Bleeding from the gastrointestinal tract - is a dangerous phenomenon, which develops in the ulcers, vascular, mechanical and other lesions of the gastrointestinal tract. Profuse flow of blood into the lumen of the digestive system can lead to serious complications and death.
Stopping and gastrointestinal bleeding therapy (FCC) conducted promptly and in a manner Conservative medicine after the results of the laboratory, hardware and tool diagnostics.
Why is bleeding from the stomach
Bleeding in the gut, stomach and other digestive organs can occur for the following reasons:
- mechanical damage to the stomach by ingestion of a foreign body;
- abdominal trauma;
- burn the gastrointestinal mucosa;
- inflammation of the mucosa and esophageal reflux disease;
- erosive gastritis;
- peptic ulcer and 12 duodenal ulcer;
- Ulcerative and bacterial inflammation of the colon;
- Crohn's disease;
- endocrine and enzymatic disorders (parathyroid dysfunction, gastrinoma);
- prolonged use of NSAID (especially salicylic acid compounds), glucocorticoids, phenylbutazone and other drugs, medicaments disorders usage rules;
- complications of operations on the gastro-intestinal tract;
- mucosal damage at the junction of the esophagus and stomach with frequent and intense vomiting (Mallory-Weiss syndrome);
- benign and malignant neoplasms of the digestive tract;
- protrusion walls of the intestine (diverticulosis);
- tuberculosis and other chronic inflammatory bowel disease;
- intestinal bacterial infections and parasitic origin (dysentery, helminthiasis et al.);
- volvulus;
- damage hemorrhoids and intestinal polyps at passage of feces;
- anal fissure;
- aortokishechny fistula;
- Hirschsprung's disease and other diseases, leading to acute obstruction of stool;
- thrombosis of the portal and hepatic veins;
- compression of the portal vein or the major related vascular tumors or large scars;
- severe liver disease (lesion cirrhotic, chronic hepatitis);
- varicose esophageal and gastric veins;
- gastrointestinal vascular atherosclerosis;
- autoimmune diseases and inflammatory genesis affecting the blood vessels (systemic lupus erythematosus, scleroderma, hemorrhagic vasculitis, polyarteritis nodosa, etc.);
- congenital vascular anomaly (Rendu-Osler-Weber disease);
- atherosclerosis and aneurysm of the arteries of the digestive tract;
- vascular occlusion intestinal mesentery;
- congenital (hemophilia) and acquired coagulation disorders (acute deficiency of vitamins C and K, hypoprothrombinemia et al.);
- hemorrhagic diathesis (thrombocytopenic purpura, radiation thrombocytopenia, chronic and acute leukemias);
- DIC;
- aplastic anemia and other diseases of the hematopoietic system;
- cardiovascular disease (inflammation of the heart valves and heart bag system, insufficient cardiac function, hypertension, and others.).
The most common causes of gastrointestinal bleeding are duodenal and gastric ulcers. They cause up to 35% of all bleeding from the gastrointestinal tract. Risk factors for the development of peptic ulcers are frequent stress, alcohol consumption and smoking.
In children, the most common causes of bleeding are volvulus (for infants) and intestinal polyposis (preschoolers).
Some causes gastrointestinal bleeding (e.g., hemorrhoids, anal fissures or polyps) provoke only poor spotting or small blood in the feces. Ulcers, vascular pathologies, digestive tract tumors and ruptures the walls of the blood is abundantly mixed with secretions (vomiting, feces) in modified or unmodified form.
Classification
Bleeding from the digestive tract are divided into groups depending on the etiology, the source and severity of hemorrhage. According to the etiology of the bleeding are divided:
- on caused gastrointestinal diseases (ulcerative and non-ulcer genesis);
- provoked to circulatory disorders in the portal vein (portal hypertension);
- on bleeding vascular diseases;
- caused by abnormalities in the hematopoietic system, including hemorrhagic diathesis.
In accordance with the classification of the localization of bleeding are the following types of violations:
- bleeding of upper gastrointestinal tract (stomach, esophagus, duodenum 12);
- bleeding of the lower digestive system (small and large intestine, rectum, hemorrhoids).
Most often it develops discharge of blood from the upper gastrointestinal tract. Esophageal, duodenal and gastric bleeding diagnosed in 8-9 out of 10 patients with bleeding in the digestive tract.
Classification by severity of bleeding
| The degree of severity of the pathology | Reduced blood volume | external displays | Systolic blood pressure and heart rate | His blood counts |
| easy | Less than 20% | The patient's condition is satisfactory: the patient experiences normal urine excretion (diuresis), possible slight weakness and dizziness. The patient is conscious. |
BP - 110 mmHg Heart rate - not more than 80 beats / min. |
erythrocyte concentration - 3.5 * higher than 1012, the level of hemoglobin - 100 g / l, hematocrit - at least 30%. |
| Central | 20-30% | Cutaneous patient pale cover, there is a strong sweating (cold sweat), urine moderately lowered. The patient is conscious. |
Blood pressure - 100-110 mm Hg HR - 80-100 beats / min. |
erythrocyte concentration - 2.5 * higher than 1012, the level of hemoglobin -80-100 g / l, hematocrit - 25-30%. |
| Weight | Over 30% | The patient's condition serious: he has been a breakdown, dizziness, severe muscle weakness, severe pallor, sweating, decreased urine output (up to complete anuria). The reactions of the patient are inhibited, there may be a loss of consciousness. |
BP - below 100 mmHg HR -. More than 100 beats / min |
Concentration of erythrocytes - below 2.5 * 1012 -less hemoglobin level of 80 g / l, hematocrit - 25% less. |
Some experts distinguish a fourth, the most severe stage of bleeding. It is characterized by a complete loss of consciousness of the patient and the development of coma.
massive internal bleedingAccompanied by severe blood loss is called profuse.
In addition, bleeding in the gastrointestinal tract can be classified according to the following criteria:
- duration blood discharge (acute or chronic bleeding);
- the presence of the external manifestations of disease (implicit or explicit);
- frequency and number of cases of blood loss (single or repetitive, recurrent).
What are the signs and symptoms
Early symptoms of bleeding in the gastrointestinal tract include:
- general weakness, weakness;
- dizziness, fainting, confusion and loss of consciousness;
- tinnitus, flickering flies in his eyes;
- nausea, vomiting;
- discoloration of gastric and intestinal secretions (vomiting and stool);
- sweating;
- excessive thirst;
- increased heart rate;
- pale skin, cyanosis of the lips, blue and reduced temperature fingertips.
Intensity of symptoms of disease depends on the intensity of bleeding, and the bcc amount of blood lost. Because of the higher initial blood volume signs of bleeding in adults may manifest later and less pronounced than in children. Even a small loss of blood in a young child may result in the need for immediate resuscitation.
Symptoms of internal bleeding in the stomach frequently occur together with signs of massive blood loss and reduce blood volume. Against the background of the manifestations of blood loss can occur pain in the affected gastrointestinal, abdominal volume increase due to accumulation of fluid (ascites), fever caused by intoxication, weight loss, sudden change or loss of taste and other pathological phenomena, indicating the reason HMC.
The main symptom of gastric bleeding is hematemesis, the nature of which may indicate the cause of the disease and the duration of bleeding.
Vomiting in various pathologies of the upper gastrointestinal tract that result in blood loss:
| Cause of bleeding in the stomach, esophagus or duodenum 12 | The color and consistency of the vomit |
| Varicose veins and esophageal erosions, profuse bleeding at break of the mucosa | Scarlet blood in vomit |
| Ulcer 12 duodenal ulcer and gastric volvulus, cancer neoplasia top departments tract, the stomach lining gap | "Coffee grounds" (dark vomiting granular structure) |
"Coffee grounds" is a product of processing blood from the stomach hydrochloric acid.
In ulcerative lesions during vomiting stomach pain decrease. Hemorrhage is not accompanied by irritation of the peritoneum and the abdominal wall voltage muscles. If massive blood loss and stomach cancer also changes the color of the chair.
Repeated vomiting blood within 1-2 hours after the first event indicates continuing bleeding and vomiting in 4-6 hours - his relapse.
When gastric bleeding bleeding symptoms in most cases, are manifested more clearly than with bleeding in the intestines. This is because the frequent causes damage to the thin wall, colon and rectum are injuries hemorrhoids, polyps and small cracks in the lining. They can provoke long, but little blood loss, which is accompanied by a slight decrease the concentration of hemoglobin and the development of compensatory tachycardia with preservation of normal blood pressure and health patient.
Symptoms of gastrointestinal bleeding, accompanied by massive blood loss may include:
- black stool;
- selection melena (tarry unformed stool with a strong unpleasant odor);
- weakness, loss of consciousness, pale skin and other symptoms of acute blood loss.
The visual color change and stool patterns only visible in blood loss of over 100 ml / day and damages rectum and colon (cracks, polyps, bleeding hemorrhoids). The occasional flow of blood (for gastric and pathologies of the lower digestive tract) blood is excreted in the stool unchanged. With prolonged massive bleeding after a few hours after the start of allocated tarry stool (feces dark with small clots).
Nature of the changes of the chair at various intestinal pathologies:
| Disease | Appearance and consistency of secretions | bleeding patterns |
| Anal fissures, hemorrhoids | Cal with scarlet streaks of blood | Chronic blood loss occurring during and after defecation on exertion. |
| Nonspecific ulcerative colitis, Crohn's disease | Watery mucus and purulent bloody impurities | The most frequently observed minor bleeding for a long time, but it does happen and massive blood loss. |
| Oncological bowel disease | Dark stool with mucus admixture | Highlight long, low-intensity. Blood mixed into the feces, turning it into a darker shade. |
During the chronic disease may experience symptoms of anemia:
- weakness, fatigue;
- decreased performance;
- frequent dizziness;
- inflammation of the mouth and tongue;
- paleness of the mucous membranes and skin.
Diagnostics
Elucidation of the causes of the syndrome of gastrointestinal bleeding requires a careful clinical examination, laboratory tests, and the use of hardware and instrumental methods diagnostics.
workup
In primary diagnosis of internal bleeding in the stomach or intestine is carried out a clinical examination of the patient in which analyzes the following data:
- medical history of the patient;
- the list of medications;
- color and consistency of secretions;
- skin coloration (pallor, jaundice);
- presence of vascular "stars", hemorrhagic manifestations and other vascular abnormalities in the skin.
If there is a suspicion of intestinal or gastric bleeding, painful abdominal palpation and rectal examination is conducted with caution. Careless of the procedure can significantly increase blood loss.
Laboratory research
For laboratory tests, which are conducted with bleeding in the stomach, esophagus, and the lower regions of the gastrointestinal tract, include:
- general blood analysis;
- Blood biochemistry (liver and kidney samples, markers of inflammation and al.);
- coagulation;
- coprogram;
- Analysis of antibodies to double-stranded DNA, and others.
instrumental methods
The most informative hardware diagnostics methods that are used in suspected intraventricular hemorrhage and intracolonic are:
- X-ray study of the esophagus and stomach;
- tseliakografiya;
- MR angiography gastrointestinal vessels;
- static and dynamic scintigraphy of the digestive tract;
- CT of the abdomen;
- X-ray of the nasopharynx, bronchi and lungs.
Fastest bleeding in the stomach can be diagnosed by endoscopy of the upper gastrointestinal tract. In pathologies of the lower tract is used barium enema, sigmoidoscopy and colonoscopy.
If it is impossible to establish the source of bleeding via endoscopy and hardware methods laparotomy performed.
How to stop bleeding
Stop the bleeding must be carried out by doctors or medical institution brigade ambulance. Even before the emergency care you must call the "fast", described the state of the patient and the nature of the discharge.
Algorithm of emergency first aid for suspected bleeding comprises the following steps:
- put the patient on his back, lifting his feet with the help of the folded clothes or pillows;
- Do not give food and drink;
- put on the painful area a compress of ice wrapped in a cloth;
- during a first aid follow the nature of respiration and heart rate;
- In case of unconsciousness bring patient in the sense of using a cotton swab dipped in ammonia;
- with long-term expectation of "first" to carry a patient on a stretcher towards the medical team.
During emergency treatment when gastric bleeding is forbidden to wash the stomach. For suspected intestinal pathology can not make the patient an enema.
Trying to stop the blood without the help of a doctor can lead to death of the patient.
How to treat
When gastrointestinal bleeding, treatment is aimed at stopping it, eliminating the root causes of disease, restore hemostasis of the organism and normal blood volume.
The danger to the patient is not only the loss of red blood cells, which carry oxygen, but also a dramatic decrease in CBV, which leads to massive small vessel thrombosis and DIC development.
Conservative treatment
Conservative treatment of gastric intestinal bleeding and bleeding is carried out as an adjunct to surgery. As the main method of therapy is used for the following indications:
- hemorrhagic syndromes;
- cardiovascular diseases;
- inoperable cancers;
- congenital pathology hematopoietic system.
The therapy may be applied hemostatic agents, cytostatic agents, anti-inflammatory and other drugs.
With the loss of a large volume of blood a patient appointed IVs with saline solutions and transfusion of blood components.
Surgery
For suspected bleeding in the gastrointestinal tract of the patient taken to the surgical department of the clinic where the diagnosis and determination of treatment tactic.
The following operations can be performed depending on the diagnosis of the patient:
- endoscopic sclerotherapy, electrocoagulation and ligation of vessels dilated intestinal, esophageal, etc .;
- closure of the ulcer and partial resection of the stomach;
- sewing ulcer 12 duodenal ulcer;
- subtotal resection of the colon with the imposition of the stoma.
Diet
treatment tactics through diet therapy depends on the underlying disease. In the pathology of the stomach the patient is assigned to a table №1, # 1a (immediately after the relief of bleeding), or №1b №2. When bowel disease or recommended diet №3 №4.
If the discharge of blood is a complication of liver disease, patients are assigned a table №5 and its variations.
Consequences and complications
Complications of the flow of blood from the gastrointestinal tract include:
- DIC;
- anemia, moderate and severe;
- acute organ failure;
- coma.
The risk of serious consequences or death increases with the untimely address to the doctor.
How to prevent the phenomenon
For the prevention of this dangerous disease you must undergo regular medical check-ups, follow the rules of the medication and live a healthy lifestyle.
Accessing the first manifestations gastroenterologist and ulcerative disease (malaise, nausea, pain in the stomach and others.) Increases the likelihood of a favorable prognosis of treatment efficacy.
To keep track of gastrointestinal bleeding in the early stages, it is recommended to take regular fecal occult blood.
