Bleeding of the upper gastrointestinal tract. An Overview of Gastric Bleeding: Causes, Diagnosis, Treatment

Gastrointestinal bleeding is the release of blood from vessels that have lost their integrity into the lumen of the digestive tract. This syndrome complicates many diseases of the digestive system and blood vessels. If the volume of blood loss is small, the patient may not notice the problem. If a lot of blood is released into the lumen of the stomach or intestines, general and local (external) signs of bleeding are sure to appear.

Types of bleeding in the gastrointestinal tract

Bleeding of the gastrointestinal tract (GIT) can be acute and chronic, latent and overt (massive). In addition, they are divided into two groups depending on where the source of blood loss is located. So bleeding in the esophagus, stomach and duodenal (duodenal) intestine is called bleeding of the upper gastrointestinal tract, bleeding in the rest of the intestine - bleeding of the lower gastrointestinal tract. If it is not possible to identify the source of bleeding, they speak of bleeding of unknown etiology, although this is a rarity due to modern diagnostic methods.

Causes of gastrointestinal bleeding

The most common causes of bleeding in the upper gastrointestinal tract are:

• and duodenal ulcer.
• , accompanied by the formation of erosions on the gastric mucosa.
• Erosive.
• Varicose veins of the esophagus. This pathology is a consequence of hypertension in the vein, through which blood departs from the abdominal organs to the liver. This condition occurs with various liver diseases - tumors, etc.
• Esophagitis.
• Malignant tumors.
• Mallory-Weiss syndrome.
• Pathology of the vessels passing in the wall of the organs of the digestive tract.

Most often, bleeding occurs with ulcerative and erosive processes in the digestive organs. All other causes are less common.

The etiology of bleeding from the lower gastrointestinal tract is more extensive:

• Pathological changes in the vessels of the intestine.
• (benign mucosal growth).
• Malignant tumor processes.
• (protrusion of the wall) of the intestine.
• Inflammatory diseases of infectious and autoimmune nature.
• Tuberculosis of the intestine.
• Bowel intussusception (especially common in children).
• Deep.
• . Helminths, sticking and clinging to the intestinal wall, damage the mucous membrane, so it can bleed.
• Injuries to the intestines with solid objects.

Among these causes, the most common are serious bleeding pathologies of the vessels of the intestinal mucosa and diverticulosis (multiple diverticula).

Symptoms of gastrointestinal bleeding

The most reliable sign of gastrointestinal bleeding is the appearance of blood in the feces or vomit. However, if the bleeding is not massive, this symptom does not manifest immediately, and sometimes it goes unnoticed at all. For example, in order to start vomiting blood, a lot of blood must accumulate in the stomach, which is not common. In the feces, blood may also not be detected visually due to the effect of digestive enzymes. Therefore, it is worth, first of all, to consider the symptoms that appear first and indirectly indicate that bleeding has opened in the digestive tract. These symptoms include:

If these symptoms have developed in a person suffering from a peptic ulcer or vascular pathology of the digestive organs, he should consult a doctor. In such situations, and without the appearance of external signs, bleeding can be suspected.

If, against the background of the general symptoms described, the vomit has an admixture of blood or the appearance of “coffee grounds”, and also if the feces have acquired the appearance of tar and an unpleasant odor, then the person definitely has serious gastrointestinal bleeding. Such a patient needs emergency care, because delay can cost him his life.

By the type of blood in the vomit or feces, one can judge where the pathological process is localized. For example, if the sigmoid or rectum bleeds, the blood in the feces remains unchanged - red. If the bleeding began in the upper intestines or stomach and it is characterized as not abundant, the feces will contain the so-called occult blood - it can only be detected using special diagnostic techniques. With advanced gastric ulcer, the patient may experience massive bleeding, in such situations there is profuse vomiting of oxidized blood (“coffee grounds”). With damage to the delicate mucous membrane of the esophagus and with varicose pathology of the esophageal veins, the patient may vomit unchanged blood - bright red arterial or dark venous.

Emergency care for gastrointestinal bleeding

First of all, you need to call an ambulance. While the doctors are driving, the patient should be laid down with his legs slightly raised and his head turned to the side in case of vomiting. To reduce the intensity of bleeding, it is advisable to put cold on the stomach (for example, ice wrapped in a towel).

Important: A person with acute gastrointestinal bleeding should not:

• drink and eat;
• take any medicines inside;
• wash the stomach;
• do an enema.

If the patient is thirsty, you can smear his lips with water. This is where the help that can be provided to a person before the arrival of a team of doctors ends. Remember: self-medication can be disastrous, especially for conditions such as gastrointestinal bleeding.

Diagnosis and treatment of gastrointestinal bleeding

The most informative diagnostic method for gastrointestinal bleeding is - and. During these procedures, doctors can detect the source of bleeding and immediately perform medical manipulations, for example, cauterization of a damaged vessel. In chronic bleeding from the stomach or intestines, patients are shown contrast, angiography and the digestive tract.

To detect occult blood in the feces, special immunochemical tests are used. In European countries and the United States, all older people are recommended to undergo such tests annually. This makes it possible to identify not only chronic bleeding, but also to suspect tumors of the gastrointestinal tract, which can begin to bleed even at small sizes (before the appearance of intestinal obstruction).

To assess the severity of bleeding, patients must be carried out, and. If the blood loss is severe, there will be shifts on the part of all these tests.

The tactics of treating patients with gastrointestinal bleeding is determined by the localization and causes of this syndrome. In most cases, doctors manage to get by with conservative methods, but surgical intervention is not ruled out. Operations are carried out as planned, if the patient's condition allows, and urgently, when it is impossible to delay.

• Bed rest.
• Before the bleeding stops, hunger, and then a strict diet, which is as gentle as possible on the digestive tract.
• Injections and ingestion of hemostatic drugs.

After stopping the bleeding, the patient is treated for the underlying disease and anemia, which almost always develops after blood loss. Iron preparations are prescribed by injection, and subsequently - orally in the form of tablets.

With massive blood loss, patients are hospitalized in the intensive care unit. Here, doctors have to solve several problems: stop bleeding and eliminate its consequences - infuse blood-substituting drugs and erythrocyte mass to restore the volume of blood circulating in the body, inject protein solutions, etc.

Sequelae of gastrointestinal bleeding

With massive bleeding, a person may develop a state of shock, acute and even death.. Therefore, it is extremely important that such a patient be taken to a medical facility with a surgical and intensive care unit as soon as possible.

If the blood loss is chronic, anemia (anemia) occurs. This condition is characterized by general weakness,

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

General information

Gastrointestinal bleeding is the most common complication of a wide range of acute or chronic diseases of the digestive system, representing a potential danger to the patient's life. The source of bleeding can be any part of the gastrointestinal tract - the esophagus, stomach, small and large intestines. According to the frequency of occurrence in abdominal surgery, gastrointestinal bleeding is in fifth place after acute appendicitis, cholecystitis, pancreatitis, and strangulated hernia.

Causes

To date, more than a hundred diseases have been described that may be accompanied by gastrointestinal bleeding. All hemorrhages can be conditionally divided into 4 groups: bleeding with lesions of the gastrointestinal tract, portal hypertension, vascular damage and blood diseases.

Bleeding that occurs with lesions of the gastrointestinal tract may be due to gastric ulcer or peptic ulcer 12p. intestines, esophagitis, neoplasms, diverticula, hiatal hernia, Crohn's disease, ulcerative colitis, hemorrhoids, anal fissure, helminthiases, injuries, foreign bodies, etc. Bleeding against the background of portal hypertension, as a rule, occurs with chronic hepatitis and cirrhosis of the liver, thrombosis of the hepatic veins or the portal vein system, constrictive pericarditis, compression of the portal vein by tumors or scars.

Bleeding that develops as a result of vascular damage can be etiologically and pathogenetically associated with varicose veins of the esophagus and stomach, periarteritis nodosa, systemic lupus erythematosus, scleroderma, rheumatism, septic endocarditis, avitaminosis C, atherosclerosis, Rendu-Osler disease, thrombosis of mesenteric vessels and others

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

Pathogenesis

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

Classification

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

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

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

Symptoms

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

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

Diagnostics

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

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

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

Treatment of gastrointestinal bleeding

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

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

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

Forecast and prevention

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

When stomach bleeding occurs, the signs are fairly easy to recognize. The main thing in this situation is to make adequate decisions and competently provide first aid, since every minute is precious with heavy blood loss.

In this case, you should not wait idly for the arrival of doctors: you must try to stop or at least reduce the intensity of blood loss. Even if the bleeding in the stomach is not severe, one should also provide the person with minimal assistance and see a doctor.

This condition occurs quite often, especially in patients with chronic diseases of the stomach and intestines. According to medical statistics, 8-9% of patients in surgical departments who come to the ambulance have such a diagnosis.

More than half of the cases are accounted for by internal bleeding of the stomach, in second place is the duodenum. Approximately 10% are bleeding from the rectum. Blood loss is rare in the middle intestine.

How and why does gastrointestinal bleeding occur?

There are three main mechanisms for the development of this state:

1. Damage to a blood vessel in the lining of the stomach or intestines. The main causes are mechanical or chemical damage, inflammation, peptic ulcer, excessive stretching of the walls of the stomach.
2. Decreased blood clotting.
3. Leakage of blood through the walls of blood vessels.

In total, there are more than two hundred reasons that can cause gastric bleeding.. And although most cases are associated with the presence of pathologies of the upper digestive tract, other diseases can also lead to this condition.

Tuberculous or syphilitic lesions of the stomach, burns, ischemia of the gastric mucosa can also lead to the development of such a pathology - but these cases are rare.
An increased tendency and a great risk exist in persons who abuse alcohol: due to changes in the vessels of the digestive organs.

Also risk factors include:

1. Avitaminosis, especially vitamin K deficiency, can cause light bleeding.
2. Shock state.
3. Blood poisoning.
4. Old age and the presence of a large number of chronic diseases.
5. Hernia of the esophagus.
6. Traumatic brain injury.
7. Low blood pressure in combination with tachycardia.

Typically, stomach and intestinal bleeding occurs when several of the factors listed in the table are present.

Intragastric bleeding may occur once and no longer disturb the person, or repeat from time to time. In the second case, we can talk about a relapsing condition. In this case, the patient needs a thorough examination, which will help to identify the whole range of reasons that each time lead to blood loss.

Acute develops suddenly and rapidly, leads to the loss of large volumes of blood and a sharp deterioration in the general condition. The person needs emergency medical attention because there is a risk of losing a large volume of blood. The sign is vomiting of red blood, confusion, low blood pressure (upper reading below 100), and loss of consciousness.

Chronic can last for days or even weeks. For the patient, it often goes unnoticed, but iron deficiency anemia develops over time. Do not hope that after a while this condition will pass by itself: examination and medical assistance are necessary to stabilize the condition.

Depending on the amount of blood loss, it happens:

1. Easy - practically does not appear. A person may notice a small amount of blood in the stool or vomit. Small vessels are usually affected and blood loss is negligible.
2. Secondary lung dizziness and a slight decrease in blood pressure.
3. Severe, in which a person can lose consciousness, not respond to the environment.

A patient with intestinal bleeding should be kept calm and consult a doctor. The more severe the condition, the sooner medical attention is needed. If you feel satisfactory, you still need to contact a general practitioner or gastroenterologist.

The patient may not notice any signs unless the lesion is extensive.

In later stages and with serious diseases, there may be:

1. Dizziness.
2. Pallor.
3. Chills, clammy sweat.
4. Weakness, fatigue.
5. The dark color of feces is almost black. The blood in the intestine has time to partially digest, so it takes on a black color. If the rectal vessels are damaged, the stool does not mix with blood.
6. Nausea.
7. Vomiting - scarlet blood with large and rapid blood loss or damage to the esophagus. With slow, but voluminous vomiting, it resembles coffee grounds - the blood coagulates under the influence of gastric juice.
8. Decreased heart rate.
9. Noise in the ears, darkening of the eyes.

Pain does not necessarily accompany this condition. Perforation of the ulcer is usually accompanied by acute sensations. If bleeding occurs when a vessel is damaged by an ulcer or it bleeds periodically, while the wall of the stomach does not break through, the pain, on the contrary, subsides.

If there is a suspicion of hemorrhage in the stomach in adults, first of all, you need to ensure rest. The optimal position is lying on your back, on a hard surface. If a person loses consciousness, care must be taken to ensure that during vomiting, the masses do not enter the respiratory system.

When vomiting scarlet blood, you should immediately call an ambulance. Throat vomiting indicates slower blood loss. But to try to stop the bleeding is necessary in both cases. To do this, put cold on the abdomen. Contact with ice - no longer than 20 minutes, then you need to take a break so as not to cause frostbite.

Never give food or water. If the patient is conscious and asks for a drink, it is worth letting him suck on ice: the cold will cause vasospasm and reduce blood loss, while there will not be a large amount of water in the stomach.

How to stop bleeding at home? In an acute condition, you can only slow down the rate of blood loss and help a person hold out until the arrival of doctors. It should be remembered that first aid can both save a person and harm.

You can't force a person to move. You can only transport on a stretcher, lowering your head below your legs. In this position, you can lay the patient before the arrival of the ambulance, placing a pillow or a rolled towel under his feet. blood flow to the head will help to avoid loss of consciousness.

It is not advisable to take medications. Only in an acute condition can you give 30-50 ml of aminocaproic acid, 2-3 crushed Dicinon tablets or a couple of tablespoons of calcium chloride. It is desirable to use one thing, since all three drugs increase blood clotting, and an overdose will lead to the formation of blood clots. You need to write down the name, dosage and approximate time of administration in order to transfer these data to the doctors.

Diagnostics

For mild and sometimes moderate bleeding, the patient is treated as an outpatient. In an acute state, hospitalization is indicated. Only in a hospital setting, doctors will be able to provide quick and qualified assistance that will help save a person's life.

Gatsroenterologist is engaged in outpatient treatment. The acute condition is stopped by the surgeon. If bleeding and pain are localized in the rectal area, a proctologist should be consulted. Depending on the results of the preliminary examination, a consultation with a hematologist or oncologist may be required.

Find out why there is blood from the mucous membrane of the stomach and intestines, as well as assess the patient's condition will help:

1. FGDS. This method allows the doctor to see the extent of the lesion. Adrenaline can also be injected during the procedure to quickly prevent blood loss.
2. Fecal occult blood test is used for internal intestinal bleeding. It allows you to determine the presence of blood impurities even if the volume of daily loss is 15 ml.
3. General blood analysis. Its decoding will help to identify the presence of inflammation, assess coagulability and identify anemia.
4. If necessary, the analysis of vomit masses is carried out.
5. X-ray and CT of the stomach or intestines.

How to treat the patient - the doctor chooses after a thorough examination.

In a hospital setting, it is usually prescribed:

1. Means to increase coagulability.
2. Preparations for replenishing blood volume.
3. proton pump inhibitors.
4. Endoscopic operations (cauterization, stitching, vessel ligation).
5. Surgical ligation of blood vessels, resection of the damaged part of the stomach or intestines.

Consequences and complications

The greater the amount of blood loss, the more dangerous the consequences. Acute bleeding can lead to hemorrhagic shock and rapid death. The loss of small volumes leads to the development of persistent anemia. If the cause of intra-intestinal hemorrhage is not identified in time, the disease can be started to the stage when doctors are powerless.

Therefore, the first thing to do with gastrointestinal bleeding is to consult a doctor. Internal bleeding is dangerous because it is difficult to assess the extent of blood loss and the likelihood of certain complications.

Video - First aid kit. internal bleeding

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Bleeding from the gastrointestinal tract is a complication of acute or chronic diseases of the digestive tract. When bleeding occurs, blood flows into the lumen of the gastrointestinal tract.

Causes

The causes of bleeding from the gastrointestinal tract can be:

Classification

According to the nature of the course, bleeding occurs:

Types of severity of blood loss:

• Light (deficiency of circulating blood flow is not more than 20%);
• Medium (deficiency is 20-30% of the total);
• Severe (deficit more than 30%).

Depending on the location of bleeding:

From the upper gastrointestinal tract:

• gastric;
• Esophageal;
• Duodenal (duodenum).

From the lower gastrointestinal tract:

• Colonic;
• Small intestine (enteral);
• Rectal (rectal).

bleeding symptoms

Bleeding from the gastrointestinal tract is characterized by the following symptoms:

With hemorrhages from the upper gastrointestinal tract the color of coffee grounds (bloody) appears. With a latent form, after 4–8 hours from the onset of bleeding, Milena's tarry stool is observed (feces become black).

For peptic ulcers of the stomach and duodenum there is a pain syndrome in the epigastrium, with intestinal bleeding, symptoms of an acute abdomen (sharp pain, tension of the peritoneum). With hepatic bleeding, the spleen and liver increase in size, a pronounced pattern of saphenous veins appears.

In chronic bleeding, the following symptoms appear:

• fatigue;
• Paleness of mucous membranes, skin;
• Reduced performance;
• dizziness, headache;
• General weakness.

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Diagnostics

The diagnosis of bleeding from the gastrointestinal tract is made on the basis of the patient's complaints, the collection of anamnesis (current diseases, heredity) during examination (measurement of blood pressure, pulse, examination of the skin), according to the results of laboratory examinations.

Diagnostic studies:

• Complete blood count, decrease in the number of red blood cells, hemoglobin;
• Blood for platelets, reduced count;
• Feces for occult blood, traces of blood in stools;
• Coagulogram, examine blood for the speed and quality of coagulation;
• FEGDS, examine the stomach cavity;
• Colonoscopy, examination of the wall of the colon;
• Sigmoidoscopy, examine the rectum and sigmoid colon;
• X-ray of the esophagus, stomach, a contrast agent is injected to determine the source of bleeding.

Treatment Methods

Bleeding from the gastrointestinal tract is an emergency condition that requires first aid:

• Call an ambulance without delay;
• Lay the patient on a flat, hard surface;
• Put ice on the stomach, which is wrapped in a cloth;
• Unfasten tight clothing, provide fresh air;
• Monitor the patient until the doctor arrives.

With symptoms of bleeding, it is MANDATORY to call an ambulance!

Ambulance perform the following urgent manipulations:

• Intramuscular injection of 4 ml of a 12.5% ​​solution of etamsylate (hemostatic agent);
• Intramuscular injection of 0.5 ml of a 0.1% solution of atropine (M-anticholinergic, inhibits the secretion of salivary, sweat glands, increases heart rate, reduces organ tone);
• Intravenously 400 ml of rheopolyglucin (saline solution to replenish the volume of circulating blood flow).

After admission to the hospital, the patient is prescribed the following procedures:

• Bed rest, physical and psycho-emotional rest;
• Probing and washing the stomach with cool water to remove clots and accumulated blood;
• Oxygen therapy (oxygen therapy), using oral nasal masks, endotracheal tubes and others;
• Cleansing enema to remove accumulated blood from the rectum. 1.5–2 liters of water at room temperature are injected into the rectum;

• Intravenous administration of blood-substituting solutions(polyvinol, Ringer's solution, gemodez). Hemodez, adults 300-500 ml, children 5-15 ml per 1 kg of weight, the frequency of administration is selected individually;

• Intramuscular and intravenous formulation of hemostatic (hemostatic) agents, dicynone, vikasol, amben. Dicinon, adults 1-2 ml 3-4 times a day, children 0.5-1 ml three times a day;

• Intramuscular and intravenous administration of iron preparations, maltofer, totem, cosmofer. Maltofer, for adults and children weighing more than 45 kg 4 ml throughout the day, for children weighing less than 6 kg ¼ ampoule (0.5 ml), 5–10 kg ½ ampoule (1 ml), 10–45 kg 1 ampoule (2 ml);

• Correction of water and electrolyte balance with the help of intravenous administration of glucose solutions, physiological solutions. Glucose 5%, 500-3000 ml per day;

• Transfusion of donor blood with large blood loss;
• Irrigation of the mucous membrane (shell) of the stomach (using a specialized gastric tube) with a hemostatic mixture: 1 ml of 0.1% adrenaline solution, 150 ml of 5% aminocaproic acid, 30 ml of 0.5% novocaine solution. After 20-30 minutes after the manipulation, such a mixture in cold form is given to the patient orally (by mouth).

With the ineffectiveness of conservative therapy, surgical intervention is used:

• Resection (removal) of the colon;
• Ligation of the veins of the esophagus and the imposition of a sigmoid (permanent or temporary sutures);
• Stem vagotomy (dissection of the main trunk of the gastric vagus nerve);
• Resection of the stomach;
• Stitching of a bleeding defect;
• When bleeding from varicose veins of the esophagus, an endoscopic stop is performed by cauterization, doping (sutures) of the altered vessels.

Diet after stopping

Food consumption is possible only 1-2 days after the bleeding stops. Dishes should be chilled, liquid or semi-liquid (mashed soups, slimy cereals, jelly), you can swallow pieces of ice.

As the state of the menu improves, they expand, gradually add:

• Scrambled eggs;
• boiled vegetables;
• Omelette;
• Baked apples;
• Meat soufflé;
• A pair of fish.

5-6 days after the bleeding stops, the patient should consume food every 2 hours in minimal portions, the daily amount of food is not more than 400 ml.

After a week, you can consume:

• Cream, sour cream;
• Rosehip broth, fruit, vegetable juices;
• Butter.

Complications

Bleeding from the gastrointestinal tract can lead to the development of the following complications:

• Anemia (anemia);
• Multiple organ failure (nonspecific reaction of the body, all organs and systems are affected);
• Hemorrhagic shock (a dangerous serious condition that threatens the life of the patient);
• Renal failure (a dangerous pathological condition in which the functioning of the kidneys is impaired);
• Fatal outcome.

Gastrointestinal bleeding is represented by the release of a certain amount of blood from vessels damaged by pathology or erosion directly into the digestive organs. Depending on the degree of blood loss and its subsequent localization, the following clear signs may appear:

• tarry or black feces;
• vomiting that resembles coffee grounds in texture;
• tachycardia;
• cold sweat;
• pallor and dizziness;
• fainting and general weakness.

Diagnosis of the described disease is carried out through colonoscopy, enteroscopy, laparotomy. As for the relief of bleeding, it is carried out surgically or conservatively.

In fact, gastrointestinal bleeding is a complication of chronic or acute diseases that affect the digestive organs. In most cases, it carries a clear threat to human life. The source of such an undesirable phenomenon may be the large or small intestine, stomach, esophagus, etc.

Causes

Gastrointestinal bleeding can be ulcerative or non-ulcerative. The first group should include:

1. Recurrent ulcers after resection of part of the stomach.
2. Numerous slit-like ulcers of the large and small intestines, which appeared against the background of severe inflammation (Crohn's disease).
3. Ulcerative nonspecific colitis.

Malignant and benign tumors are usually formed in the transverse colon, or rather, in its descending section.

The second group includes:

• cracks found in the rectum;
• chronic hemorrhoids against the background of exacerbation;
• diverticula in the intestine.

In addition to these reasons, feces mixed with blood are found in infectious lesions of the intestine, for example, tuberculosis, dysentery, typhoid fever.

Symptoms

The first and alarming symptom indicating gastrointestinal bleeding is blood found during bowel movements or coming out on its own. Usually at the very beginning of the disease, it is not allocated. It is important to take into account the change in the color of feces while taking activated charcoal, medicines containing iron. Some food products lead to a similar change, it can be pomegranate, chokeberry, blueberry, black currant.

It must be remembered that such a change in children occurs against the background of ingestion of sputum or blood during nosebleeds, and in adults - during pulmonary bleeding.

The degree of bleeding in the gastrointestinal tract is detected by the first signs:

• a sharp drop in blood pressure;
• blanching of the skin;
• "flies" in the eyes, dizziness.

The etiology of the occurrence of this disease is different and manifests itself individually against the background of a particular diagnosis. The main symptoms of gastrointestinal bleeding are represented by the following factors:

1. Cancer of the rectum or colon leads to chronic anemia, the discharge of blood is not strong. Therefore, malignant tumors are often detected as a result of examination of a person with anemia. Feces are mixed with blood and mucus if the tumors are located on the left side of the large intestine.
2. Ulcerative nonspecific colitis causes the patient to frequent urge to false defecation. The stool becomes watery, an admixture of mucus, pus, and blood is found. Against the background of a long-term such condition, there is a risk of developing anemia.
3. The presence of hemorrhoids is indicated by bleeding during defecation or with a sharp physical exertion, the discharge has a characteristic scarlet color. Normally, feces do not mix with blood. Other signs of this disease include pain in the anus, burning, severe itching.

Symptoms of the disease in children

Gastrointestinal bleeding in children in most cases occurs before the age of three years. Congenital pathologies may appear in the form of:

• partial infarction of the large intestine associated with obstruction or volvulus;
• duplication of the small intestine;
• ulcerative necrotic enterocolitis.

In this case, the child has pronounced bloating, there is constant vomiting, regurgitation. Greenish stool mixed with blood and mucus. In the gastrointestinal tract - acute bleeding.

What to do if symptoms of the disease are detected

First aid for gastrointestinal bleeding consists of several important points:

• calling an ambulance;
• location of the patient in a strictly horizontal position with slightly raised legs;
• preventing the entry of any substances into the body (food, water, drugs);
• fixing on the stomach of a heating pad with ice;
• the presence of fresh and cool air in the room;
• regular monitoring of the patient.

If we talk about the provision of emergency care for internal bleeding in children, it is practically no different. The situation is complicated by the fact that it is much more difficult to calm a baby than an adult. In the event that the disease is caused by trauma, it is necessary to describe the traumatic factor to the doctor as accurately as possible. It can be a chemical substance, a sharp object, etc.

As for the provision of emergency medical care, it directly depends on the nature and strength of the bleeding, on the general condition of the patient. The presence of a large volume of arterial scarlet blood that cannot be stopped by conventional means is a prerequisite for the patient to be urgently taken to the surgical department.

Treatment of the disease

Gastrointestinal bleeding is eliminated in two ways - using conservative means or surgically.

In the event that in a short time it is not possible to eliminate the bleeding, an emergency operation is indicated. It is desirable to restore the amount of lost blood by infusion therapy before surgery. In particular, this is an intravenous infusion of blood or drugs that replace it. Such preparation is not carried out when there is a clear threat to the patient's life.

There are two types of surgery, it all depends on medical indications:

• endoscopic method, including laparoscopy, colonoscopy, sigmoidoscopy;
• open classical operation.

The essence of the treatment is represented by the fact that the veins of the stomach and esophagus are ligated, the affected area is removed and the damaged vessels are coagulated.

The syndrome of gastrointestinal bleeding is also subject to medical treatment. First of all, hemostatic drugs are administered to the patient. Further, the accumulated blood is evacuated from the gastrointestinal tract, which is carried out through cleansing enemas or using a nasogastric tube. The next step is to restore blood loss and at the same time ensure the normal functioning of vital organs. Further, the disease is diagnosed directly and its treatment is carried out.

Depending on the consequences of stopping bleeding, the patient is prescribed a diet that helps restore blood, increase its coagulability and improve the general condition of the body.

When filling out a medical history, it is now customary to use special codes. This procedure is necessary for the convenience and standardization of the diagnosis, as well as for its confidentiality. Therefore, a system has been created that classifies diseases, it is displayed in digital coding. Thus, all kinds of diseases concerning the digestive organs belong to class XI: K00-K93.

Gastrointestinal bleeding can occur at any age. It is pathological, congenital, infectious, often a threat to life. It is important to help the patient at the first symptoms and place him in a medical facility.