of hemorrhage, which has developed on the basis of a violation of hemostasis; the presence of severe intercurrent diseases (heart failure, heart defects, etc.), inoperable cancer processes, severe leukemia.

In case of bleeding from varicose veins of the esophagus, its endoscopic stop can be carried out by ligation or sclerosis of the altered vessels. According to indications, they resort to endoscopic arrest of gastroduodenal bleeding, colonoscopy with electrocoagulation or chipping of bleeding vessels. In some cases, surgical control of gastrointestinal bleeding is required.

So, with a stomach ulcer, a bleeding defect is sutured or an economical resection of the stomach is performed. With a duodenal ulcer complicated by bleeding, the stitching of the ulcer is supplemented with stem vagotomy and pyloroplasty or antrumectomy. If bleeding is caused by nonspecific ulcerative colitis, produce subtotal resection of the colon with the imposition of ileo- and sigmostoma.

Forecast and prevention

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