Gastrointestinal bleeding: symptoms, diagnosis, emergency care
Gastric bleeding is extremely dangerousa condition that, in the absence of timely assistance, can lead to complications such as shock and multiple organ failure. The causes of blood loss can be very different. That is why many people are interested in additional information about this pathology.
What symptoms are accompanied by blood loss? What are the causes of the appearance of pathology? What does the emergency help look like with gastric bleeding? What methods of treatment does modern medicine offer? Answers to these questions will be useful to many readers.
Bleeding due to stomach diseases
In fact, there are many diseases of the digestive system that can lead to bleeding.
- First of all it is necessary to talk about ulcerativedisease, since in 15-20% of patients this pathology is complicated by bleeding. Against the background of this disease, thrombosis of the vessel (its wall bursts due to a sudden increase in pressure) or its damage under the influence of gastric juice is possible.
- To the list of the reasons it is necessary to carry and availabilitymalignant tumors in the stomach. Continuous growth of the neoplasm can lead to vascular damage. In addition, bleeding may be due to trauma to the tumor itself.
- Risk factor is the presence of a diverticulum - this is a kind of protrusion of the stomach wall. Inflammation or trauma of this structure is often accompanied by damage to blood vessels and loss of blood.
- With diaphragmatic hernia, the cardiac part orThe bottom of the stomach can move into the chest cavity. As a result of a similar pathology, gastric juice starts to be thrown into the esophagus. Damage to the mucous membrane of this organ is sometimes accompanied by bleeding.
- The same result can result in a polypstomach. Despite the fact that this benign formation, its trauma or ulceration of the walls under the influence of gastric juice is accompanied by a loss of blood. In addition, the polyp can be twisted around its leg or infringed, which also leads to damage to small vessels.
- The cause may be hemorrhagic gastritis. This form of the disease is accompanied by inflammation of the gastric mucosa and the formation of erosive areas on it.
- There is also a so-called "stress" ulcer. As you know, nervous overexertion and strong emotions affect all systems of organs. Against the background of stress, the adrenal glands synthesize a huge amount of glucocorticosteroids, which leads to increased production of gastric juice. Under the influence of hydrochloric acid, the walls of the stomach can ulcerate, which is accompanied by damage to blood vessels and the appearance of bleeding.
It is worth noting that each of these diseaseshas its own unique clinical picture. The presence of nausea, heartburn, epigastric pain - all these are important symptoms, which must be reported to the doctor.
Diseases of blood vessels
Gastric bleeding is not always directly related to diseases of the digestive organs. The loss of blood can be caused by damage to blood vessels.
- The risk factors include varicose veinsveins of the upper part of the stomach and esophagus. With a similar pathology, the vessel walls become very weak, which increases the risk of their damage and, consequently, the occurrence of bleeding. In turn, varicose veins can be the result of tumors and cirrhosis of the liver, thrombosis or compression of the portal vein, chronic lymphocytic leukemia.
- The cause of hemorrhage can be a systemicvasculitis. This is an autoimmune disease that is accompanied by damage to the vascular walls as a result of the action of specific antibodies produced by the immune system. The veins and arteries become weak, which increases the risk of their rupture.
- Atherosclerosis is a pathology that is characterized byformation on the walls of vessels of atherosclerotic plaques. As a result of this process, the lumen of the vessel decreases. Any injury or a sharp jump in blood pressure can lead to damage to the artery wall.
Problems with blood coagulability
In some cases, gastric bleeding is associated with impaired coagulation processes. The list of risk factors is quite large.
- Hemophilia is a hereditary pathology, which is accompanied by a violation of blood clotting. Clots are not formed, so stop bleeding is very difficult.
- Leukemia (acute and chronic forms) - cancer of the blood, which disrupts the process of hematopoiesis in the bone marrow, in particular, there are problems with the formation of platelets.
- Hemorrhagic diathesis is also accompanied by increased bleeding and coagulation problems.
- Vitamin K plays an important role in the formation of thrombi in vascular injury. With its deficiency, hemorrhages in the internal organs, increased bleeding.
- Hypoprothrombinemia is a pathology accompanied by a deficiency of prothrombin in the blood.
Gastrointestinal bleeding: symptoms
The earlier a person is givenqualified care, the lower the likelihood of incompatible life complications. So how does the clinical picture look with gastric bleeding? Symptoms are very diverse.
- First, there are common signs of hemorrhage. The person becomes listless, complains of dizziness, noise in the ears. The patient's pulse is weak, blood pressure gradually decreases. The patient's skin turns pale, often a cold sweat appears. There is a retardation, confusion. It is difficult for the patient to concentrate, it is difficult to answer questions. Possible loss of consciousness.
- Of course, there are other features thatcharacterized by gastric bleeding. A sign of pathology, and very characteristic - vomiting with blood. Most often, vomit in a consistency resemble coffee grounds, because the blood, getting into the stomach, is exposed to hydrochloric acid. If there is scarlet unchanged blood in the vomit, this can indicate a massive arterial bleeding from the stomach (the loss of blood is so fast and massive that the blood does not have time to react with acidic gastric juice).
- Traces of blood are present in the fecal masses. The cala acquires a black color and a tarry consistency. If the secretions are visible veins of scarlet unchanged blood, then this indicates the presence of intestinal, and not gastric bleeding.
If a person has these symptoms,then it must be immediately taken to the hospital. First aid for gastric bleeding is very important. Lack of timely therapy can result in death of the patient.
Internal gastric bleeding is an extremely dangerous condition that can provoke the development of complications.
- Abundant loss of blood often leads to hemorrhagic shock.
- The risk of acute anemia is high. In the blood, the number of red blood cells sharply decreases, as a result of which cells and tissues do not receive enough oxygen (it is the erythrocytes that ensure its transportation).
- On the background of gastric bleeding, an acute form of renal failure often develops.
- There is a risk of multiple organ failure. This is the body's response to stress caused by blood loss, resulting in a failure in the work of several systems of organs.
It should be noted that untimely assistance with gastric bleeding, as well as attempts to cope with the problem on their own can result in the death of the patient.
A patient with symptoms of hemorrhage should be taken to the hospital. Diagnosis of gastric bleeding includes a number of procedures.
- As a result of a general blood test, you can see that the number of erythrocytes and platelets is much lower than normal - this indicates a possible internal bleeding.
- A coagulogram is performed if there is a suspicion of a violation of normal clotting of the blood.
- Fibrogastroduodenoscopy is a procedure, duringwhich the doctor using a special probe examines the mucous membrane of the esophagus, stomach and upper intestine. This technique sometimes allows you to accurately determine the place of bleeding and assess its scale.
- Radiography of the stomach is performed in order to determine the possible cause of bleeding. For example, in the picture the doctor can see ulcerative lesions, diaphragmatic hernia, available tumors, etc.
- Angiography is a procedure that allowsto estimate the current of blood in a certain vessel. Using a special catheter, a contrast medium is injected into the vessel, followed by a series of X-rays. On them the painted vessel is perfectly visible, thus it is possible to trace a current of blood.
- Scanning using isotopes involves the introduction of labeled red blood cells into the patient's body. Red corpuscles accumulate at the site of bleeding - it can be visualized in pictures.
- Magnetic resonance imaging allows a doctorreceive three-dimensional images of organs, assess the extent of damage, detect a bleeding site, etc. This procedure is mandatory if the patient is shown a surgical procedure.
First aid for gastric bleeding
Noticing the person described above, you need to urgently call a team of doctors. First aid for gastrointestinal bleeding is extremely important. Its algorithm is as follows.
- The patient needs to be laid, you can put a small pillow under your feet.
- The patient should not move, it is recommended to remain at rest.
- In case of bleeding, one should not eat or drink, as this stimulates the work of the stomach, due to which the loss of blood increases.
- On the stomach you need to put something cold, for example, pieces of ice wrapped in a towel. The cold narrows the blood vessels, thereby stopping the bleeding.
All other measures aimed at stopping the bleeding of the gastrointestinal tract are already conducted in a hospital.
- As a rule, first the stomach is washed with ice water - this helps to narrow the blood vessels. A special probe with a tube is injected directly into the stomach through the oral or nasal cavity.
- In the same way, adrenaline and norepinephrine are delivered to the stomach. These substances are stress hormones that cause vasospasm and provide an opportunity to stop blood loss.
- Intravenously, patients are given medications that areincrease blood clotting. As a result of this therapy, thrombi form in the damaged areas of blood vessels, which helps stop or slow the loss of blood.
- If gastric bleeding has led to the loss of large amounts of blood, a transfusion is shown to the patient (donor blood, frozen plasma, blood substitutes) can be used.
If the bleeding is small, it can be stoppedwith the help of endoscopic procedures. These include the already described obkalyvanie damaged areas of adrenaline and norepinephrine. In addition, other techniques may be used.
- Electrocoagulation is a procedure in which a special endoscope is injected into the stomach and the damaged walls of the organ and vessels are cauterized by means of an electric current.
- Laser coagulation - tissues are cauterized with a laser beam.
- Sometimes on the walls of the stomach, applications of special medical glue are applied.
- It is also possible to endoscopically overlap metal clips and thread the damaged vessels.
When is surgery necessary?
Unfortunately, in some cases, gastric bleeding can be stopped only during a full surgical intervention. The operation is shown in the following cases:
- there is massive bleeding and a rapid decrease in blood pressure;
- attempts to stop the loss of blood were medically ineffective;
- the patient has systemic disorders (eg, ischemic heart disease, problems with cerebral circulation);
- After a successful medical or endoscopic treatment, the bleeding started again.
Operations on the stomach can be carried out either throughincision of the abdominal wall, and by means of laparoscopic equipment (only small punctures are made in the abdominal region). There are many procedures designed to eliminate bleeding:
- stitching of the damaged part of the organ;
- removal of the stomach or some part of it (here everything depends on the cause of bleeding);
- endovascular procedures, in which the probe is inserted through the femoral artery, reach the bleeding vessel and overlap its lumen.
A suitable methodology can only be definedthe attending physician, since everything here depends on the general condition of the patient, the degree of blood loss, the cause of bleeding, the presence of concomitant pathologies, etc.