Degrees of gastrointestinal bleeding. Bleeding from the gastrointestinal tract

Gastric bleeding is one of the most common conditions that occurs against the background of various diseases of the stomach and duodenum. At the same time, venous or arterial blood flows freely into the lumen of the stomach. The volume of lost blood can reach 3-4 liters, and therefore the prognosis for gastric bleeding is not always favorable, and in the absence of therapeutic measures it can lead to the death of the patient.

Classification of gastric bleeding

Today, there are many principles for dividing gastric bleeding into different groups.

Due to the occurrence:

• Ulcerative bleeding – the source of bleeding is chronic and acute gastric ulcers of any location;
• Non-ulcer bleeding – the causes of bleeding are varied, you can read about them below.

According to the nature of the flow:

• Ongoing:
  • Jet or profuse,
  • Capillary,
  • Recurrent,
  • Unstable;
• Finished.

According to the severity of the clinical picture:

• Mild severity – vomiting once or twice, darkening of the stool, changes in blood pressure and pulse are not observed. Full compensation for the condition.
• Moderate severity – vomiting more than once, decreased blood pressure: systolic to 90 mm Hg. Art., slight tachycardia - pulse up to 100 beats per minute. Relative compensation of condition.
• Severe severity - repeated vomiting of blood, non-stop, drop in blood pressure: systolic up to 60 mm Hg. Art. and lower, significant tachycardia - up to 120 beats. per minute with a possible transition to bradycardia (pulse less than 60 beats). Decompensation of the condition.

According to the endoscopic picture:

• IA – blood flows from the site of injury in a stream;
• IB – drip bleeding from damage to the mucous membrane;
• IIA – a thrombosed vessel is observed at the bottom of the ulcer;
• IIB – the ulcer is closed by a blood clot;
• IIC – an ulcer without signs of bleeding is observed;
• III – the source of bleeding cannot be detected.

In addition, there is a division of gastric bleeding into:

• Acute and chronic, differing in the time of bleeding;
• Hidden and obvious, characterized by the absence or presence of corresponding clinical symptoms in a person;
• Single and recurrent, divided by frequency of bleeding.

Causes of stomach bleeding

Today, more than 100 possible causes of gastric bleeding can be identified. Let's talk about the most common among them.

The first large group of reasons is associated with the pathology of the stomach itself.

Gastric ulcer. In 10-20% of cases, this disease is characterized by the development of gastric bleeding. In this case, the mechanism of bleeding can be different: either direct damage to the vessel occurs due to the aggressive contents of the stomach, or the vessel ruptures due to a blood clot formed in it.

Malignant neoplasms of the stomach. They are characterized by constant growth deep into the wall of the organ with possible damage to the integrity of the blood vessels. Stomach cancer can be either a separate disease or develop against the background of a peptic ulcer.

Diverticular disease and isolated diverticula. In this case, small “finger-like” protrusions are formed in the wall of the stomach. Against the background of damaging factors, inflammation of the diverticulum occurs - diverticulitis (with the risk of damage to the vessels of the organ wall in this place).

Diaphragmatic hernia. The disease is characterized by weakness of the diaphragm and movement of part of the stomach into the chest cavity through the esophageal opening of the diaphragm. Bleeding can occur either due to the constant effect of stomach hydrochloric acid on the thin mucous membrane of the esophagus, or due to the formation of stomach ulcers at the junction of the stomach with the chest cavity.

Polyps in the stomach. A polyp is a benign tumor of the gastric mucosa. Damage to blood vessels can occur due to the formation of an ulcer on the polyp, trauma and formation, or local circulatory disorders in the polyp.

In addition to causes related to the stomach, there is a large group of diseases of other organs that can also lead to the development of gastric bleeding.

Portal hypertension with varicose veins of the esophagus and upper stomach. At the bottom of the esophagus there is a very large venous plexus - this is the junction of veins from two different venous systems. These veins lie very superficially and can be easily injured, especially against the background of diseases associated with their expansion: hepatitis of the liver resulting in cirrhosis, tumors of the liver and biliary tract, portal vein thrombosis, portal vein compression syndromes in various pathologies.

Systemic vasculitis with damage to blood vessels of any location (including gastric). With these diseases, damage to the inner lining of the blood vessels occurs, which leads to their increased fragility and frequent ruptures.

Pathology of the blood coagulation system leads to an increased risk of bleeding from any location, including from the vessels of the stomach. Any microtrauma against the background of these diseases can lead to serious gastric bleeding.

Causes of stomach bleeding in children

The causes of gastric bleeding in children differ from those typical for adults and vary depending on the age of the child:

• In newborns, the most common cause of gastric bleeding is hemorrhagic disease of the newborn, associated with a lack of vitamin K and a violation of the synthesis of blood clotting factors as a result.
• In children from 1 to 3 years of age, gastric bleeding most often occurs due to various intussusceptions, diverticula and diaphragmatic hernias of the stomach.
• In children aged 3 to 7 years, the most common cause is gastric polyposis, which occurs as a hereditary disease.

In addition, a common cause of gastric bleeding in children are various infectious diseases affecting the gastrointestinal tract (salmonellosis, dysentery, etc.), injuries and foreign bodies entering the stomach.

Complications of gastric bleeding

The most common complications of ongoing gastric bleeding are posthemorrhagic anemia and hemorrhagic shock.

Posthemorrhagic anemia is characterized by a decrease in the level of hemoglobin and red blood cells in the patient and is associated with a constant loss of hemoglobin and extravascular destruction of red blood cells. Does not pose a serious threat to health if corrected in a timely manner.

Hemorrhagic shock develops against the background of massive blood loss and is characterized by a drop in blood pressure, the development of acute cardiac and pulmonary failure and kidney damage due to their hypoxia. The condition poses a mortal danger to the patient and requires immediate assistance from the resuscitation team.

Therefore, if any symptoms of gastric or gastrointestinal bleeding appear, it is necessary to immediately contact a specialist in a medical institution to carry out diagnostic measures and organize rational treatment.

Symptoms

Gastric bleeding is a serious complication of a number of diseases of the stomach and other organs of the human body, characterized by the outpouring of venous or arterial blood into the lumen of the stomach.

Symptoms of gastric bleeding are varied and depend on a number of factors: the disease against which the bleeding developed; volume and duration of blood loss. At the same time, certain patterns can be identified in the development of the clinical picture and the symptoms can be divided into several groups.

General symptoms of blood loss

The first signs of gastric bleeding are the appearance in the patient of gradually increasing general weakness, lethargy, and a decrease in physical and intellectual performance. Further blood loss leads to the development of symptoms of stage 1 hemorrhagic shock: a person experiences dizziness, attacks of general weakness, becomes pale, cold sticky sweat appears on the forehead and back, tachycardia occurs and a drop in blood pressure occurs (systolic pressure up to 90 mm Hg). In this case, a slight initial mental arousal is possible, which is replaced by apathy and indifference to the environment.

Vomiting and changes in stool

Changes in bowel movements and the appearance of vomiting with certain characteristics are the most important symptoms of gastric bleeding. When bleeding, as a rule, the vomit has the appearance of “coffee grounds” with a brown color and blood clots. If the bleeding is profuse, then the blood may not be changed and be red-scarlet in color.

The next characteristic sign of gastric bleeding is baby-like stool or melena. It is characterized by a black color and is a symptom of bleeding from the upper gastrointestinal tract. It is important to note that it is the appearance of melena in a person that allows one to suspect hidden bleeding from the stomach or small intestine. If there are streaks of scarlet blood in the stool, then the source of bleeding is in the anus.

Symptoms of stomach bleeding in children

The general picture of the development of gastric bleeding in children is similar to that in adults. But due to the fact that children cannot always describe their sensations, some symptoms may go unnoticed.

The appearance of vomiting blood and baby-like stools are characteristic signs of gastric bleeding at any age. In addition, the child experiences lethargy, lack of interest in the things and people around him, pale skin and visible mucous membranes, and cold extremities. As internal bleeding progresses, facial features become sharper, dark circles form around the eyes, the child begins to yawn and tries to go to bed, despite the severity of the condition. Such signs are characteristic of dehydration due to the loss of a large volume of blood.

Very often, gastric bleeding in children is characterized by a hidden course. Then the symptoms of posthemorrhagic anemia come to the fore: weakness, dizziness, increased fatigue during physical and mental work, pallor.

Symptoms in combination with peptic ulcer

Among all the causes of gastric bleeding, ulcers due to gastric ulcers and other conditions occupy a leading place - 60-80% in the structure of causes. At the same time, a number of factors play a great role in the occurrence of ulcers: a person’s diet, medication intake, concomitant pathology, etc. Bleeding from ulcers is usually characterized by massiveness and a high mortality rate. In 15-20% of cases, it is gastric bleeding that is the reason for seeking medical help. Most often, such a complication of peptic ulcer disease occurs in people over 40 years of age with the presence of risk factors (taking non-steroidal anti-inflammatory drugs, smoking, non-compliance with dietary restrictions, etc.). Very often, bleeding precedes or develops simultaneously with perforation of the stomach wall.

The pattern of symptoms for peptic ulcers with bleeding is very specific. Against the background of a painful attack in the upper abdomen, a feeling of weakness, and unpleasant sensations in the mouth, the pain syndrome suddenly goes away and vomiting occurs - either in the form of “coffee” grounds, or in the form of slightly changed blood. If perforation develops during bleeding, then the pain takes on a dagger-like hue, the patient begins to feel severe weakness, dizziness and nervous excitement. Symptoms of peritonitis develop: diffuse pain throughout the abdomen, tension in the anterior abdominal wall, a rise in body temperature to 38-39 degrees. In most cases, this condition is fatal.

It is very important that if any of these symptoms appear, immediately contact a medical institution to receive specialized first aid, carry out diagnostic measures and prescribe treatment for the patient.

Diagnostics

When the first signs of gastric bleeding appear, you should immediately consult a doctor, since this condition poses a great danger to human life. Emergency care provided to the patient is aimed at eliminating the symptoms and identifying the causes of this condition.

Diagnosis of gastrointestinal bleeding includes:

• endoscopic examination;
• X-ray of the stomach;
• vascular angiography;
• radioisotope scanning;
• capsule endoscopy;
• colonoscopy;
• magnetic resonance imaging;
• blood test;
• coagulogram;
• rectal and external examination;
• stool analysis for the presence of hidden bleeding.

Differential diagnosis of gastric bleeding also includes an analysis of factors that could provoke the disease. The person’s lifestyle and what medications he or she takes must be taken into account. The patient’s medical record must be studied to determine the presence of concomitant diseases that could cause the main signs of gastric bleeding.

Clinical examination

Examination of a sick person must include the following:

• examination of the condition of the skin. This takes into account the presence of hematomas, dilated small vessels and other factors that may affect the correct diagnosis;
• digital examination of the rectum, which helps to identify the presence of bleeding. Also, this diagnostic method is necessary to assess the patient’s condition, to identify tumors or hemorrhoids;
• palpation of the abdominal cavity, which reveals possible enlargement of the liver or spleen, accumulation of fluid, and the appearance of various neoplasms;
• determining the size of lymph nodes.

When gastrointestinal bleeding occurs, a change in stool occurs, so a stool analysis is required. This may indicate the localization of the problem - in the stomach, intestines, or rectum.

A clinical study is not able to identify the causes of bleeding, but it may well determine the severity of the patient’s condition and the degree of blood loss. The diagnosis is also influenced by the presence or absence of pain during palpation of the abdominal cavity.

Laboratory research

Diagnosis of gastric bleeding necessarily includes a number of laboratory methods:

• General blood test - determines the amount of hemoglobin, red blood cells, leukocytes, platelets, ESR. These data may change for the worse even after bleeding has stopped;
• coagulogram - determination of blood clotting disorders. It is carried out using special equipment, where several indicators are analyzed that indicate the presence of pathologies;
• biochemical analysis - reveals the amount of urea, creatine in the blood and determines other equally important data that directly affects the diagnosis and treatment tactics.

These analyzes are of great value if they are performed several times. The main indicators that are visible over time indicate the course of the disease and the effectiveness of treatment.

Endoscopic examination

A comprehensive diagnosis of gastric bleeding necessarily includes examination using a fibrogastroscope, at the end of which there is a small camera. This allows the gastroenterologist to carefully examine the mucous membrane of the esophagus and stomach. This study is very informative and in most cases determines the source of bleeding in the digestive system.

Endoscopy is performed as follows:

• The person lies on his left side.
• An anesthetic spray is used to numb the mucous membrane.
• A special mouthpiece is placed in the patient's mouth.
• The doctor inserts a special device through the person’s mouth into the stomach - a fibrogastroscope, which is a flexible cord. During this time, the patient should not move and breathe intensively through the nose.

This study is quite unpleasant, but it takes a little time and is very informative.

X-ray of the stomach

How to determine gastric bleeding? In many cases, an X-ray of the stomach using a contrast agent will be quite informative. Using this study, it is possible to assess the condition of the walls of this organ and identify various pathologies.

X-rays are performed exclusively on an empty stomach. If the stomach is filled with food, the contrast agent will not be able to distribute properly throughout its walls.

Research methodology:

• The person should drink a solution containing barium sulfate. A special feature of this substance is that it does not transmit x-rays.
• Several x-ray pictures are taken. In this case, the person must take different positions so that the study is as informative as possible.
• An analysis of x-rays is carried out, on which the stomach is clearly visible.

Angiography

Angiography or X-ray contrast examination is indicated when there is a suspicion that gastric bleeding is caused by vascular pathology. This may be caused by atherosclerosis or other serious disorders.

This study is carried out using a special contrast agent, which is injected into the vessel using a catheter. After this, an x-ray is taken. The resulting images clearly show the vessel. Based on the data obtained, it is possible to draw conclusions about the cause of gastric bleeding.

Radioisotope scanning

This study is carried out in cases where other diagnostic methods have failed to identify the causes of bleeding.

Before radioisotope scanning, a solution containing red blood cells, which are marked with a contrast agent, is injected into the blood of a sick person. After this, they accumulate in large quantities at the site of bleeding. It can be identified in photographs taken by a special device.

Magnetic resonance imaging

This study is carried out when the doctor needs additional data about the health status of a sick person. Magnetic resonance imaging allows you to obtain a 3D image of a specific organ or images with layer-by-layer sections of the necessary parts of the body.

This study is very informative and is carried out using a special installation - a tomograph.

Colonoscopy – indications and how it is performed

Colonoscopy is considered the most informative method for diagnosing defects of the large intestine. With its help, you can identify pathologies that caused heavy bleeding. The procedure is carried out with a special long probe - an endoscope. It is inserted through the anus into the intestines, after which the doctor sees an image of the mucous membrane on the screen. A significant disadvantage of the method is that a colonoscopy cannot be performed if a person has intense bleeding.

This procedure is quite complex and time-consuming. To avoid discomfort, you must strictly follow all the doctor’s instructions. Before the procedure, you need to completely cleanse the intestines. To do this, you need to take a special drug in the evening if the colonoscopy takes place in the morning. To reduce pain, antispasmodics are also prescribed. For the same purpose, immediately before inserting the probe into the intestines, the doctor injects the patient with an anesthetic.

The procedure does not last long. On average, 10-15 minutes are enough.

Capsule endoscopy is an innovative method for diagnosing gastrointestinal bleeding

In some cases, a doctor may decide to use a modern capsule endoscopy method to diagnose pathologies of the digestive system. It consists in the fact that the patient must swallow a special endocapsule.

This device transmits in real time an image of the mucous membranes of the digestive system. Capsule endoscopy allows you to identify pathologies of the stomach, esophagus, small and large intestines, and duodenum, which may have gone unnoticed during other studies.

The duration of the procedure is 8-9 hours. The advantage of diagnosis is that the patient does not need to lie down during this time. A person can do his usual activities. There is also no need to specifically remove the endocapsule. When the device passes through the entire digestive tract, it comes out naturally on its own.

Treatment

Gastric bleeding poses a serious danger to human health due to the high likelihood of severe complications, including death. That is why timely provision of medical care and stopping gastric bleeding are the most important tasks for this disease.

Treatment of gastric bleeding requires the immediate initiation of therapeutic measures, which include two directions of influence on the patient’s body:

• Drug treatment;
• Surgical treatment.

Drug therapy

Treatment of the patient begins with non-drug treatment. The patient is recommended to undergo strict bed rest and limit any physical activity, which is necessary to reduce the risk of recurrent bleeding. In addition, a special diet is used, which continues after gastric bleeding has stopped.

Conservative treatment for mild gastric bleeding is most often considered as a backup option. But for him, there are a number of specific indications:

• Bleeding of the 1st and 2nd degrees, which does not pose a threat to human health.
• The presence of severe concomitant diseases (hematological pathology - acute and chronic leukemia, malignant neoplasms of various localizations, chronic heart failure in the decompensation phase, etc.);
• Pathology of the hemostasis system, threatening the increase or development of new bleeding when attempting surgery.

These indications for conservative treatment are inherently contraindications for surgery, since they significantly worsen the prognosis in the postoperative period for a particular patient.

Drug therapy, based on its effect on certain causes of gastric bleeding, can be divided into three options:

• Aimed at the patient’s hemostasis system;
• Directly directed at the source of bleeding;
• Infusion therapy aimed at restoring circulating blood volume.

Drugs that affect the hemostatic system have a complex effect on its individual components. These drugs include Etamsylate, Vikasol, Aminocaproic acid, etc. Octreotide, which increases platelet aggregation and reduces the secretion of hydrochloric acid in the stomach, shows a good therapeutic effect. Most often, these drugs are administered intramuscularly or intravenously, since taking them by mouth will not be effective. If the latter option is possible, then Omez, Gastrocepin and Vasopressin are used. Omeprazole is used in high dosages, which allows you to quickly stop bleeding.

An important step in the prevention of repeated bleeding from the vessels of the stomach is the prescription of proton pump inhibitors (Omeprazole, etc.) in standard dosages.

The most important stage of treatment (especially in the case of massive blood loss) is the restoration of an adequate volume of circulating blood. For this purpose, crystalline and colloidal solutions are used. For mild blood loss, Reopoliglucin or a 5% glucose solution mixed with saline is most often used. In case of blood loss to a greater extent, plasma-substituting solutions and blood with its components are used.

Some authors suggest using folk remedies in treatment, however, this therapy has not confirmed its effectiveness and most often poses a risk to human health when used not in combination with medications.

In modern medicine, methods of endoscopic treatment of gastric bleeding are actively used. For this purpose, either cauterization of the bleeding vessel is used with an electric current, or with elevated temperature through an endoscope inserted into the lumen of the stomach, or locally adhesive substances are used through the same route of administration. These treatment methods have proven to be the most effective with minimal risk of side effects. In addition, with the help of endoscopic devices it is possible to suturing bleeding vessels, both in the lumen of the esophagus and in the stomach, which is undoubtedly a good method of stopping gastric bleeding.

In addition to the use of medications, the stomach is periodically washed with chilled water, which allows it to be cleared of blood clots and causes a reflex vascular spasm, which reduces bleeding.

All patients with ulcer bleeding should be examined for infection with the bacteria Helicobacter pylori, which causes damage to the mucous membrane. If the test result is positive, then it is necessary to prescribe combined antibacterial therapy to completely destroy it.

Surgical treatment

Surgical treatment is indicated for the third degree of severity of gastric bleeding, or if the blood loss is massive and recurrent. In addition, surgery is the method of choice in case of perforation of a gastric ulcer with the development of intra-abdominal bleeding. Such treatment methods can be performed in two ways: laparoscopically (through small incisions on the anterior wall of the abdomen and using special endoscope devices); or, laparotomy (using a wide incision in the abdomen for better access to the stomach). The choice of treatment method is determined by the surgeon.

If bleeding occurs from the lower esophagus and the cardiac part of the stomach, then a special Blackmore probe is used to compress dilated and damaged venous vessels. This probe is inserted into the esophagus and inflated with air, providing a hemostatic effect.

Help with gastric bleeding involves surgically cutting the terminal branches of the vagus nerves that innervate the gastric mucosa and its vessels. This allows you to cause a spasm of the arterial bed and reduce or completely stop gastric bleeding. In addition, it is possible to surgically remove part of the stomach with a bleeding ulcer, which leads to complete hemostasis. The next operation of choice may be ligation of the bleeding vessel using a surgical thread or the application of a special metal rivet.

Endovascular surgery methods are increasingly being used. In this case, the surgeon enters the patient’s arterial bed through the femoral artery and, using a special probe, can block the lumen of the arteries bleeding in the stomach. These operations are carried out very quickly and are quite effective in the long term.

It is important to remember that the appearance of any signs of gastric bleeding can lead to the development of life-threatening complications, including death. That is why timely contact with a medical institution for a high-quality diagnostic process and the appointment of adequate therapy are the most important priorities for a patient with symptoms of gastric bleeding.

Medicines

Stomach bleeding most often stops on its own. Only 20% of cases require active medical intervention through endoscopy or surgery.

If it is impossible to carry them out or there are contraindications to surgical hemostasis, conservative therapy is used, prescribing special medications for this purpose.

In case of gastric bleeding, to restore the volume of circulating blood, its derivatives or balanced salt solutions are prescribed, depending on the severity of the blood loss. Drugs from the following groups are prescribed as hemostatic agents:

• Proton pump inhibitors,
• H2-histaminolytics (in the absence of inhibitors);
• tranexanoic acid,
• Aminocaproic acid,
• Aprotinin,
• Terlipressin.

It should be noted that a frequently prescribed drug for gastric bleeding called Etamsylate or Dicynon treats vascular pathology only at the level of the microvasculature. It is ineffective for stopping more serious blood loss.

How to treat gastric bleeding is decided by the attending physician. This pathology is mainly dealt with by general surgeons. Self-medication can lead to dire consequences.

Blood replacement therapy

Indicated for severe blood loss (more than 50% of the total volume, as well as for coagulopathies with impaired coagulation function) and the presence of signs of hemorrhagic shock. For transfusion are used:

• red blood cell mass,
• fresh frozen plasma,
• platelet mass,
• cryoprecipitate.

Before this procedure, a conversation is held between the attending physician and the patient and/or his relatives to warn about contraindications, possible complications of blood transfusion and the consequences of refusing it. The patient's informed consent is required.

With massive blood loss, there are no contraindications for blood transfusion. Transfusion is not recommended against the background of myocardial infarction, pulmonary edema, stroke, endocarditis, thromboembolism, valve defects, tuberculosis, rheumatism and severe kidney and liver diseases.

The most common complications of this procedure may be acute hemolysis of red blood cells due to an incompatibility reaction, as well as fever and chills.

If there are signs of hypovolemic shock, solutions for intravenous infusion are also used:

• saline solution 0.9%,
• hydroxyethyl starch,
• polyglyukin,
• rheopolyglucin.

Antisecretory therapy

It is represented by two groups of blockers - proton pumps and histamine H2 receptors.

The choice of one group or another depends on individual indications. The drugs are not used at the same time.

The mechanism of action of these drugs is due to the blockade of the production of hydrochloric acid in gastric juice and directly depends on the dose and route of administration. Therefore, during the first two to three days from the onset of bleeding, their intravenous administration as a bolus (loading doses) is recommended, including before surgery or endoscopy.

Tablets for stomach bleeding are prescribed only after it has stopped: including in the postoperative period (for at least a month of daily use).

Proton pump inhibitors are more effective, but in their absence or contraindications, H2 histaminolytics are used.

Proton pump inhibitors

These include omeprazole (Losec), rabeprazole, pantoprazole (Controloc), esomeprazole (Nexium).

Indicated for gastric ulcers as a cause of bleeding, as well as for Mallory-Weiss syndrome.

Contraindicated for intolerance and allergic reactions.

Side effects are possible in the form of disturbances in the functioning of the gastrointestinal tract, as well as headaches, weakness, chest pain, nephritis (reactions such as inflammation of the kidney tissue).

Histamine H2 receptor blockers

Represented by ranitidine, famotidine (Kvamatel).

Indications are the same as for proton pump inhibitors.

Contraindications to their use are (except for individual intolerance and allergies) childhood, cirrhosis of the liver. Not recommended for use by pregnant and lactating women.

Adverse reactions can be in the form of decreased blood pressure, headaches, sexual dysfunction and allergic reactions.

Terlipressin

Indicated for bleeding from varicose veins of the esophagus, erosions and rupture of the mucous membranes of the esophagus and stomach (Mallory-Weiss syndrome). Used when other drugs are ineffective.

It is a synthetic derivative of vasopressin, which has many side effects.

Contraindicated in case of coronary heart disease and vascular pathology.

Side effects: ischemic reactions of the myocardium, intestines, skin (up to their necrosis - infarction), arrest or disturbances of heart rhythm such as ventricular arrhythmias. Monitoring of indicators from the cardiovascular system and prophylactic administration of nitroglycerin are required in the presence of systolic blood pressure more than 100 mm Hg.

Sandostatin

It is used when localizing the source of bleeding from the veins of the esophagus or stomach, as well as when leaking blood from erosions and ulcers.

A synthetic derivative of the hormone somatostatin (Octreotide). The effect is associated with a decrease in blood flow to internal organs.

Contraindicated in case of individual intolerance.

Side effects manifest themselves in the form of disorders of the gastrointestinal tract and carbohydrate metabolism (decrease or increase in blood glucose), as well as hair loss.

Fibrinolysis inhibitors

These include tranexamic acid, aminocaproic acid and aprotinin. They have a hemostatic effect by inhibiting (terminating) fibrinolysis, inhibiting the work of enzymes or the formation of coagulation factors (plasmin).

Tranexamic acid

It is used for prolonged and severe blood loss with signs of activation of fibrinolysis (dissolution of fibrin involved in stopping bleeding).

However, clinical studies have not confirmed its effectiveness.

Contraindicated in case of individual intolerance, subarachnoid hemorrhage, renal failure, thrombophilia (venous thrombosis, myocardial infarction), and in colorblind people.

Use in pregnant and lactating women has not been studied.

Possible side effects in the form of dyspepsia, weakness, drowsiness, palpitations, allergies.

Aminocaproic acid

Prescribed for ongoing bleeding.

Contraindicated in case of individual intolerance, thrombosis and embolism, renal and liver failure, stroke, pregnancy, hematuria, hypotension, heart defects.

Adverse reactions manifest themselves in the form of rhabdomyolysis (reaction of “digestion” of muscle tissue), renal failure, seizures, decreased blood pressure and allergies.

Less effective when taking anticoagulants and antiplatelet agents.

Aprotinin

Kontrikal, Gordoks, Trasylol - analogues. It has a less toxic effect on the kidneys, and the likelihood of venous thrombosis is lower.

Very allergenic, so it is used quite rarely.

Recombinant human factor VIIa

In case of severe profuse bleeding, recombinant activated human factor VIIa (rFVIIa) coagulation may be prescribed.

Contraindicated in case of serious disorders in the blood coagulation system, as it can lead to thrombosis and thromboembolism. To prevent this complication, the patient is given a preliminary injection of plasma containing normal clotting factors.

Rarely used due to high price.

Prevention of relapse

After a reliable stop of bleeding, prevention of its recurrence is carried out.

Antisecretory drugs continue to be taken as prescribed by the doctor.

If possible, the factors that caused blood loss should be eliminated. For example, conduct a course of eradication of Helicobacter pylori, which is a common cause of stomach and duodenal ulcers.

To prevent bleeding from varicose veins of the esophagus, beta2-blockers (propranolol) are prescribed.

Folk remedies

Stomach bleeding can be caused by a number of diseases: tumors, ulcers, polyps, etc. The first signs of bleeding in the stomach are dark brown stools and vomiting blood. In case of severe and profuse bleeding, you should immediately consult a doctor or call emergency help. Treatment should be carried out under the supervision of specialists.

In some cases, traditional medicine helps stop bleeding. Useful plants and herbs help increase blood viscosity, thereby stopping the flow.

How to stop stomach bleeding at home

If the patient has the first signs of blood loss, you need to put him to bed and create peace. Eating is not recommended. Place a cold compress or ice on the patient's stomach. Prepare a hemostatic agent according to one of the recipes and give it to the patient according to the recommendations.

• 1 tbsp. l. horsetail is steamed for an hour in 250 ml of boiling water. Afterwards, strain the broth and give the patient ½ glass each time after meals.
• A tablespoon of pink immortelle flowers is infused in 250 ml of boiling water. Then the infusion is strained and given to the patient 1 tbsp. l. every 2 hours.
• A decoction of blueberries is brewed and served to the patient as tea three times a day.

Parsley helps prevent stomach bleeding. Eating it prevents the occurrence of various types of hemorrhages. Traditional medicine advises using decoctions of chamomile, bearberry, and yarrow. All these herbs have hemostatic properties.

Treatment with folk remedies for gastric bleeding is an effective method of combating pathology. However, do not forget that self-medication without the supervision of a doctor and his recommendations is very dangerous.

The information is for reference only and is not a guide to action. Do not self-medicate. At the first symptoms of the disease, consult a doctor.

The mortality rate for gastrointestinal bleeding (GIB) is 7-15%, therefore, it is advisable to hospitalize patients with moderate and severe bleeding in the ICU, where they undergo further examination and treatment. Responsibility for the patient must be shared. Immediately call a surgeon and endoscopist to the patient, and, if necessary, other specialists. In case of a serious and extremely serious condition of the patient, it makes sense to hold a consultation.

Bleeding stops on its own in approximately 80% of cases. Continued bleeding requires stopping it endoscopically as soon as possible. If this is not possible, then resort to active surgical tactics. In some cases, endovascular intervention or conservative treatment is performed.

The main tasks assigned to an anesthesiologist-resuscitator in the treatment of patients with gastrointestinal tract:

• Carrying out the prevention of recurrent bleeding after it has stopped;
• Restoration of systemic hemodynamics and other indicators of homeostasis. Naturally, the volume of assistance provided can vary widely: from resuscitation measures to simple dynamic monitoring of the patient;
• Providing assistance during endoscopic intervention or surgical intervention (if necessary);
• Timely detection of recurrent bleeding;
• In relatively rare cases, conservative treatment of bleeding is performed.

Sequence of assistance

If the patient received anticoagulants before bleeding occurred, they should, in most cases, be discontinued. Assess the severity of the condition and the estimated amount of blood loss based on clinical signs. Vomiting blood, loose stools with blood, melena, changes in hemodynamic parameters - these signs indicate ongoing bleeding. Arterial hypotension in the supine position indicates large blood loss (more than 20% of the blood volume). Orthostatic hypotension (a decrease in systolic blood pressure above 10 mm Hg and an increase in heart rate by more than 20 beats per minute when moving to a vertical position) indicates moderate blood loss (10-20% of blood volume);

In the most severe cases, tracheal intubation and mechanical ventilation may be required before endoscopic intervention. Provide venous access with a peripheral catheter of sufficient diameter (G14-18); in severe cases, install a second peripheral catheter or catheterize the central vein.

Take a sufficient volume of blood (usually at least 20 ml) to determine the group and Rh factor, combine blood and conduct laboratory tests: general blood count, prothrombin and activated partial thromboplastin time, biochemical parameters.

Infusion therapy

Begin infusion therapy with balanced salt solutions.

Important! If there are signs of ongoing bleeding or unstable hemostasis has been achieved, blood pressure should be maintained at the minimum acceptable level (SBP 80-100 mm Hg), i.e. infusion therapy should not be too aggressive. Blood transfusions are carried out if adequate infusion therapy fails to stabilize the patient’s hemodynamics (blood pressure, heart rate). Consider the need for blood transfusion:

When the hemoglobin level decreases below 70 g/l. when bleeding has stopped;

With ongoing bleeding, when hemoglobin is below 90-110 g/l.

In case of massive blood loss (more than 50-100% of the blood volume), transfusion treatment is carried out in accordance with the principles of “Hemostatic resuscitation”. It is believed that each dose of packed red blood cells (250-300 ml) increases hemoglobin levels by 10 g/l. Fresh frozen plasma is prescribed for clinically significant coagulopathy, including drug-induced coagulopathy (for example, the patient is receiving warfarin). And in case of massive blood loss (>50% of blood volume). If reliable hemostasis is achieved, there is no need to administer FFP even with significant blood loss (more than 30% of the blood volume). Dextrans (polyglucin, rheopolyglucin), solutions (HES) can increase bleeding, and their use is not recommended.

Antisecretory therapy

Optimal conditions for the implementation of the vascular-platelet and hemocoagulation components of hemostasis are created at pH > 4.0. Proton pump inhibitors and H2-histamine receptor blockers are used as antisecretory drugs.

Attention! It is not advisable to prescribe H2-histamine receptor blockers and proton pump inhibitors at the same time.

Medicines of both groups suppress the production of hydrochloric acid in the stomach and thereby create conditions for stable hemostasis of the bleeding vessel. But proton pump inhibitors show more consistent results in reducing gastric acidity and are significantly more effective in reducing the risk of recurrent bleeding. The antisecretory effect of proton pump inhibitors is dose-dependent. Therefore, the use of high doses of drugs is currently recommended, so the prescription regimens indicated below are not a typo by the author.

Patients are prescribed an intravenous infusion of one of the following proton pump inhibitors:

• (Losec) 80 mg IV as a loading dose, followed by 8 mg/hour.
• (Controloc) 80 mg IV as a loading dose, followed by 8 mg/hour.
• (Nexium) 80 mg IV loading dose, followed by 8 mg/hour.

The loading dose of the drug is administered in approximately half an hour. Intravenous administration of the drug is continued for 48-72 hours, using, depending on possibilities, a bolus or continuous route of administration. In the following days, they switch to oral administration of the drug at a daily dose of 40 mg (for all of the proton pump inhibitors listed in this paragraph). The approximate duration of the course is 4 weeks.

Attention. The administration of proton pump inhibitors should be started before endoscopic intervention, as this reduces the likelihood of recurrent bleeding.

In the absence of proton pump inhibitors, or patients intolerant of them, intravenous H2-histamine receptor blockers are prescribed:

• Ranitidine 50 mg IV every 6 hours or 50 mg IV followed by 6.25 mg/hour IV. After three days, 150-300 mg orally 2-3 times a day;
• Famotidine 20 mg IV drip every 12 hours. Orally for treatment use 10-20 mg 2 times/day or 40 mg 1 time/day.

Preparation for gastroscopy

After relative stabilization of the patient’s condition (SBP more than 80-90 mm Hg), it is necessary to conduct an endoscopic examination, and, if possible, determine the source and stop the bleeding.

The following procedure can facilitate gastroscopy against the background of ongoing bleeding. 20 minutes before the intervention, the patient is given intravenous erythromycin by rapid infusion (250-300 mg of erythromycin is dissolved in 50 ml of 0.9% sodium chloride solution and administered over 5 minutes). Erythromycin promotes rapid evacuation of blood into the intestine, and thereby facilitates the identification of the source of bleeding. With relatively stable hemodynamics, 10 mg metoclopramide is used intravenously for the same purposes.

In patients with valvular heart disease, antibiotic prophylaxis is recommended before performing gastroscopy. Sometimes, to remove blood clots from the stomach (to facilitate endoscopic examination), a large-bore gastric tube (24 Fr or larger) must be inserted. It is recommended to lavage the stomach with water at room temperature. After the procedure is completed, the probe is removed.

Using a gastric tube for the purpose of diagnosing and controlling bleeding (if endoscopic examination is possible), in most cases, is considered inappropriate.

Further tactics

Depends on the results of the endoscopic examination. Below we consider the most common options.

Upper gastrointestinal bleeding

Peptic ulcer of the stomach, duodenum, erosive lesions

Bleeding classification (based on Forrest classification)

I. Continued bleeding:

a) massive (jet arterial bleeding from a large vessel)

b) moderate (blood spilled from a venous or small arterial vessel quickly floods the source after it is washed off and flows down the intestinal wall in a wide stream; jet arterial bleeding from a small vessel, the jet nature of which periodically stops);

c) weak (capillary) - slight leakage of blood from a source that can be covered by a clot.

II. Current bleeding:

a) the presence at the source of bleeding of a thrombosed vessel, covered with a loose clot, with a large amount of altered blood with clots or contents like “coffee grounds”;

b) a visible vessel with a brown or gray blood clot, while the vessel may protrude above the bottom level, a moderate amount of “coffee grounds” type contents.

c) the presence of small pinpoint thrombosed brown capillaries that do not protrude above the bottom level, traces of contents like “coffee grounds” on the walls of the organ.

Currently, combined (thermocoagulation + application, injections + endoclipping, etc.), which has become the de facto standard, endohemostasis provides effective stoppage of bleeding in 80-90% of cases. But not all institutions where patients with ulcer bleeding are admitted have the necessary specialists.

Attention. If the bleeding continues, endoscopic stopping is indicated; if it is ineffective, stopping the bleeding surgically.

If surgical hemostasis is not possible

Quite often there are situations when it is not possible to perform both endoscopic and surgical hemostasis. Or they are contraindicated. We recommend the following amount of therapy:

Proton pump inhibitors are prescribed. And in their absence - H2-histamine receptor blockers.

In the treatment of erosive and ulcerative bleeding, especially with slow bleeding (type Forrest Ib), the use of sandostatin () has a good effect - 100 mcg IV bolus, then 25 mcg/hour until the bleeding stops, and better - for two days .

If bleeding continues, one of the following fibrinolysis inhibitors is simultaneously prescribed for 1-3 days (depending on the data of control endoscopy):

• aminocaproic acid 100-200 ml of 5% solution IV for 1 hour, then 1-2 g/hour until bleeding stops;
• tranexamic acid - 1000 mg (10-15 mg/kg) per 200 ml of 0.9% sodium chloride 2-3 times a day;
• (Contrical, Gordox, Trasylol) compared to the previous drugs, has less nephrotoxicity and a lower risk of venous thrombosis. Due to the risk of allergic reactions (0.3%), 10,000 units IV is administered initially. For the same reasons, the drug is now rarely used to treat bleeding. If there is no reaction, 500,000 - 2,000,000 units are administered intravenously over 15-30 minutes, then infused at a rate of 200,000 - 500,000 units/hour until the bleeding stops;

Recombinant activated human factor VIIa (rFVIIa) blood coagulation agent (Novo-Seven) at a dose of 80-160 mg/kg IV is prescribed if other therapy is ineffective. Significantly increases the risk of thrombosis and embolism. In case of significant coagulopathy, before its administration, the deficiency of coagulation factors should be corrected by transfusion of fresh frozen plasma in a volume of at least 15 ml/kg/body weight. The drug is quite effective even with severe bleeding. But, due to its high cost, its widespread use is impossible.

Attention. Etamsylate (dicinone), often prescribed for patients with bleeding, is in fact completely ineffective. Actually, the drug does not have any hemostatic effect at all. Intended for the treatment of capillaropathies as an adjuvant.

For erosive lesions, mucosal ruptures (Mallory-Weiss syndrome) and (or) ineffectiveness of the above therapy, use an intravenous bolus at a dose of 2 mg, and then 1 mg intravenously after 4-6 hours until the bleeding stops. Vasopressin is just as effective, but has more complications. Vasopressin is administered using a drug dispenser into the central vein according to the following scheme: 0.3 IU/min for half an hour, followed by an increase of 0.3 IU/min every 30 minutes until bleeding stops, complications develop, or the maximum dose is reached - 0.9 IU/min. As soon as the bleeding has stopped, the rate of administration of the drug begins to be reduced.

Complications of therapy with vasopressin and terlipressin may develop - ischemia and myocardial infarction, ventricular arrhythmias, cardiac arrest, intestinal ischemia and infarction, skin necrosis. This type of treatment should be used with extreme caution in cases of peripheral vascular diseases and coronary heart disease. Vasopressin is administered while monitoring cardiac activity. The infusion is reduced or stopped if angina, arrhythmia or abdominal pain occurs. Simultaneous intravenous administration of nitroglycerin reduces the risk of side effects and improves treatment results. Nitroglycerin is prescribed if systolic blood pressure exceeds 100 mmHg. Art. The usual dose is 10 mcg/min IV, increasing by 10 mcg/min every 10-15 minutes (but not more than 400 mcg/min) until systolic blood pressure decreases to 100 mmHg. Art.

The bleeding stopped. Further therapy

The administration of the above-mentioned antisecretory drugs is continued. The probability of recurrent bleeding after endoscopic or medical stop is about 20%. For timely diagnosis, dynamic monitoring of the patient is carried out (hourly blood pressure, heart rate, hemoglobin 2 times a day, repeated endoscopic examination every other day). Hunger is not indicated (unless surgical or endoscopic intervention is planned); table 1 or 1a is usually prescribed;

Insertion of a nasogastric tube to control bleeding, as mentioned above, is not indicated. But it is installed if the patient is unable to eat on his own and needs enteral nutrition. Prophylactic administration of antifibrinolytics is not indicated (aminocaproic and tranexamic acid, aprotinin).

It is believed that 70-80% of duodenal and gastric ulcers are infected with Helicobacter pylori. Eradication should be carried out in all patients who have this infection. This speeds up the healing of the ulcer and reduces the frequency of recurrent bleeding. A common and quite effective regimen: omeprazole 20 mg twice a day + clarithromycin 500 mg twice a day + amoxicillin 1000 mg twice a day. The duration of the course is ten days.

Bleeding from varicose veins of the esophagus or stomach due to portal hypertension

Mortality reaches 40%. In our country, endoscopic bleeding control (sclerotherapy, endoscopic ligation of nodes, etc.), surgical and endovascular interventions are used relatively rarely. Most often, drug treatment, tamponade of varicose veins with a balloon probe, and surgery are used. Note that the use of factor VIIa (rFVIIa) was ineffective in these patients. The safest and most effective method of conservative therapy is considered to be intravenous administration of sandostatin (octreotide) - 100 mcg IV bolus, then 25-50 mcg/hour for 2-5 days.

If therapy is ineffective, terlipressin 2 mg is prescribed intravenously, then 1-2 mg every 4-6 hours until bleeding stops, but not more than 72 hours. If therapy is ineffective or if there is massive bleeding, a Blackmore-Sengstaken probe is installed. Methodology: perform local anesthesia of the nasopharynx with lidocaine aerosol. Before insertion, the probe is checked by inflating both balloons, lubricated with conductive gel for ECG electrodes or glycerin (sometimes simply moistened with water), the balloons are folded around the probe and in this form are passed through the nasal passage (usually the right one) into the stomach. Sometimes inserting a probe through the nose is impossible and it is placed through the mouth. Then 200-300 ml of water is injected into the distal (spherical) balloon, the entire probe is pulled up until resistance to movement appears, and carefully fixed in this position. After this, air is pumped into the esophageal balloon with a sphygmomanometer to a pressure of 40 mmHg. Art. (unless the probe manufacturer recommends different air and water input volumes or cylinder pressures).

Through the lumen of the probe, gastric contents are suctioned, i.e., dynamic control is carried out over the effectiveness of hemostasis, and feeding is carried out. It is necessary to monitor the pressure in the esophageal cuff every 2-3 hours. After bleeding has stopped, the pressure in the balloon should be reduced gradually. The probe with the deflated balloon is left in place for 1-1.5 hours so that if bleeding resumes, tamponade can be repeated. If there is no bleeding, the probe is removed. Ulceration and necrosis of the mucosa can occur quite quickly, so the duration of the probe in the esophagus should not exceed 24 hours, but sometimes this period has to be increased.

Patients are prescribed cefotaxime 1-2 g IV three times a day, or ciprofloxacin 400 mg IV 2 times a day for the purpose of prevention. Liver failure is being treated. To prevent hepatic encephalopathy, prescribe lactulose orally 30-50 ml every 4 hours.

Prevention of bleeding from varicose veins of the esophagus or stomach

The administration of a non-selective beta-blocker (but not other beta-blockers) reduces the pressure gradient in the hepatic veins and reduces the likelihood of rebleeding. In this case, the effects of beta-2 adrenergic blockade are important, due to which a narrowing of splanchnotic vessels occurs, which leads to a decrease in blood flow and pressure in varicose vessels of the esophagus and stomach.

An individual maximum tolerated dose is selected, reducing the resting heart rate by approximately 25% of the initial level, but not lower than 50-55 beats per minute. The approximate starting dose is 1 mg/kg/day, divided into 3-4 doses.

Bleeding from the lower gastrointestinal tract

The main causes of bleeding from the lower gastrointestinal tract are angiodysplasia, diverticulosis, inflammatory bowel diseases, neoplasms, ischemic and infectious colitis and diseases of the anorectal region. Clinically manifested by bloody stools - scarlet or dark burgundy blood coming from the rectum.

Diagnostic problems

Endoscopic diagnosis very often turns out to be ineffective; it is rarely possible to find the source of bleeding, much less stop the bleeding. However, this largely depends on the qualifications of the endoscopist. Angiography is used if the cause of bleeding cannot be determined after colonoscopy. During surgery, it is also difficult to determine the source of bleeding. Sometimes there are several sources of bleeding (for example, inflammatory bowel disease).

Attention. Before surgery, FGS should be performed to exclude bleeding from the upper gastrointestinal tract.

Emergency surgery due to ongoing bleeding is associated with a high mortality rate (~25%). Therefore, persistent conservative treatment should be the main method of treatment for these patients.

Treatment:

• It is necessary to achieve stabilization of the condition during diagnostic measures.
• The scope of the examination is determined by the diagnostic capabilities of the healthcare facility;
• Based on the results obtained, try to establish the cause of the bleeding. Then the treatment will be targeted;
• If the exact cause of bleeding is unclear, measures are taken to maintain systemic hemodynamics and hemostatic agents are used.

Emergency surgery is indicated:

• with ongoing bleeding and the development of hypovolemic shock, despite intensive therapy;
• with ongoing bleeding that requires transfusion of 6 or more units of blood per day;
• if it was not possible to determine the cause of bleeding after colonoscopy, scintigraphy or arteriography;
• when establishing an accurate diagnosis of a disease (using colonoscopy or arteriography), the best treatment method for which is surgery.

In which blood flows into the lumen of the stomach. In general, the term “gastrointestinal bleeding” is usually 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).

Stomach Bleeding Facts:

• This condition is one of the most common reasons for hospitalization of patients in surgical hospitals.
• Today, more than 100 diseases are known that can be accompanied by bleeding from the stomach and intestines.
• About three-quarters (75%) of all bleeding from the stomach or duodenum is due to an ulcer.
• Bleeding develops in approximately every fifth patient 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 receives food from the esophagus, partially digests it, mixes it and sends it further to the duodenum.

Anatomy of the stomach

Sections of the stomach:

• entrance section (cardia)– the transition of the esophagus into the stomach and the area of ​​the stomach immediately adjacent to this place;
• fundus of the stomach– the upper part of the organ, which looks like a vault;
• body of stomach– main part of the organ;
• outlet part (pylorus of the stomach)- the transition of the stomach into the duodenum and the area of ​​the 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 and pancreas. On the right are the liver and gall bladder.

The stomach wall consists 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 to muscle tissue, the stomach can contract, mix and push food into the intestines. At the junction of the esophagus into the stomach and the stomach into 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.
• The outer shell is a thin film of connective tissue.

Normally, an adult's stomach on an empty stomach has a volume of 500 ml. After eating, it usually expands to a volume of 1 liter. The stomach can stretch to a maximum of 4 liters.

Stomach functions

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 blood to 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.

At the junction of the esophagus and the stomach there is a venous plexus. In some diseases, the veins of which it consists expand and are easily injured. This leads to severe bleeding.

Types of stomach bleeding

Depending on the reason:

• ulcerative– caused by peptic ulcer disease, the most common;
• non-ulcer– due to other reasons.

Depending on the duration of bleeding:

• spicy– develop quickly and require emergency medical care;
• chronic– less intense, lasting for a long time.

Depending on how severe the signs of bleeding are:

• obvious– manifest themselves clearly, all the symptoms are present;
• hidden– there are no symptoms, this is usually characteristic of chronic gastric bleeding – only the patient’s pallor is noted.

Causes of stomach bleeding

Cause of stomach bleeding	Development mechanism	Features of manifestations
Diseases of the stomach itself
Gastric ulcer	In approximately 15%-20% of patients, gastric ulcers are complicated by bleeding. Causes of bleeding in gastric ulcers: direct damage to the vessel by gastric juice; development of complications – blocking the lumen of a vessel with a thrombus, causing it to burst.	Main symptoms of a stomach ulcer: pain, which occurs or becomes stronger immediately after eating; vomit, after which the patient feels better; 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 independently or be a complication of peptic ulcer disease. When the tumor begins to disintegrate, bleeding occurs.	Main symptoms of stomach cancer: most often the disease develops in older 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.
Gastric diverticulum	Diverticulum- This is a protrusion in the wall of the stomach. In order to understand what it looks like, you can imagine rubber surgical gloves: each “finger” is a “diverticulum”. This disease is rare. Bleeding occurs as a result of damage to the vessel due to inflammation of the diverticulum wall.	Main symptoms of gastric diverticulum: often the diverticulum is asymptomatic and is detected only during examination; belching, swallowing air while eating; an incomprehensible feeling of discomfort in the abdomen; dull weak pain; Sometimes a diverticulum manifests itself as quite severe pain, pallor, and weight loss.
Diaphragmatic hernia	Diaphragmatic hernia is a disease in which part of the stomach rises through an opening in the diaphragm into the chest cavity. Causes of bleeding with diaphragmatic hernia: damage to the esophageal mucosa gastric juice, which is thrown into it; An ulcer complicating a diaphragmatic hernia.	Bleeding with a diaphragmatic hernia develops in approximately 15%-20% of patients. In most cases, it is hidden, that is, not accompanied by any symptoms. But it can also be quite strong.
Stomach polyps	Stomach polyps These are fairly common benign tumors. Bleeding occurs as a result of: ulceration of the polyp under the influence of gastric juice; polyp injuries; circulatory disorders(for example, if a large pedunculated polyp twists or “falls” into the duodenum and is strangulated).	Polyps usually do not show themselves before bleeding begins. If they are large enough, the passage of food through the stomach is disrupted.
Mallory-Weiss syndrome	Mallory-Weiss syndrome – bleeding that occurs when the mucous membrane ruptures at the junction of the esophagus and the stomach. Reasons: prolonged vomiting due to alcohol poisoning, ingestion of large amounts of food; a predisposing factor is a diaphragmatic hernia, a condition in which part of the stomach protrudes through the diaphragmatic opening of the esophagus into the chest cavity.	Bleeding can be very intense, so much so that the patient can die if emergency medical care is not provided.
Hemorrhagic gastritis	A type of gastritis in which erosions (surface defects) appear on the gastric mucosa and there is a risk of bleeding.	Main symptoms: discomfort, pain in the upper abdomen after eating food, especially spicy, sour, smoked, fried, etc.; decreased appetite and weight loss; heartburn, belching; nausea and vomiting; bloating, heaviness in the abdomen; presence of blood in vomit and stool.
Stress ulcer	Stress has a negative impact on many internal organs. A person who is often nervous has a higher likelihood of developing various pathologies. During severe stress in an extreme situation, the adrenal cortex begins to produce hormones (glucocorticoids), which increase the secretion of gastric juice and cause circulatory problems in the organ. This can lead to superficial ulcers and bleeding.	It is often very difficult to identify a stress ulcer, since it is not accompanied by pain or other severe 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.	At the junction of the esophagus and the stomach there is a venous plexus. It is the junction of branches of the portal vein (which collects blood from the intestines) and the superior vena cava (which collects 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 varicose veins of the esophagus: liver tumors; portal vein thrombosis; chronic lymphocytic leukemia; compression of the portal vein in various diseases.	In the early stages there are no symptoms. The patient does not suspect that he has esophageal varices. Bleeding develops unexpectedly, against the background of a state of complete health. It can be so strong that it quickly leads to death.
Systemic vasculitis: periarteritis nodosa; Henoch-Schönlein purpura.	Systemic vasculitis- This is a group of autoimmune diseases in which blood vessels are damaged. Their walls are affected, resulting in increased bleeding. Some of the systemic vasculitis manifests itself in the form of gastric bleeding.	With systemic vasculitis, the symptoms of gastric bleeding are combined with the symptoms of the underlying disease.
Atherosclerosis, high blood pressure.	If blood vessels are damaged and blood pressure increases, there is a risk that the wall of one of the vessels will burst during an injury or another surge in pressure and bleeding will develop.	Gastric bleeding is preceded by symptoms characteristic of arterial hypertension: headaches; dizziness; “tinnitus”, “floaters before the eyes”; weakness, increased fatigue; periodic redness of the face, feeling of heat; sometimes there are no symptoms; when measuring blood pressure using a tonometer, it turns out to be above 140 mm. Hg Art.
Bleeding disorder
Hemophilia	A hereditary disease manifested by a blood clotting disorder and severe complications in the form of hemorrhages. Only men suffer.
Acute and chronic leukemias	Leukemia is a blood tumor in which hematopoiesis in the red bone marrow is disrupted. The formation of platelets - blood platelets, which are necessary for normal coagulation - 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 blood clotting disorders and increased bleeding.
Vitamin deficiency K	Vitamin K plays an important role in the blood clotting process. With its deficiency, there is increased bleeding, hemorrhages in various organs, and internal bleeding.
Hypoprothrombinemia	A large number of different substances take part in the process of blood clotting. One of them is prothrombin. Its insufficient content in the blood may be congenital or 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; decreased blood pressure; frequent weak pulse; dizziness and tinnitus; lethargy, confusion: the patient reacts sluggishly to his surroundings, answers questions with a delay; 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 over a short time. If emergency assistance is not provided, death may occur. With chronic gastric bleeding, the patient may experience slight pallor, weakness and other symptoms for a long time.
Vomiting blood	The appearance of vomit and blood depends on the source and intensity of the bleeding: Gastric bleeding is characterized by vomiting that resembles “coffee grounds.” Vomit takes on this appearance due to the fact that the blood entering the stomach is exposed to hydrochloric acid. If unchanged red blood is present 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 influence of hydrochloric acid. Scarlet blood with foam may indicate pulmonary hemorrhage. Only a specialist doctor can finally establish the source of bleeding, make the correct diagnosis and provide effective assistance!
Blood in stool	Stomach bleeding is characterized by melena – black, tarry stool. 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 there is probably intestinal bleeding rather than gastric bleeding.

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

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:

• Mild degree. The patient's condition is satisfactory. He is conscious. Mild dizziness bothers me. Pulse no more than 80 beats per minute. Blood pressure is not lower than 110 mm. Hg Art.
• Moderate severity. The patient is pale, the skin is covered with cold sweat. Worried about dizziness. The pulse is increased to 100 beats per minute. Blood pressure – 100-110 mm. Hg Art.
• Severe stomach bleeding. The patient is pale, very inhibited, answers questions late, and does not react to the environment. Pulse is more than 100 beats per minute. Blood pressure is below 100 mm. Hg Art.

Only a doctor can adequately assess the patient’s condition after examination and examination. Mild bleeding can turn into severe bleeding at any time!

Diagnosis of gastric bleeding

Which doctor should you contact if you have stomach bleeding?

With chronic gastric bleeding, the patient is often unaware that he has this pathological condition. Patients turn to specialized specialists regarding symptoms of the underlying disease:

• for pain and discomfort in the upper abdomen, nausea, indigestion - see a therapist, gastroenterologist;
• If there is increased bleeding or a large number of bruises appear on the body, see a therapist or hematologist.

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

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

In what cases should you call an ambulance?

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

• Severe weakness, pallor, lethargy, rapid deterioration of condition.
• Loss of consciousness.
• Vomiting "coffee grounds".

If, in case of intense acute gastric bleeding, medical assistance is not provided in time, the patient may die from large blood loss!

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

What questions might the doctor ask?

During a conversation and examination of the patient, the doctor faces 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 your appointment:

• What complaints are you worried about at the moment? When did they arise? How has your condition changed since then?
• Have you had gastrointestinal bleeding in the past? Have you contacted doctors with similar problems?
• Do you have a stomach or duodenal ulcer? If so, 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 operations for diseases of the stomach and abdominal veins? If so, for what reason and when?
• Do you suffer from any liver disease or bleeding disorder?
• How often and in what quantity do you drink alcohol?
• Do you ever have nosebleeds?

How does a doctor evaluate a patient with stomach bleeding?

Typically, the doctor asks the patient to undress to the waist and examines his skin. Then he feels the stomach, doing this carefully so as not to increase the bleeding.

What examination can be prescribed?

Study title	Description	How is it carried out?
Fibrogastroduodenoscopy	An endoscopic examination, during which the doctor examines the mucous membrane of the esophagus, stomach, and duodenum. Most often, it is possible to establish the location and source of bleeding.	The study is carried out on an empty stomach. The patient lies on the couch on his left side. Anesthesia of the mucous membrane is carried out using a spray. A special mouthpiece is placed between the teeth. The doctor inserts a fibrogastroscope into the patient's stomach through the mouth - a flexible tube with a miniature video camera at the end. At this time, the patient should breathe deeply through the nose. Usually the inspection does not take much time.
X-ray of the stomach	To identify the cause of gastric bleeding, X-rays with contrast are performed. The doctor can assess the condition of the organ walls, identify ulcers, tumors, diaphragmatic hernia and other pathological conditions.	The study is carried out on an empty stomach. The stomach must be empty, otherwise the contrast will not be able to fill it evenly. The patient drinks a solution of barium sulfate, a substance that does not transmit x-rays. After this, X-rays are taken in different positions: standing, lying down. The images clearly show the contours of the stomach filled with contrast.
Angiography	X-ray contrast study of blood vessels. It is performed when there is a suspicion that gastric bleeding is a consequence of atherosclerosis or other vascular disorders.	A contrast solution is injected into the desired vessel through a special catheter. Then x-rays are taken. The painted vessel is clearly visible on them.
Radioisotope scanning	It is carried out according to indications when the bleeding site cannot be detected by other means. 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 device.	A solution containing labeled red blood cells is injected into the patient's vein, after which images are taken.
Magnetic resonance imaging	It is carried out according to indications when the doctor needs additional information to make a correct diagnosis. Using MRI, you can obtain slice-by-slice or three-dimensional images of a specific area of ​​the body.	The study is performed in a specialized department using a special installation.
General blood test	Deviations that can be detected in a general blood test for gastric bleeding: decrease in the number of erythrocytes (red blood cells) and hemoglobin (anemia associated with blood loss); a decrease in the number of platelets (blood platelets) indicates a decrease in blood clotting.	Blood is taken in the usual way from a finger or from a vein.
Blood clotting study - coagulogram	The study is used in cases where there is a suspicion that gastric bleeding is associated with a blood clotting disorder.	The blood is examined using a special apparatus. A number of indicators are assessed, 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 hospitalized.

There are two tactics for treating gastric bleeding:

• without surgical intervention (conservative);
• operation.

Only a doctor can make the right decision. He conducts an examination and examination, establishes the cause and location of the bleeding, and 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 the bleeding to subside, but during movement it may increase.
Cold in the epigastric region		The most common method is to use an ice pack wrapped in a cloth.
Gastric lavage with ice water	Under the influence of cold, blood vessels constrict, which helps stop bleeding.	Gastric lavage is carried out using a probe - a tube that is inserted into the stomach through the mouth or nose.
Injection of adrenaline or norepinephrine into the stomach through a tube	Adrenaline and norepinephrine are “stress hormones.” They cause vasospasm and stop bleeding.	A tube is inserted into the patient's stomach through which medications can be administered.
Intravenous administration of hemostatic solutions	Special hemostatic solutions contain substances that increase blood clotting.	Medicines are administered intravenously using a drip.
donor 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 intended 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.

Endoscopic treatment methods:

• 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 using a laser.
• Stitching threads or metal clips.
• Application of special medical glue.

These methods are used mainly for minor bleeding.

Surgery for stomach bleeding

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

• attempts to stop bleeding without surgery are unsuccessful;
• severe bleeding and a significant decrease in blood pressure;
• severe disorders in the patient’s body that can lead to a deterioration of the condition: coronary heart disease, impaired blood flow in the brain;
• repeated bleeding after it has already been stopped.

The most common types of operations for gastric bleeding:

• Suturing the bleeding area.
• Removal of part of the stomach (or the entire organ, depending on the cause of the bleeding).
• Plastic surgery of the junction of the stomach and duodenum.
• Surgery on the vagus nerve, which stimulates the secretion of gastric juice. As a result, the condition of the patient with peptic ulcer improves and the risk of relapse is reduced.
• Endovascular operations. The doctor makes a puncture in the groin area, inserts a probe through the femoral artery, reaches the bleeding lesion and closes its lumen.

Stomach surgeries can be performed through an incision or laparoscopically through punctures in the abdominal wall. The attending physician selects the appropriate type of surgical treatment and provides detailed information to the patient and his relatives.

Rehabilitation after gastric surgery

Depending on the type of operation, its duration and volume may vary. Therefore, rehabilitation periods may vary.

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

• on the first day the patient is allowed to move his arms and legs;
• breathing exercises usually begin on the second day;
• on the third day the patient can try to get to his feet;
• on the eighth day, if the course is favorable, the sutures are removed;
• on the 14th day they are discharged from the hospital;
• Subsequently, the patient engages in physical therapy; physical activity is prohibited 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 or drink water. You can only wet your lips with water.
• Day 2: you can only drink water, half a glass a day, in teaspoons.
• Day 3: You can take 500 ml of water, broth or strong tea.
• Day 4: you can take 4 glasses of liquid per day, dividing this amount into 8 or 12 doses; jelly, yogurt, and slimy soups are allowed.
• From the 5th day you can consume any amount of liquid soups, cottage cheese, semolina porridge;
• From the 7th day, boiled meat is added to the diet;
• From the 9th day, the patient switches to a normal, gentle diet, excluding irritating foods (spicy, etc.), and foods prepared with whole milk.
• Subsequently, frequent meals in small portions are recommended - up to 7 times a day.

Preventing stomach bleeding

The main measure to prevent gastric bleeding is timely treatment of the diseases that lead to it (see above - “causes of gastric bleeding”).

There are many reasons why gastrointestinal bleeding can occur; it can complicate several hundred diseases. With this pathology, blood flows directly into the lumen of the gastrointestinal tract. This should not be confused with abdominal bleeding, when when the organs of the digestive system are damaged, blood leaks into the abdominal cavity.

Reasons

A common cause of gastrointestinal bleeding is esophageal varices.

Depending on the source, bleeding is distinguished from the upper and lower gastrointestinal tract; such separation is necessary, since the symptoms of the pathology, methods of diagnosis and treatment can differ significantly.

Bleeding from the upper gastrointestinal tract:

• and (up to 70% of requests);
• esophagitis (inflammation of the esophagus, including as a result of burns);
• Mallory-Weiss syndrome (superficial damage to the mucous membrane of the esophagus as a result of repeated severe vomiting, coughing, overeating, sometimes even hiccups);
• , and duodenum.

There are also many other reasons that are quite rare.

Bleeding from the lower gastrointestinal tract:

• tumors and polyps;
• infectious colitis;
• damage to the intestinal walls by foreign bodies;
• complications of infectious diseases (typhoid fever, cholera, etc.);
• etc.

In surgical practice, bleeding from the lower part of the gastrointestinal tract is somewhat less common than from the upper part. One of the causes of bleeding from any source, including the organs of the digestive system, may be blood diseases, which reduce its coagulability.

Symptoms of gastrointestinal bleeding

The signs of this pathology are very diverse; it is often not possible to reliably determine the source of bleeding from them; this requires additional instrumental diagnostics.

General signs of blood loss

The first nonspecific symptoms may be:

• increasing weakness;
• dizziness;
• fainting;
• paleness of the skin and mucous membranes;
• strong thirst;
• the appearance of cold sticky sweat;
• increased heart rate;

In severe cases, shock may develop.

If the bleeding is small, then the symptoms will increase slowly; if it is severe, then external signs will appear quite soon. If you know that a person suffers from any chronic gastrointestinal disease, if such complaints appear, you should immediately consult a doctor.

Vomit

After some time, which depends on the intensity of the bleeding, the patient may vomit. Its color resembles the color of coffee grounds (this color of vomit is the result of a chemical reaction of blood components with gastric juice and hydrochloric acid). The appearance of vomiting “coffee grounds” indicates that the bleeding has been going on for several hours, and the stomach already contains about 150-200 ml of blood.

Vomiting mixed with scarlet unchanged blood may indicate bleeding from the veins of the esophagus, and a combination of “coffee grounds” and “fresh” blood is possible, since some of it flows into the stomach, and some comes up. Or it may be profuse bleeding from the stomach or duodenum, when the blood does not have time to mix with the contents of the stomach and comes out unchanged. Such a patient must be urgently taken to the hospital, otherwise he may die.

Changing the stool

The color and consistency of stool also depends on the intensity and duration of the onset of bleeding. The appearance of changes in stool indicates that bleeding has been ongoing for at least several hours. With minor bleeding, the color of the stool may change only the next day, or it may even remain the same, and the presence of blood in the stool can only be detected using the Gregersen reaction.

With such bleeding, darkening of the stool may occur; it may turn black, but remain dense. Excessive blood loss is accompanied by the appearance of black, tarry stools called melena.

The appearance of scarlet blood in unchanged stool in the absence of vomiting and general signs of blood loss in most cases indicates bleeding from hemorrhoids or anal fissure. This condition does not threaten the patient’s life, but, of course, requires treatment.

The patient, along with general nonspecific symptoms, may present with vomiting and changes in stool; only one of these signs may appear.

First aid for gastrointestinal bleeding

If symptoms of gastrointestinal bleeding appear, the patient should be hospitalized in a hospital as soon as possible.

If symptoms of this formidable complication appear, it is necessary to transport the patient to the hospital as quickly as possible. If this is not possible, you need to call an ambulance, making sure to inform the dispatcher that the person may be bleeding.

Before the ambulance arrives, the patient must be laid on a flat surface and his legs elevated. Any physical activity is excluded.

Ice should be placed on the area of ​​suspected bleeding (through a towel or several layers of fabric), this will help slow down blood loss by constricting blood vessels.

Many patients suffering from chronic gastrointestinal diseases, which can suddenly be complicated by bleeding, are warned by their doctor about the need to keep some hemostatic drugs in their home medicine cabinet. The most common are aminocaproic acid and 10% calcium chloride solution. If such drugs are at hand, then you can give the patient to drink 30-50 ml of aminocaproic acid or one or two ampoules of calcium chloride.

Prevention

The described pathology never occurs on its own - it is always a complication of a disease, less often an injury. All patients suffering from chronic diseases of the digestive system (and in most cases, peptic ulcers) must undergo regular preventive examinations with a doctor, undergo tests as prescribed, and perform endoscopic examinations.

In the presence of such diseases, it is necessary to constantly follow the diet recommended by the doctor, since in many cases the cause of exacerbation of the disease and the occurrence of complications is precisely the error in nutrition and alcohol consumption.

Which doctor should I contact?

If symptoms of gastrointestinal bleeding appear, immediate assistance from a surgeon is needed. After it stops, treatment by a gastroenterologist, proctologist, or oncologist is necessary. In some cases, consultation with a hematologist will be required.

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 intestines and associated organs, or trauma. If measures are not taken to stop it in time, it can pose a serious danger to the patient’s life.

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

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

Types of intestinal bleeding

By location of blood loss:

• Occurred in the upper intestine (duodenum);
• Occurring in the lower intestine (small, colon, rectum).

According to the method of manifestation:

• Having obvious signs of presence;
• Hidden, unnoticeable to the victim.

According to the nature of the course:

• In acute form;
• In chronic form.

By duration:

• One-time;
• Recurrent.

Reasons

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

They are usually divided into 4 groups:

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

These include:

• Duodenal ulcer, which arose after gastrectomy 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 burn to the mucous membrane (due to poisoning with concentrated acid, mercury, lead, etc., long-term use of medications);
• Ulcers in places of mechanical trauma to the gastrointestinal tract;
• Formed due to stress or physical strain.

Non-ulcer intestinal bleeding:

Intraintestinal effusion in infants can provoke intestinal volvulus and intestinal obstruction.

The disease is expressed not so much by bleeding, but by constipation, gas formation, and acute animal pain.

Another factor is congenital intestinal anomalies 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 severe enough, it is not difficult to diagnose. It is determined by the presence of blood in stool and vomit.

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

Dark stool is not always a sign of intestinal bleeding. Sometimes this is a consequence of eating foods rich in iron or certain medications. And sometimes it is the result of a patient swallowing blood (this can happen, among other things, if the nasopharynx or oral cavity is damaged).

When blood clots are visible on the surface of feces, we can conclude that there is a disease in the lower part of the large intestine. In the case when the blood mixes with the stool, forming streaks, the lesion is located in the upper sections. Liquid, foul-smelling stools with a characteristic shine most likely indicate damage to the small intestine.

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

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

Other symptoms of intestinal bleeding

• Anemia. It occurs as a result of prolonged blood loss when the body is unable to compensate for lost red blood cells. Anemia, without resorting to medical tests, can be diagnosed due to a weak, drowsy state, dizziness, fainting, excessive pallor, cyanosis, brittle hair and nails, tachycardia;
• Various digestive disorders: nausea, vomiting, diarrhea or constipation, excessive gas, bloating;
• Some 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. Thus, a duodenal ulcer is accompanied by severe, sharp pain in the abdomen, and it decreases when bleeding opens. In cancer patients, the pain is aching, dull and appears sporadically. In 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:

• Decrease in the patient’s body weight;
• The appearance of spider veins;
• Severe redness of the palms (erythema).

In such patients, the medical history often reveals a history of hepatitis or prolonged use of alcohol.

Problems with blood clotting that accompany cirrhosis cause massive, persistent intestinal bleeding.

Nonspecific ulcerative colitis is accompanied by a false urge to go to the toilet, and the stool itself is liquid, purulent, mucous, and mixed with blood. In inflammatory diseases, intestinal bleeding is observed against a background of high temperature.

Colon cancer is characterized by slight bleeding and tarry stool, coupled with typical symptoms for this disease: sudden weight loss, loss of appetite.

It should be remembered that sometimes 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 intestinal bleeding

It happens:

• Satisfactory: the person is conscious, his blood pressure, hemoglobin and red blood cell count are at normal levels, but his pulse is increased;
• Medium-heavy: coagulability worsens, hemoglobin sharply decreases (to half of normal), pressure drops, tachycardia and cold sweat appear. The skin is pale;
• Heavy: the face swells, hemoglobin is very low (up to 25% of normal), blood pressure is greatly reduced, and the pulse is increased. There is retardation in movements and speech. This condition often leads to coma and requires urgent resuscitation measures.

How to stop at home

If the intestines are bleeding, first aid consists of measures aimed at reducing blood loss:

• The patient should be kept at rest: lay him on his back and slightly raise his legs:
• Do not stimulate the gastrointestinal tract under any circumstances. Drinking and eating during intestinal bleeding should be avoided;
• Constrict blood vessels as much as possible: place an ice heating pad or something cold on the possible lesion.

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

Diagnosis of intestinal bleeding

Patients with bleeding are examined by a gastroenterologist and an endoscopist. The condition of the skin is assessed, the abdomen is palpated. A digital examination of the rectum is carried out, the purpose of which is to identify polyps and hemorrhoids, 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 value of hemoglobin and red blood cells and the blood’s ability to clot.

Feces are tested for occult blood. The patient's history is taken, blood pressure and pulsation are checked.

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 another) and
• Colonoscopy (examination of the upper sections).
• Additional information is obtained by x-ray examination and scintigraphy using labeled red blood cells.

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

Treatment

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

What does endoscopy show?

Blood flow indicators and its cellular composition are constantly assessed. Blood products are administered to the patient.

But most often, treatment is conservative in nature and is aimed at eliminating the source of intestinal bleeding, revitalizing the hemostatic system and replacing blood to normal volume.

Drugs are prescribed to stop bleeding.

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

Rehabilitation

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

The lesions heal for at least six months, and during this time the patient’s diet should be given the closest attention. After 6 months, the patient undergoes a re-examination 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:

• Slimy cereal soups;
• Liquid porridges;
• Purees (meat, fish, vegetables);
• Kissels and jelly;
• Milk;
• Weak tea;
• Vegetable juices.

Excluded:

• Solid;
• Spicy food;
• Everything that causes irritation of the mucous membrane.

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

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