In order to establish a more accurate diagnosis, doctors examine the gastrointestinal tract using fibrogastroscopy. If bleeding is detected, it is necessary to establish whether it is dangerous if urgent action is necessary. Due to the classification of Forest bleeding can differentiate extremely dangerous condition and a little dangerous. Clear system allows us to describe the specifics of the pathology and changes in development that have taken place since the previous endoscopy.
How is the diagnosis
Bleeding, if present, are classified according to various criteria - etiology, severity, size and other features of the disease. Doctor on Forrest name with the team created a uniform system of describing the stomach and duodenum pathologies and developed a protocol that is still filled after the EGD. There are several versions of this classification. They were developed in the last 2 decades. But based on the classification still 3 basic points.
The very diagnosis includes: medical history, blood analysis in the laboratory, carrying out instrumental examination.
advantages of the method
It is believed that the classification of the most informative Forest. This methodology is now used throughout the world. With fibergastroscope system clearly makes it possible to visualize what is going on with an ulcer, and understand what treatment is administered. Doctors anywhere in the world can read the illness and make a decision.
Another advantage of the classification - the ability to immediately assess the risk of recurrent bleeding, the possibility of preventive treatment.
Indications for
Clear diagnostic indications for fibrogastroduodenoscopy are:
- clarify the location and extent of pathology;
- differential diagnosis;
- Biopsy pathology (TBD form ulcers or cancer).
In addition to diagnostic, still have a therapeutic indications. The main therapeutic indications include:
- Removing small size of Oncology.
- dangerous Hemostasis (F1a and F1b).
- If the bleeding was not great, but there is a risk of complications, the doctor may prescribe surgery for resection - removal of part of the stomach.
Classification is designed only for erosive-ulcerous diseases. For bleeding caused by the rupture of mucous gastric junction or cancerous infiltration, can not apply the classification Forest. It is treated as a medical error, which carries consequences.
Classification
Discovered bleeding can be active or stopped. If it is not, the doctor detects that it is not revealed. Total distinguish 3 main groups of bleeding Forest.
forrest 1a
Found the damaged vessel. Intense bleeding. It is necessary to stop the bleeding, another pulse will fall, and will begin to suffer cardiac hemodynamics. In such cases, surgery is shown. The threat of complications of almost 80%. It is also high percentage of mortality in the postoperative period.
forrest 1b
Multiple small bleeding. Damaged capillaries. In the case of diffuse infiltration of blood is effective as a method of hemostasis, electrocautery. The threat of recurrence of approximately 10%. With the help of electrocoagulation threat and prevent the patient is prescribed bed rest for a few days.
Complications of these kinds - Forrest 1A and 1B - there are more than half the cases.
forrest 2a
On the screen of the endoscope detected recently bleeding vessel. There are risks of re-exacerbation of ulcers and loss of blood. The second group is set when the signs of recent bleeding detected. Often there are doubts about the group. That they did not arise, it decided to make the diagnosis using an endoscope, when found in the stigma cavity of the stomach during the examination. Stigma - it is bruising.
forrest 2b
Discovered a blood clot - a clot. Upon detection of a blood clot before 1998 it was considered that there was no danger. The patient has not been mapped. But a 1998 study D. Lowe's study showed that the clot-clot often only covers damaged eroded vessel. Therefore anticoagulant drugs still need.
forrest 2c
Discovered the black bottom of the ulcer. The hydrochloric acid layer was detected ulcer hematin. Hematin - oxidation product of hemoglobin contained in blood. It means a slight loss of red blood cells has been, but the threat of death there. Weather favorable. Treatment is prescribed conservative.
Forrest 3
Ulcer with a clean bottom - it's Forrest 3. The diagnosis means that the source of blood loss is not detected. Morphologic study areas such ulcers became apparent that the white bottom can bleed. Eroded the vessel due to fibrin is not visible during the inspection. Fibrin is a protein involved in folding process (coagulation) of blood. But drip bleeding there may be present.
Contraindications
Contraindications are divided into absolute and relative. By absolute, ie. E. to those under which definitely can not diagnose, include:
- the presence of asthma in a patient;
- epilepsy with frequent seizures;
- atlantoaxial subluxation - cervical spine injury.
And never spend EGD with esophageal cancer or severe burns it.
Relative contraindications are:
- coronary artery disease;
- inflammatory diseases of the oral cavity, pharynx, esophagus or airway;
- aortic aneurysm and others.
Diagnosis in these cases will be held in the period when the patient begins remission. Or diagnosis will have to spend in other ways, if the patient does not want to be exposed to dangerous for him to study.
additional studies
Besides EGD Gastroenterologist need, and other information about the patient's state of health. A clear diagnosis will be established after several incremental research. The physician needs to evidence complement each other and create an overall picture.
A comprehensive study of the whole organism.
- The study of the patient's blood. Need blood chemistry.
- The composition of urine.
- Medical history (anamnesis), as well as information about the presence of other diseases.
- MRI diagnosis of all internal organs.
If you are experiencing fatigue, paleness, dizziness - are clear signs of blood loss, the patient is required to monitor the blood pressure and hemodynamics of the heart. Those who have been diagnosed any heart disease, fibrogastroscopy carried out under the supervision of an experienced cardiologist.
How to stop bleeding ulcer
ulcer bleeding fraught with the loss of hemoglobin, Oxygen transfer deterioration in the tissues, decrease in heart rate and other effects. One of the tasks of a doctor during an endoscopy - stabilized hemostasis, the blood does not leak from the gastrointestinal tract.
Methods hemostatic effects are different. Popular mechanical, electro-thermal and chemical methods. The most effective hemostasis - is endoscopic injection. With the help of an endoscope he is inserted into the submucosa near the ulcer chemical drug that can stop the blood pulsing rapidly. For this purpose 1% epinephrine, mixed with saline.
gastrectomy
If you set the type of F1a - pulsating jet, blood quickly fills the gastrointestinal tract. In some cases, you can not avoid self-medication. You should immediately call an ambulance. Giant ulcers that more than 2,5-3 cm in diameter, and peptic operated on urgently.
Tactics surgeons in preparation for surgery consists of three points:
- Definitions Group on Forrest.
- Implementation of an early endoscopy, in which the determined level and mucosal damage risk.
- Determining the level and timing of operation. Determined what needed resection: resection of the distal, proximal, or gastrectomy.
In cases where the ulcer is dangerous, and there is a risk of repeated heavy bleeding, is assigned to the planned distal gastrectomy. The operation does not raise any concerns. In the course of its body removed 2/3, the gatekeeper. The remaining stump connected to the small intestine or duodenum with. The operation is possible only after a full stop bleeding.
Total resection, or gastrectomy with resection - the removal of more than 90% of body tissues. Appointed after endoscopy when observed recurrent ulceration have been lost large amounts of blood found pyloric stenosis.
