The nature of stool during gastric bleeding. Gastrointestinal bleeding

Intestinal bleeding is a pathological condition characterized by heavy loss of blood due to diseases of the gastrointestinal tract, traumatic damage to the mucous membrane, hemorrhoids, endocrine pathologies, infections of various etiologies, syphilis and even tuberculosis.

There are several factors that can cause bleeding, they are:

• Specific.
• Non-specific.

Specific causes include:

• diseases of the digestive system with the appearance of ulcers and inflammation;
• , tumors and malignant formations;
• traumatic damage to the mucous membrane;
• hemorrhoids, provided that they are internal in nature.

Causes of nonspecific intestinal bleeding include:

• Various disorders of the endocrine system.
• Nasal or pulmonary bleeding with reflux of biological fluid into the esophagus.
• Eating food that contains dyes that can change the color of the stool.

These reasons most often lead to the appearance of blood from the organs of the digestive system, but a similar phenomenon is also observed with syphilis or tuberculosis.

Diseases of the gastrointestinal tract are the main factor in the occurrence of internal bleeding. Ulcers and lesions that appear on the surface of the intestine begin to bleed profusely as stool passes, which leads to the development of a pathological condition.

Bleeding leads to the appearance of nonspecific symptoms if it is not profuse and occurs in a latent form.

An example is nonspecific or Crohn's disease. During the course of these diseases, multiple or single foci of erosion appear on the surface of the intestine.

Polyps and tumors, as well as malignant formations, are growths of connective, glandular or other tissue. As a result of natural processes of digestion, formation, tumors or polyps are damaged, hence the appearance of blood in the stool.

Injuries to the mucous membrane should be regarded as damage to the digestive organs; they can occur when a foreign body enters the stomach and intestines. Hemorrhoids are a disease of the rectum that occurs due to varicose veins.

During the course of the pathological process, venous nodes of various sizes are formed on the outside of the anus or inside the rectum. They can be injured by feces and bleed profusely.

Types of disease

Bleeding as a condition has a certain classification, it happens:

• pungent or copious;
• moderate;
• insignificant.

Abundant or acute is characterized by significant loss of blood, is active and requires emergency hospitalization of the patient.

Moderate blood loss over a short period of time may go unnoticed. But as soon as changes occur in a person’s condition, hospitalization will be required.

Minor blood losses are considered dangerous because they can go unnoticed for a long time. During this period, against the background of the condition, certain changes occur in the human body.

In case of heavy bleeding, the patient is immediately hospitalized, and in case of minor bleeding, treatment is carried out on an outpatient basis.

Signs, symptoms and first aid for intestinal bleeding

The disease has a number of characteristic symptoms, they depend on the type of condition and the disease that led to the loss of biological fluid.

What are the symptoms of internal bleeding in the intestines:

• General weakness.
• Paleness of the skin.
• Iron taste in mouth.
• Change in color of stool.
• Vomiting or diarrhea with blood.

Against the background of an infectious disease, in addition to blood in the stool, a person’s temperature rises and signs of intoxication appear in the body.

Weakness, pale skin, decreased blood pressure are signs of iron deficiency anemia, which develops with moderate and minor bleeding.

But if the loss of biological fluid is acute, there is a sharp pain in the abdomen, loss of consciousness, and a frequent urge to defecate with the release of blood clots and mucus.

Signs of bleeding in the intestines can increase, be hidden, and appear periodically. When collecting anamnesis, the patient recalls 2-3 cases when he noticed the appearance of red streaks in the stool and a change in its color.

What does the shade tell you?

The color of the stool can tell you what the nature of the bleeding is:

• if the stool changes color, becomes dark, liquid and the person complains of frequent urges, then blood loss is abundant;
• if there are clots of blood and mucus in the stool, the stool has a bright red or scarlet tint, then the bleeding is either moderate or profuse;
• if the feces have not changed color and only sometimes streaks resembling blood appear on their surface, then the loss of biological fluid is insignificant.

Based on the color of the feces, the doctor can determine in which part of the intestine the bleeding site is located:

• If the stool is dark, then the large intestine should be examined.
• If the stool has a brighter shade, it is the small intestine.
• If blood appears after emptying and resembles a scarlet trickle on the surface, then the cause of this phenomenon is considered to be hemorrhoids.

As a sign of the disease:

• intestinal tuberculosis: prolonged diarrhea mixed with blood, significant weight loss, general intoxication of the body;
• nonspecific inflammatory disease: damage to the eyes, skin lesions and joints;
• infections: increased body temperature, prolonged diarrhea mixed with mucus and blood;
• hemorrhoids and anal fissure: pain in the perineum, difficulty bowel movements, blood on toilet paper;
• oncological tumors: pain in the abdomen, profuse vomiting of blood, loss of appetite, deterioration in general health.

If the stool has changed color, and the act of defecation does not cause discomfort to the person, there is no pain and the state of health is normal, then the cause may be the foods consumed the day before. Fruits, berries and vegetables (blueberries, pomegranates, beets, etc.) can color stool.

How to stop intestinal bleeding

If blood loss is profuse, then at home it is necessary to provide the person with first aid:

1. Lay it on a flat surface.
2. Place ice or a bottle of cold water on the abdominal area.
3. Call an ambulance.

• drink hot drinks;
• Eating;
• bathe in a hot bath.

It is prohibited to perform any physical activity that may cause an increase in blood pressure and increased bleeding.

When the medical team arrives, they will provide the patient with the following assistance:

• measure blood pressure levels;
• will administer hemostatic drugs intravenously.

Without special equipment, doctors will not be able to determine the cause of the pathological condition. For this reason, the person will be given an injection of a drug that will help reduce the rate of blood loss. After the injection, the patient will be placed on a stretcher and taken to the hospital.

Diagnostics

If pathological signs appear, you should contact:

• to a gastroenterologist;
• see an endocrinologist.

A consultation with a gastroenterologist will help establish the exact fact of the disease, but in addition to this specialist, you should also contact an endocrinologist. It will help determine whether the pathological condition is associated with metabolic disorders in the body.

First diagnostic procedures:

• You will need to donate blood for a clinical analysis in order to determine the concentration of red blood cells, nephrocytes, hemoglobin and hematocrit.
• As well as feces for the presence of hidden blood (coagulogram), the study is relevant in various branches of medicine, and is used in cardiology when making a diagnosis. Prescribed for myocardial infarction and bleeding of various etiologies.

During the examination, the gastroenterologist pays attention to:

• on the color of the patient’s skin;
• to heart rate.

The doctor should measure the blood pressure level and find out whether the person has previously lost consciousness.

A manual or palpation examination of the rectum is carried out to identify the presence of hemorrhoids in this area, which could have suffered significant damage, resulting in the appearance of blood.

Hemorrhoids are treated by a proctologist, not a gastroenterologist, so the doctor can redirect the patient to another specialist if the cause of the bleeding is varicose veins of the rectum.

What tests will help make a diagnosis:

• Endoscopy.
• Sigmoidoscopy.
• Colonoscopy.

An endoscopic examination is carried out by introducing special endoscope devices through natural pathways, with the help of which doctors are able to examine the mucous membrane of an organ under multiple magnification, identify the area that has undergone pathological changes and make a diagnosis for the patient.

Sigmoidoscopy is an examination performed using a special endoscope, which helps to identify the presence of foci of inflammation in the area of ​​the colon and rectum. The endoscope is inserted through the anus, without the use of anesthesia.

Thus:

The information obtained is sufficient to determine the localization of the pathological process and identify changes in the mucous membrane. Sigmoidoscopy requires preliminary preparation.

Colonoscopy is a modern diagnostic method using an endoscope in the form of a thin tube with a microcamera at the end. The tube is inserted into the patient's anus, while air is supplied.

This allows you to smooth out the folds of the intestines. A fibrocolonoscope helps determine the condition of the mucous membrane of organs and detect sluggish bleeding. If a tumor or polyp is detected, collect material for a biopsy.

An endoscopic examination with the insertion of a probe helps not only to diagnose the patient, but also to carry out procedures to localize the source of bleeding. Using electrodes, cauterize the vessel or perform a polypectomy. Detect a blood clot in the organ cavity and determine its characteristics.

If the cause of blood loss cannot be determined, the following is prescribed:

• Mesentericography involves the introduction of labeled red blood cells into the mesenteric artery. After which the patient undergoes an x-ray. The picture shows the movement of specially colored bodies. The procedure allows us to identify characteristic architectural vascular features using contrast.
• Scintigraphy is a method of radioisotope diagnostics. The procedure is very specific and involves introducing a radiopharmaceutical into the body and tracking and recording the radiation produced. Isotopes can be found in organs and tissues, which helps to identify pathological foci of inflammation and bleeding. The procedure helps to evaluate the work of a particular organ and identify deviations.

Mesentericography is effective only if blood loss is 0.5 ml per minute or more intense. If it is possible to detect a lesion, then doctors can use the previously inserted catheter to perform sclerotherapy.

If the bleeding intensity is lower, no more than 0.1 ml per minute, then scintigraphy is prescribed - the introduction of isotope-labeled red blood cells into the human body.

Why is this needed:

Intravenous administration of blood cells helps to detect the source of bleeding, but the examination cannot provide clear information about its location. As part of the diagnosis, the process of movement of red blood cells is monitored, this is done using a special camera.

Lastly, radiographic studies of the intestinal passage are carried out. In order for the examination to take place, the patient takes a barium suspension.

This is a contrast agent, the progress of which will be monitored using x-rays. The contrast will pass through the large and small intestines. And when the passage enters the cecum, the study is considered certified.

X-rays of the intestine may distort the results of other examinations performed using an endoscope. For this reason, the study is carried out last, and its results are assessed after the bleeding has stopped, no earlier than 48 hours.

Treatment of intestinal bleeding

After transporting the patient to the hospital, procedures begin. If the loss of biological fluid is significant, then drip administration of plasma or blood is prescribed.

Volumes of transfusions:

• Plasma: 50-10 ml, less often 400 ml.
• Blood: 90-150 ml.
• If bleeding is heavy: 300-1000 ml.

In addition to drip transfusion, intramuscular injection of blood protein is used; the indication for such procedures is arterial hypertension. If blood pressure is high, blood transfusion by drip is not advisable.

• the patient needs complete rest;
• compliance with bed rest.

The patient should remain in bed and not experience any emotional or physical stress that could worsen his condition.

It is also practiced to administer homeostatic drugs that can stop or slow down the loss of biological fluid:

• Atropine sulfate.
• Benzohexonium solution.
• Rutin, Vikasol.

Benzohexonium solution is administered only if the blood pressure level is not reduced; it helps to reduce intestinal motility, reduce vascular tone, and stop blood loss.

Along with medications, a person is given a hemostatic sponge, crushed into pieces, to swallow.

If blood pressure drops sharply, drugs are used to increase its level: Caffeine, Cordiamine. If the pressure is below 50 mm, then blood transfusion is suspended until the pressure level stabilizes.

Surgery

Indications for emergency surgery:

• Ulcer. Provided that it is not possible to stop intestinal bleeding or a relapse of the condition occurs after stopping. The most effective procedures are those carried out in the first two days from the moment of contacting a medical institution.
• Cirrhosis of the liver. Provided that the disease is advanced and its treatment with conservative medicine has not led to the desired results.
• Thrombosis. In combination with acute abdominal syndrome.
• Tumors of oncological and other nature. Provided that the bleeding cannot be stopped.

If the cause of the bleeding cannot be determined, then the operation is performed urgently. During this procedure, the surgeon opens the abdominal cavity and tries to independently determine the cause of blood loss. If the lesion cannot be detected, then resection is performed - removal of part of the intestine.

There are other less traumatic methods of surgical treatment:

• Sclerosis is the introduction of a special substance into a bleeding, burst or damaged vessel, which “glues it together” and thereby stops the loss of biological fluid.
• Arterial embolism - ligation of it with special collagen or other rings, as a result of which the bleeding stops, since the blood flow to the organ is limited in a particular area.
• Electrocoagulation is the cauterization of a burst or damaged vessel with a hot electrode.

But if, during the opening of the abdominal cavity, the surgeon finds a tumor or polyp, he cuts out the formation, and the resulting material is sent for histological examination. Further treatment of the patient will depend on the results of histology.

Recovery after bleeding

All procedures boil down to limiting physical activity and following special nutritional rules. The first day a person is prescribed fasting, he can drink cold water, orally in the form of droppers or intramuscular injections, and a 5% glucose solution is administered.

Fasting can be extended for another 1–2 days. Refusal of food is replaced by inclusion in the diet of: milk, raw eggs, fruit juices and jellies. The products are consumed exclusively cold, so as not to provoke a relapse of the condition.

By the end of the week, eat scrambled eggs, mashed porridge, soaked crackers, and meat purees. In parallel with the diet, drug therapy is carried out, which is aimed at stopping the root cause of the pathological condition.

Intestinal bleeding is considered dangerous; loss of biological fluid, even in small quantities, affects a person’s health. If measures are not taken in time, systematic blood loss can lead to death.

Intestinal bleeding accounts for only 10% of the total volume of bleeding with which patients are admitted to the hospital. But every year more than 70 thousand people die from intestinal bleeding.

Gastrointestinal bleeding is the flow of blood from damaged vessels into the cavity of the organs that make up the digestive system. The main risk group for this disorder includes older people - from forty-five to sixty years old, but it is sometimes diagnosed in children. It is noteworthy that it occurs several times more often in men than in women.

• Etiology
• Classification
• Symptoms
• Diagnostics
• Treatment
• Complications
• Prevention

More than a hundred diseases are known against which such a symptom can develop. These may be gastrointestinal pathologies, various damage to blood vessels, a wide range of blood diseases, or portal hypertension.

The nature of the manifestation of the symptoms of the clinical picture directly depends on the degree and type of hemorrhage. The most specific manifestations can be considered the occurrence of blood impurities in vomit and feces, pallor and weakness, as well as severe dizziness and fainting.

The search for the source of hemorrhage in the gastrointestinal tract is carried out by performing a wide range of instrumental diagnostic methods. To stop gastrointestinal tract disease, conservative methods or surgical intervention will be required.

Why is there bleeding from the stomach?

Bleeding in the intestines, stomach or other digestive organs can develop for the following reasons:

The most common causes of gastrointestinal bleeding are duodenal and gastric ulcers. They cause up to 35% of all bleeding from the gastrointestinal tract. Risk factors for the development of peptic ulcers are frequent stress, drinking alcohol and smoking.

Important information: How to stop bleeding from a cut (bleeding wounds) and first aid for wounds and bleeding

In children, the most common causes of bleeding are volvulus (for infants) and intestinal polyposis (for preschoolers).

Some causes of intestinal bleeding (for example, hemorrhoids, anal fissures or polyps) provoke only scanty spotting or small amounts of blood in the stool. With ulcers, vascular pathologies, tumors and ruptures of the walls of the gastrointestinal tract, blood flows profusely, mixing with secretions (vomiting, feces) in a changed or unchanged form.

Diagnostic methods

As for the differential diagnosis of gastrointestinal bleeding, it suggests a complete examination, which begins with determining the medical history, assessing stool and vomit, and performing a rectal digital examination. The color of the skin must be taken into account. The abdominal area is carefully palpated to avoid aggravation of the gastrointestinal tract. It is necessary to review the coagulogram, determine the level of urea and creatine, and a kidney test.

X-ray methods will be useful:

• irrigoscopy;
• celiacography;
• x-ray and angiography.

The most effective and accurate method of diagnosis is endoscopy (FGDS, gastroscopy and colonoscopy, as well as esophagoscopy). These tests will help determine the presence of a surface defect on the mucosa, as well as the source of the gastrointestinal tract.

Classification

Bleeding from the digestive tract is divided into groups depending on the etiology, source of hemorrhage and severity. According to the etiology of bleeding, they are divided into:

• for diseases caused by the gastrointestinal tract (ulcerative and non-ulcerative origin);
• for blood circulation disorders in the portal vein (portal hypertension);
• for bleeding in vascular diseases;
• on pathologies of the hematopoietic system, incl. hemorrhagic diathesis.

In accordance with the classification of bleeding by localization, the following types of this disorder are distinguished:

• bleeding from the upper parts of the digestive tract (stomach, esophagus, duodenum);
• bleeding from the lower digestive organs (small and large intestines, rectum, hemorrhoids).

Most often, bleeding occurs from the upper gastrointestinal tract. Esophageal, duodenal and gastric bleeding are diagnosed in 8-9 out of 10 patients with hemorrhages in the digestive tract.

Classification of bleeding according to severity

Pathology severity	Decreased circulating blood volume	External manifestations	Systolic blood pressure and pulse rate	Blood counts
Lightweight	Less than 20%	The patient's condition is satisfactory: the patient has normal urine output (diuresis), slight weakness and dizziness are possible. The patient is conscious.	Blood pressure - 110 mm Hg. Heart rate - no more than 80 beats/min	The concentration of erythrocytes is above 3.5*1012, the hemoglobin level is more than 100 g/l, the hematocrit is at least 30%.
Average	20-30%	The patient's skin turns pale, there is severe sweating (cold sweat), and urine output is moderately reduced. The patient is conscious.	Blood pressure - 100-110 mm Hg. Heart rate - 80-100 beats/min	The concentration of erythrocytes is above 2.5*1012, the hemoglobin level is 80-100 g/l, the hematocrit is 25-30%.
Heavy	Over 30%	The patient's condition is serious: he experiences a loss of strength, dizziness, severe muscle weakness, severe pallor of the skin, sweating, and a decrease in the volume of urine excreted (to complete anuria). The patient's reactions are inhibited, and loss of consciousness may occur.	Blood pressure - below 100 mm Hg. Heart rate - more than 100 beats/min	The concentration of erythrocytes is below 2.5*1012, the hemoglobin level is less than 80 g/l, the hematocrit is less than 25%.

Some experts also distinguish the fourth, most severe stage of bleeding. It is characterized by complete loss of consciousness in the patient and the development of coma.

Massive internal bleeding, accompanied by severe blood loss, is called profuse.

Additionally, bleeding in the gastrointestinal tract can be classified according to the following criteria:

• duration of bleeding (acute or chronic bleeding);
• the presence of external manifestations of pathology (hidden or obvious);
• frequency and number of cases of blood loss (single or repeated, recurrent).

Treatment of intestinal bleeding

After transporting the patient to the hospital, procedures begin. If the loss of biological fluid is significant, then drip administration of plasma or blood is prescribed.

Volumes of transfusions:

• Plasma: 50-10 ml, less often 400 ml.
• Blood: 90-150 ml.
• If bleeding is heavy: 300-1000 ml.

In addition to drip transfusion, intramuscular injection of blood protein is used; the indication for such procedures is arterial hypertension. If blood pressure is high, blood transfusion by drip is not advisable.

• the patient needs complete rest;
• compliance with bed rest.

The patient should remain in bed and not experience any emotional or physical stress that could worsen his condition.

It is also practiced to administer homeostatic drugs that can stop or slow down the loss of biological fluid:

• Atropine sulfate.
• Benzohexonium solution.
• Rutin, Vikasol.

Benzohexonium solution is administered only if the blood pressure level is not reduced; it helps to reduce intestinal motility, reduce vascular tone, and stop blood loss.

Along with medications, a person is given a hemostatic sponge, crushed into pieces, to swallow.

If blood pressure drops sharply, drugs are used to increase its level: Caffeine, Cordiamine. If the pressure is below 50 mm, then blood transfusion is suspended until the pressure level stabilizes.

What are the signs and symptoms

Early symptoms of bleeding in the gastrointestinal tract include:

• general weakness, adynamia;
• dizziness, fainting, confusion and loss of consciousness;
• ringing in the ears, flickering spots in the eyes;
• nausea, vomiting;
• change in color of gastric and intestinal secretions (vomit and feces);
• sweating;
• strong thirst;
• increased heart rate;
• pallor of the skin, cyanosis of the lips, blue discoloration and decreased temperature of the fingertips.

The severity of the symptoms of the pathology depends on the intensity of bleeding, the volume of blood volume and the amount of blood lost. Due to the larger initial volume of circulating blood, signs of bleeding in adults may manifest later and less clearly than in children. Even minor blood loss in a small child may require immediate resuscitation.

Symptoms of internal bleeding in the stomach often appear simultaneously with signs of massive blood loss and a decrease in circulating blood volume. Against the background of manifestations of blood loss, pain may be observed in the affected part of the gastrointestinal tract, an increase in the volume of the abdomen due to the accumulation of fluid (ascites), fever caused by intoxication, loss of body weight, a sharp change or loss of taste and other pathological phenomena indicating the cause of the gastrointestinal tract.

The main symptom of gastric bleeding is bloody vomiting, the nature of which may indicate the cause of the pathology and the duration of the bleeding.

Vomiting in various pathologies of the upper gastrointestinal tract, which lead to blood loss:

“Coffee grounds” are a product of treating blood from the stomach with hydrochloric acid.

With ulcerative lesions, stomach pain is reduced during vomiting. Bleeding is not accompanied by irritation of the peritoneum and tension of the muscles of the anterior abdominal wall. With massive blood loss and stomach cancer, the color of the stool also changes.

Repeated vomiting with blood 1-2 hours after the first episode indicates continued bleeding, and vomiting after 4-6 hours indicates its relapse.

With gastric bleeding, the symptoms of blood loss in most cases are more pronounced than with bleeding in the intestines. This is due to the fact that common causes of damage to the walls of the small, large and rectal intestines are injuries to hemorrhoids, polyposis and small cracks in the mucosa. They can provoke prolonged but insignificant blood loss, which is accompanied by a slight decrease in hemoglobin concentration and the development of compensatory tachycardia while maintaining normal blood pressure and the patient’s well-being.

Symptoms of intestinal bleeding, accompanied by massive blood loss, may include:

• black feces;
• discharge of melena (unformed, tarry stool with a strong unpleasant odor);
• weakness, loss of consciousness, pale skin and other manifestations of acute blood loss.

Visual changes in the color and structure of stool are visible only with blood loss of more than 100 ml/day and damage to the rectum and colon (cracks, polyps, bleeding hemorrhoids). In case of a one-time leakage of blood (with a stomach ulcer and pathologies of the lower parts of the digestive tract), the blood is excreted unchanged in the stool. With prolonged massive bleeding, a few hours after it starts, tarry stools (dark stool with small clots) are released.

The nature of stool changes in various intestinal pathologies:

In the chronic course of the pathology, symptoms of anemia may occur:

• weakness, fatigue;
• decreased performance;
• frequent dizziness;
• inflammation of the mouth and tongue;
• pallor of the mucous membranes and skin.

Types of internal bleeding of the digestive system

Intragastric bleeding It may occur once and not bother the person again, or it may recur from time to time. In the second case, we can talk about a recurrent condition. In this case, the patient needs a thorough examination, which will help identify the whole range of reasons that each time lead to blood loss.

Acute disease develops suddenly and rapidly, leading to the loss of large volumes of blood and a sharp deterioration in general condition. The person requires emergency medical attention because there is a risk of losing a large amount of blood. Signs include vomiting red blood, confusion, low blood pressure (high reading below 100) and loss of consciousness.

Chronic can last for several days or even weeks. The patient often goes unnoticed, but iron deficiency anemia develops over time. You should not hope that this condition will go away on its own after a while: examination and medical care are necessary to stabilize the condition.

Depending on the volume of blood loss, it can be:

1. Light - practically does not manifest itself. A person may notice a small amount of blood in their stool or vomit. Usually small vessels are affected and blood loss is negligible.
2. Moderate mild dizziness and slight decrease in blood pressure.
3. Severe, in which a person may lose consciousness and not respond to the environment.

A patient with intestinal bleeding should be provided with rest and consultation with a doctor. The more severe the condition, the faster medical help is needed. If you feel satisfactory, you still need to see a therapist or gastroenterologist.

Diagnostics

Determining the cause of gastrointestinal bleeding syndrome requires a thorough clinical examination, laboratory tests, as well as the use of hardware and instrumental diagnostic methods.

Clinical examination

For the primary diagnosis of internal bleeding in the stomach or intestines, a clinical examination of the patient is performed, during which the following data are analyzed:

• patient history;
• list of medications taken;
• color and consistency of discharge;
• skin color (pallor, yellowness);
• the presence of spider veins, hemorrhagic manifestations and other vascular pathologies on the skin.

If there is a suspicion of intestinal or gastric bleeding, palpation of the painful part of the abdomen and rectal examination are carried out with caution. Careless procedure can significantly increase blood loss.

Laboratory research

Laboratory tests that are performed for bleeding in the stomach, esophagus, and lower gastrointestinal tract include:

• general blood analysis;
• blood biochemistry (liver and kidney tests, markers of inflammatory processes, etc.);
• coagulogram;
• coprogram;
• analysis of antibodies to double-stranded DNA, etc.

Instrumental methods

The most informative hardware diagnostic methods that are used when intragastric and intraintestinal hemorrhage are suspected are:

• X-ray examination of the esophagus and stomach;
• celiacography;
• MR angiography of gastrointestinal tract vessels;
• static and dynamic scintigraphy of the digestive tract;
• CT scan of the abdominal cavity;
• X-ray of the nasopharynx, bronchi and lungs.

Gastric bleeding can be most quickly diagnosed using upper gastrointestinal endoscopy. For pathologies of the lower parts of the tract, irrigoscopy, sigmoidoscopy and colonoscopy are used.

If it is impossible to determine the source of hemorrhage using endoscopy and hardware methods, a diagnostic laparotomy is performed.

Factors in the development of the disease are multiple. It is necessary to identify the provocateur as quickly as possible. Even if it is possible to completely eliminate the pathological process, no one can guarantee that a relapse will not occur. It is highly likely that this will happen.

Among the main factors:

Stomach ulcer

According to studies until 2010, this point was considered key in etiology. As it turned out later, not everything is so simple. The risks are really growing, which is quite obvious.

The reason for gastric bleeding is as follows: the normal integrity of the mucous membrane is disrupted, the tissues of the organ are richly supplied with blood, therefore any destructive, structural changes are highly likely to lead to disruption of the local vascular (vascular) network.

However, despite the possibility of high-quality treatment and breakthroughs in medicine, statistics on stomach bleeding do not change. Doctors suggest that there is a group of disorders. Among which, the ulcer plays an important role, but it is not the only and not the exclusive cause of hemorrhage in the stomach.

Violations of the oncological plan

Tumors. Often we are talking about completely benign structures. These are the so-called polyps. In fact, their good quality in a broad sense is very conditional.

They grow quite deeply into the tissue and ultimately cause disruption of the local circulatory network. Also, do not forget about the possibility of cancer transformation.

Malignant tumors cause bleeding in the gastrointestinal tract almost from the first stages. But critically acute conditions are observed closer to the final phase of the disease. When active decay and infiltrative germination begins through all the walls and layers of the stomach.

Digestive tract injuries

Observed as a result of the influence of a mechanical factor. Mostly. We are talking about the consumption of inedible objects, sharp objects with perforation of the wall of a hollow organ, also about impact, exposure to direct kinetic force. For example, during an accident, a fight, or a fall from a great height.

Against the background of this disorder, direct ruptures of the stomach are possible, which leads to the leakage of blood into the organ cavity or into the peritoneum.

Invasive interventions

Including diagnostic ones. There is an iatrogenic effect. In this case, doctors are to blame. Medical procedures can provoke problems of this kind even if they are carried out correctly and technically correctly.

The question lies in the individual characteristics of the human body. Medical errors cannot be ruled out; this also happens.

Liver pathologies

Hepatitis, cirrhosis, tumor processes. Mainly in sub- and decompensation. A number of coagulation factors are produced in this organ. Without normal functional activity there is no way to ensure adequate coagulation. Therefore, violations begin. The more significant the problem, the more dangerous the pathological process itself.

Disorders of the hematopoietic system itself

From hemophilia to others. The entire list of diagnoses located in the classifier in the corresponding section, one way or another, can provoke gastric bleeding.

Hypocoagulation

A generalized name for the processes during which a decrease in clotting occurs. Usually this is not an independent diagnosis, but just a syndrome, a clinical finding. Read more about the causes of poor blood clotting in this article.

These are the main causes of intragastric bleeding. There are others too. The list is incomplete.

How to stop bleeding

Stopping bleeding should be carried out by doctors from a medical institution or an emergency medical team. Even before emergency assistance is provided, it is necessary to call an ambulance, describing the patient’s condition and the nature of the discharge.

The algorithm for providing emergency first aid for suspected bleeding includes the following steps:

• Place the patient on his back with his legs elevated using folded clothing or a pillow;
• do not allow the victim to drink or eat;
• apply a compress of ice wrapped in cloth to the painful area;
• When providing first aid, monitor your breathing pattern and heart rate;
• in case of loss of consciousness, bring the patient to his senses using cotton wool soaked in ammonia;
• when waiting for a long time for an ambulance, carry the patient on a stretcher towards the medical team.

During emergency care for gastric bleeding, it is forbidden to lavage the stomach. If you suspect intestinal pathology, you should not give the patient an enema.

An attempt to stop the bleeding without the help of doctors can lead to the death of the patient.

Emergency care for stomach bleeding

What is emergency treatment for bleeding from the stomach? All necessary steps are listed below:

• Providing bed rest, which helps reduce the rate of bleeding.
• Applying a cold compress (we will consider the algorithm below).
• Washing the stomach with ice water, the essence is to spasm the bleeding vessels and subsequently stop or slow down the blood flow.
• Prescription of adrenaline or norepinephrine drugs through a gastric tube. This group of hormones belongs to stress factors that cause compensatory narrowing of the lumen of blood vessels.
• Replenishment of total circulating blood volume (TBV) by administering hemostatic solutions intravenously.
• Use of donor blood, blood substitutes and frozen plasma as a replacement for lost blood.

Other therapy is carried out if indicated.

How to treat

For gastrointestinal bleeding, treatment is aimed at stopping it, eliminating the root cause of the pathology, restoring hemostasis of the body and normal blood volume.

The danger for the patient is not only the loss of red blood cells that carry oxygen, but also a sharp decrease in blood volume, which leads to massive thrombosis of small vessels and the development of disseminated intravascular coagulation syndrome.

Conservative treatment

Conservative treatment of gastric bleeding and intestinal blood loss is carried out as an adjunct to surgery. As the main method of therapy, it is used for the following indications:

• hemorrhagic syndromes;
• cardiovascular diseases;
• inoperable malignant tumors;
• congenital pathologies of the hematopoietic system.

Therapy may include hemostatic agents, cytostatics, anti-inflammatory and other drugs.

If a large volume of blood is lost, the patient is prescribed IVs with saline solutions and transfusions of blood components.

Surgery

If bleeding in the gastrointestinal tract is suspected, the patient is taken to the surgical department of the clinic, where diagnosis and treatment tactics are determined.

Depending on the diagnosis, the patient may undergo the following operations:

• endoscopic sclerosis, electrocoagulation and ligation of dilated vessels of the intestine, esophagus, etc.;
• suturing of the ulcer and partial resection of the stomach;
• suturing duodenal ulcer;
• subtotal resection of the large intestine with stoma.

Diet

Treatment tactics using diet therapy depend on the underlying disease. For pathologies of the stomach, the patient is prescribed table No. 1, No. 1a (immediately after stopping the bleeding), No. 1b or No. 2. For intestinal diseases, diet No. 3 or No. 4 is recommended.

If bleeding is a complication of liver pathology, the patient is prescribed table No. 5 and its variations.

Prevention

No specific preventive measures have been developed for this disorder; to avoid problems with hemorrhages in the gastrointestinal tract, it is necessary:

• promptly treat diseases that can lead to such complications;
• undergo regular examination of adults and children by a gastroenterologist.

The prognosis directly depends on predisposing factors, the degree of blood loss, the severity of concomitant ailments and the age category of the patient. The risk of complications and mortality is always extremely high.

How to prevent the phenomenon

To prevent the development of this dangerous pathology, it is necessary to undergo regular medical examinations, follow the rules of taking medications and lead a healthy lifestyle.

Contacting a gastroenterologist at the first manifestations of ulcerative and vascular diseases (malaise, nausea, stomach pain, etc.) increases the likelihood of a favorable prognosis for the effectiveness of therapy.

To detect intestinal bleeding in the early stages, it is recommended to regularly take a stool occult blood test.

Cold compress

A trusting relationship must be established with the patient. He needs to understand the purpose and process of applying a cold compress. The algorithm of actions performed with his consent is as follows:

Recovery period: lifestyle and diet

After completing a course of drug treatment, the specialist strongly recommends that the patient change his lifestyle and diet. You should exclude intense physical activity for at least 4 weeks, avoid hypothermia, stress, do not visit saunas and steam baths, and ensure a good night's sleep.

The following should be excluded from the diet:

• fat meat,
• salted and smoked fish,
• canned vegetables, fruits, marinades,
• seasonings,
• alcohol,
• strong coffee,
• soda,
• fast food,
• confectionery, baked goods.

Portions should be small, food should be low-fat, pureed, and meals should be taken at least 5 times a day at equal intervals. After 4–6 weeks of following the diet, you can make it less strict, but only after consulting a doctor.

The patient’s menu must include the following products:

• scrambled eggs;
• biscuits, crackers;
• weak black tea;
• cereals;
• a small amount of potatoes;
• poultry, steamed fish;
• pureed soups;
• a little butter, fermented milk products.

If a patient has undergone gastric suturing surgery, he does not consume anything for the first 24 hours after the procedure. On the second day and over the next week, broth from skinless chicken breast, as well as dried fruit compote, is poured into his nasal probe. The daily norm is 1 liter of each of these liquids. On the 7th–10th day, you are allowed to start gradually eating food: mashed potatoes without oil, soft-boiled eggs, pureed soup without frying.

The patient's lifestyle after surgery plays an important role. For the first 10 days, standing up is strictly prohibited, after which the specialist removes one or all tubes, and the patient is allowed to stand up for a short time. The recovery period lasts at least 6 weeks. The recommendations are similar to those given to patients after undergoing conservative treatment.

Indications for surgical treatment

Acute gastric bleeding is an indication for surgery for:

• lack of positive results from previously performed conservative and endoscopic measures;
• the patient’s condition is unstable or serious, which may become more complicated in the near future (for example, coronary artery disease or stroke);
• repeated bleeding.

First aid

With severe and prolonged bleeding, the patient may experience blue lips. Often the patient has a feeling of lack of air. Vision may be significantly reduced. The person's condition deteriorates sharply. Such symptoms clearly indicate acute gastric bleeding. "Emergency" must be called immediately. Any delay in time is fraught with serious consequences. Statistics show that more than 17% of patients die from gastric blood loss.

What to do before the medical team arrives? First aid for gastric bleeding is to ensure complete rest for the patient. It is recommended to lay the patient horizontally. It is strictly forbidden to give him food or water. If possible, cold should be placed on the stomach, in the upper area. This could be a bubble or an ice bag. Under no circumstances should you do enemas or rinse your stomach!

It is necessary to carefully monitor the general condition of the patient. If he loses consciousness, be sure to revive him. For such purposes, use a cotton swab soaked in ammonia.

A. Emergency colonoscopy

B. Emergency sigmoidoscopy

B. Irrigoscopy

D. Survey fluoroscopy of the abdominal organs

D. Control of passage through the gastrointestinal tract of barium administered per os

Features of the course in adults and children

The symptoms of the disease in an adult and a child are almost the same. But in the former, the disease often develops gradually; they do not pay attention to the first signs, so complications often develop. In children, gastrointestinal tract always occurs acutely, but due to the rapid restoration of blood vessels and gastric mucosa, symptoms may appear for a short time and disappear. The baby becomes active again, plays and asks for food. You should not postpone a visit to the doctor even if there have been no repeated manifestations within 24 hours.

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.

Rehabilitation measures after surgery

• Day one - you can move your arms and legs.
• Day two - the beginning of the introduction of breathing exercises.
• Day three - you can try to get back on your feet.
• Day eight - postoperative sutures are removed.
• Day fourteen - discharge from the department with recommendations to limit physical activity for a month and the need to perform a set of physical therapy exercises.

The need for surgery

Surgical treatment of patients can be divided into 2 methods - active and expectant tactics. In the first case, doctors perform surgery at the level of hemorrhage.

Expectant treatment involves stopping the flow of blood using conservative means. Surgeons then perform a planned operation.

Surgical treatment is carried out when diagnosing profuse bleeding, ulcers in the projection of the great vessels, and in case of unfavorable endoscopic examination.

Patient preparation lasts about 2 hours and depends on the intensity of the hemorrhage. To stop gastroduodenal bleeding, it is appropriate to use endotracheal anesthesia.

If the patient does not have an ulcer or other pathological lesions of the stomach walls, then a longitudinal gastrotomy can be performed.

All bleeding vessels are stitched, bandaged and diathermocoagulated.

The duration of the operation depends on the patient’s condition and possible complications. If patients are in a difficult situation, palliative surgery is urgently needed.

Doctors carefully stitch the bleeding vessels and perform a wedge-shaped excision of the ulcer. It may be necessary to stitch the stomach walls and apply a seromuscular node.

Possible complications

The main complications are:

• the appearance of hemorrhagic shock from blood loss;
• development of acute iron deficiency anemia;
• acute liver and kidney failure.

A life-threatening situation is the development of multiple organ failure, when the function of several vital organs and systems suffers. In such a situation, patients need resuscitation measures to save life. Any attempts at self-treatment or lack of timely hospitalization often lead to the death of the patient.

When gastric bleeding occurs, symptoms may vary in severity depending on the underlying disease and its severity. This phenomenon is considered a serious complication of a number of diseases, requiring urgent measures. Large blood losses can be life-threatening, and therefore knowledge of first aid techniques will help to avoid tragic consequences. It is important to strictly observe prohibitions on the consumption of a number of foods, since it is poor nutrition that often provokes pathology.

The essence of the problem

Gastrointestinal bleeding is the effusion of blood into the lumen of the intestines or stomach. This phenomenon is not considered an independent disease, but usually expresses pathognomonic signs of different origins. It has been established that bleeding in the stomach can occur with the development of more than 100 different diseases, and therefore a problem often arises in terms of making a diagnosis.

In order to understand the mechanism of intestinal bleeding, you need to become familiar with the anatomy of the organ. The human stomach is a kind of hollow “bag” into which food enters from the esophagus, where it is partially processed, mixed and sent to the duodenum. The organ consists of several sections:

• entrance section, or cardia;
• gastric fundus (in the form of a vault);
• body;
• pylorus of the stomach (transition of the stomach into the duodenum).

The gastric wall has a three-layer structure:

• mucous membrane;
• muscle layer;
• outer shell of connective tissue.

The volume of the stomach in adults is usually 0.5 liters and expands to 1 liter when eating.

The blood supply to the stomach is provided by arteries passing along the edges - on the right and left. Numerous small branches branch off from the large ones. In the area of ​​the cardia there is a venous plexus. Bleeding is possible if any of the listed vessels are damaged. The most common source of intestinal bleeding can be the venous plexus, since for a number of reasons the veins dilate, which increases the risk of damage.

Types of pathology

Depending on the etiological mechanism, there are 2 main types of gastric bleeding: ulcerative (occurring from a stomach ulcer) and non-ulcerative. According to the nature of the pathology, acute and chronic forms are distinguished. In the first case, internal bleeding develops very quickly with intense blood loss, which requires urgent medical measures. The chronic clinic is characterized by a long course with small constant leaks of blood into the gastric lumen.

Taking into account the severity of the phenomenon, 2 types are distinguished: obvious and hidden bleeding. In the first option, all signs of gastric bleeding are intense and easily detected. A latent course is characteristic of a chronic process, while the definition of the disease is hampered by the absence of pronounced symptoms, and the presence of pathology, as a rule, is indicated only by indirect signs, in particular the pallor of a person. According to the severity of the manifestation, the following degrees are distinguished: mild, moderate and severe.

The clinical picture of intestinal bleeding also depends on the location of the source of hemorrhage. The following main options are distinguished:

1. Bleeding in the upper part of the gastrointestinal tract: esophageal, gastric, duodenal.
2. Bleeding in the lower sections: small, large and rectal.

Etiology of the phenomenon

Most often, the causes of gastric bleeding are associated with the development of peptic ulcers in the organ itself or the duodenum. They are recorded in almost every fifth sick person with this pathology. In this case, direct damage to the blood vessels by gastric juice occurs or complications develop in the form of the formation of a blood clot, leading to rupture of the vessel.

The problem under consideration can also be caused by reasons not related to peptic ulcer:

• erosion of the gastric mucosa;
• ulcers provoked by injuries, burns, surgery (so-called stress ulcers);
• ulcers caused by a long course of treatment using potent drugs;
• Mallory-Weiss syndrome, i.e. damage to the mucous membrane due to intense vomiting;
• ulcerative colitis;
• tumor formations, polyps;
• Gastric diverticulum, caused by a protrusion of the stomach wall;
• diaphragmatic hernia associated with protrusion of part of the stomach into the abdominal cavity.

Causes due to disruption of the structure of blood vessels are also recorded:

• the formation of atherosclerotic plaques in the vascular walls;
• vascular aneurysms;
• venous expansion in portal hypertension due to liver dysfunction;
• connective tissue diseases: rheumatism, lupus erythematosus;
• systemic vasculitis: periarteritis nodosa, Henoch-Schönlein purpura.

Sometimes the cause of bleeding is a bleeding disorder. The main pathologies of this type include thrombocytopenia and hemophilia. In addition, blood loss can be caused by mechanical trauma when a solid body enters the stomach, as well as infectious lesions - salmonellosis, dysentery, etc.

Symptomatic manifestations

There are several groups of signs of bleeding in the stomach. With any internal bleeding in the human body, general symptoms develop:

• pale skin;
• general weakness and apathy;
• cold sweating;
• arterial hypotension;
• the appearance of a rapid but weakened pulse;
• dizziness;
• noise in ears;
• confusion and lethargy.

With intense blood loss, a person may lose consciousness.

Pathognomonic signs of the phenomenon under consideration include vomiting and defecation with blood. Bleeding can be determined by the characteristic appearance of the vomit: it resembles “coffee grounds.” In this case, blood is released that was affected by acid in the stomach. At the same time, in case of bleeding from the esophagus or severe damage to the gastric arteries, scarlet, unchanged blood may be released in the vomit. Blood impurities in the stool give it the appearance of a tarry substance.

The severity of a sick person’s condition with gastric bleeding is assessed according to 3 degrees:

1. A mild degree is determined when the patient’s general condition is satisfactory. Slight dizziness is possible, pulse is up to 76–80 beats per minute, pressure is not lower than 112 mm Hg.
2. The average degree is established in the presence of pronounced pallor of the skin with cold sweating. The pulse may increase to 95–98 beats, and the pressure may drop to 98–100 mmHg.
3. Severe severity requires emergency assistance. It is characterized by such a sign as obvious inhibition. The pulse exceeds 102 beats, and the pressure drops below 98 mm Hg.

If treatment is not carried out or carried out incorrectly, the pathology progresses quickly.

Providing emergency assistance

With the development of acute gastric bleeding, symptoms increase very quickly. If you do not start timely treatment, the consequences can become very serious. If there is a sharp deterioration in a person’s condition, severe weakness and pallor, clouding of consciousness, or vomiting in the form of “coffee grounds,” it is necessary to urgently call an ambulance.

Before doctors arrive, first aid for gastric bleeding is provided. How to stop blood loss in an emergency? Complete rest and ice compress are provided. The patient is placed in a supine position with his legs slightly elevated. Ice is placed in the abdominal area. In severe circumstances, an intramuscular injection of calcium gluconate and Vikasol is performed. It is possible to use Dicynon tablets.

Principles of pathology treatment

Treatment of gastric bleeding is aimed at combating the underlying disease and eliminating the symptom itself and its consequences. It can be carried out using conservative or surgical methods, depending on the type of pathology and the severity of its course.

Treatment is based on the following principles:

1. With mild damage. A strict diet is provided for gastric bleeding, an injection of Vikasol is prescribed, calcium-based drugs are taken, as well as vitamins.
2. With moderate severity. Treatment includes endoscopy with chemical or mechanical stimulation of the source of bleeding. Blood transfusion is possible.
3. In case of severe pathology. Emergency resuscitation measures and, as a rule, surgery are provided. Treatment is carried out in a hospital setting.

Conservative therapy is aimed at stopping bleeding. To achieve this, the following measures are taken:

1. Gastric lavage with a cold solution. It is carried out using a tube inserted through the mouth or nose.
2. Administration of drugs to induce vascular spasms: Adrenaline, Norepinephrine.
3. Intravenous injection (drip) of hemostatic agents.
4. Transfusion using donor blood or blood substitutes.

Endoscopic methods are carried out using special instruments. The most commonly used methods are:

• injecting the ulcer with adrenaline;
• electrocoagulation of destroyed small vessels;
• laser exposure;
• suturing the damaged area with threads or special clips;
• use of special glue.

An important element of treatment is proper nutrition. Diet after stomach bleeding should be strictly maintained. What can you consume after taking emergency measures and eliminating the acute course? On the first day you should not eat or drink at all. The next day you can start consuming liquid (100–150 ml). Meals over the next 3–4 days include the gradual introduction of broths, pureed soups, fermented milk products, and liquefied porridges. You can eat normally, but within the limits of a gentle diet, only 9–10 days after the bleeding has stopped. Subsequent meals are carried out in accordance with table No. 1 with a transition to less rigid diets. The meal schedule is set frequently (7–8 times a day), but in measured portions.

Bleeding in the stomach is considered a very dangerous manifestation of certain diseases. If such a pathology is detected, measures must be taken urgently.

Gastrointestinal bleeding is the flow of blood from damaged vessels into the cavity of the organs that make up the digestive system. The main risk group for this disorder includes older people - from forty-five to sixty years old, but it is sometimes diagnosed in children. It is noteworthy that it occurs several times more often in men than in women.

More than a hundred diseases are known against which such a symptom can develop. These may be gastrointestinal pathologies, various damage to blood vessels, a wide range of blood diseases, or portal hypertension.

The nature of the manifestation of the symptoms of the clinical picture directly depends on the degree and type of hemorrhage. The most specific manifestations can be considered the occurrence of blood impurities in vomit and feces, pallor and weakness, as well as severe dizziness and fainting.

The search for the source of hemorrhage in the gastrointestinal tract is carried out by performing a wide range of instrumental diagnostic methods. To stop gastrointestinal tract disease, conservative methods or surgical intervention will be required.

Etiology

Currently, there is a wide range of predisposing factors that cause the occurrence of such a serious complication.

Hemorrhages of the digestive tract associated with a violation of the integrity of blood vessels are often caused by:

• organs of the gastrointestinal tract, in particular the stomach or;
• the formation of plaques of atherosclerotic nature;
• aneurysm or dilation of the vessel, which is accompanied by thinning of its wall;
• diverticula of the gastrointestinal tract;
• septic

Often, hemorrhages in the gastrointestinal tract are the result of blood diseases, for example:

• any form of leakage;
• which are responsible for blood clotting;
• - is a genetic pathology, against the background of which there is a violation of the blood clotting process;
• and other ailments.

Bleeding in the gastrointestinal tract due to leakage often occurs when:

• liver damage;
• compression of the portal vein by tumors or scars;
• the formation of a blood clot in the veins of the liver.

In addition, it is worth highlighting other causes of gastrointestinal bleeding:

• a wide range of injuries and injuries of the abdominal organs;
• penetration of a foreign object into the gastrointestinal tract;
• uncontrolled use of certain groups of medications, for example, glucocorticoid hormones or non-steroidal anti-inflammatory drugs;
• influence or nervous overstrain for a long time;
• traumatic brain injuries;
• surgical intervention on the organs of the digestive system;

Gastrointestinal bleeding in children is caused by the following factors:

• hemorrhagic disease of newborns is the most common cause of such a disorder in infants under one year of age;
• – often causes gastrointestinal hemorrhages in children from one to three years old;
• colon - explains the appearance of this symptom in preschool children.

Children of the older age group are characterized by similar etiological factors inherent in adults.

Classification

There are several varieties of such a symptom or complication, ranging from the nature of its occurrence to possible sources. Thus, two types of gastrointestinal bleeding are distinguished:

• acute – divided into voluminous and small. In the first case, there is a sudden appearance of characteristic symptoms and a significant deterioration in the person’s condition, which can occur even after ten minutes. In the second situation, the symptoms of blood loss gradually increase;
• chronic – characterized by the manifestation of anemia, which is recurring in nature and continues for a considerable time.

In addition to the main forms, there are also obvious and hidden, single and recurrent hemorrhage.

According to the location of the source of blood loss, it is divided into:

• hemorrhage from the upper gastrointestinal tract - the appearance of the disorder occurs against the background of damage to the esophagus, stomach or duodenum;
• bleeding from the lower zones of the gastrointestinal tract, which includes organs such as the small and large intestines, as well as the rectum.

Classification of gastrointestinal bleeding according to the severity of its occurrence:

• mild degree - the person is conscious, blood pressure and pulse indicators deviate slightly from the norm, the blood begins to thicken, but its composition does not change;
• moderate degree - characterized by a more pronounced manifestation of symptoms, decreased blood pressure and increased heart rate, blood clotting is not impaired;
• severe – characterized by the patient’s serious condition, a significant decrease in blood pressure and an increase in heart rate;
• coma – observed with significant blood loss, which can reach three liters of blood.

Symptoms

The degree of intensity of expression of clinical signs will directly depend on the severity of such a disorder. The most specific symptoms of gastrointestinal bleeding:

• vomiting with blood. With hemorrhages from the stomach or intestines, the blood remains unchanged, but with ulcerative lesions of the duodenum or stomach it can take on the color of “coffee grounds”. This color is due to the fact that the blood comes into contact with the contents of the stomach. It is worth noting that with blood loss from the lower gastrointestinal tract, a similar symptom does not appear;
• the appearance of blood impurities in the stool. In such situations, the blood may also be unchanged, which is inherent in hemorrhages from the lower gastrointestinal tract. The blood will change approximately five hours after the start of bleeding in the upper gastrointestinal tract - the stool has a tarry consistency and takes on a black tint;
• severe bleeding;
• release of large amounts of cold sweat;
• pale skin;
• the appearance of “flies” before the eyes;
• gradual decrease in blood pressure and increase in heart rate;
• the appearance of tinnitus;
• confusion;
• fainting;
• hemoptysis.

Such clinical manifestations are most typical for the acute course of such a disorder. In chronic hemorrhages, the following symptoms predominate:

• weakness and increased fatigue of the body;
• decreased performance;
• pallor of the skin and mucous membranes;
• deterioration of health.

In addition, the chronic form and acute gastrointestinal bleeding will be accompanied by symptoms that are characteristic of the underlying disease.

Diagnostics

Identification of the sources and causes of such manifestations is based on instrumental examinations of the patient, but requires the implementation of other comprehensive diagnostic measures. Thus, the clinician first of all needs to independently perform several manipulations, namely:

• get acquainted with the patient’s medical history and life history;
• carry out a thorough physical examination, which must necessarily include careful palpation of the anterior wall of the abdominal cavity, examination of the skin, as well as measurement of heart rate and blood pressure;
• conduct a detailed survey of the patient to determine the presence, first time of appearance and intensity of symptoms. This is necessary to establish the severity of the hemorrhage.

Laboratory tests that have diagnostic value are:

• General and biochemical blood test. They are carried out to identify changes in blood composition and clotting ability;
• analysis of feces for occult blood.

Instrumental examinations to establish the correct diagnosis include the following procedures:

• FEGDS – for hemorrhages from the upper gastrointestinal tract. Such a diagnostic endoscopic procedure can turn into a therapeutic one;
• sigmoidoscopy or colonoscopy - if the source of blood loss is in the colon. Such examination is also divided into diagnostic and therapeutic;
• radiography;
• vascular angiography;
• irrigoscopy;
• celiacography;
• MRI of the abdominal organs.

Such diagnostic measures are necessary not only to establish the source of hemorrhage, but also to carry out a differential diagnosis of gastrointestinal bleeding. Blood loss with a focus in the gastrointestinal tract should be distinguished from pulmonary and nasopharyngeal hemorrhage.

Treatment

Acute hemorrhage or exacerbation of chronic hemorrhage can occur anywhere at the most unexpected moment, which is why it is necessary to know the rules of emergency assistance to the victim. First aid for gastrointestinal bleeding includes:

• providing a person with a horizontal position so that the lower limbs are higher than the rest of the body;
• applying a cold compress to the area of ​​the suspected source. This procedure should last no more than twenty minutes, after which they take a short break and apply cold again;
• taking medications by mouth only if absolutely necessary;
• exclusion of food and liquid intake;
• a complete ban on gastric lavage and cleansing enema.

Treatment of gastrointestinal bleeding in a medical facility consists of:

• intravenous injections of blood replacement drugs - to normalize blood volumes;
• transfusion of donor blood - in cases of massive hemorrhages;
• administration of hemostatic medications.

In cases of ineffectiveness of drug therapy, endoscopic surgical interventions may be necessary, which are aimed at:

• ligation and sclerosis of damaged vessels;
• electrocoagulation;
• puncture of bleeding vessels.

Often they resort to open surgery to stop hemorrhages.

Complications

If symptoms are ignored or therapy is not started in a timely manner, bleeding of the gastrointestinal tract can lead to a number of serious complications, including the development of:

• hemorrhagic shock due to loss of large amounts of blood;
• acute;
• multiple organ failure;
• premature birth – if the patient is a pregnant woman.

Prevention

No specific preventive measures have been developed for this disorder; to avoid problems with hemorrhages in the gastrointestinal tract, it is necessary:

• promptly treat diseases that can lead to such complications;
• undergo regular examination of adults and children by a gastroenterologist.

The prognosis directly depends on predisposing factors, the degree of blood loss, the severity of concomitant ailments and the age category of the patient. The risk of complications and mortality is always extremely high.

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Bleeding from the gastrointestinal tract is a dangerous phenomenon that develops with ulcerative, vascular, mechanical and other lesions of the gastrointestinal tract. Excessive bleeding into the lumen of the digestive organs can lead to serious complications and death.

Stopping and treating gastrointestinal bleeding (GIB) is carried out promptly or using conservative medicine methods after receiving the results of laboratory, hardware and instrumental diagnostics.

Why is there bleeding from the stomach?

Bleeding in the intestines, stomach or other digestive organs can develop for the following reasons:

The most common causes of gastrointestinal bleeding are duodenal and gastric ulcers. They cause up to 35% of all bleeding from the gastrointestinal tract. Risk factors for the development of peptic ulcers are frequent stress, drinking alcohol and smoking.

How often do you get your blood tested?

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Only as prescribed by the attending physician 30%, 1192 vote

Once a year and I think that’s enough 17%, 677 votes

At least twice a year 15%, 589 votes

More than twice a year but less than six times 11%, 433 vote

I take care of my health and rent once a month 6%, 249 votes

I'm afraid of this procedure and try not to pass 4%, 167 votes

21.10.2019

In children, the most common causes of bleeding are volvulus (for infants) and intestinal polyposis (for preschoolers).

Some causes of intestinal bleeding (for example, hemorrhoids, anal fissures or polyps) provoke only scanty spotting or small amounts of blood in the stool. With ulcers, vascular pathologies, tumors and ruptures of the walls of the gastrointestinal tract, blood flows profusely, mixing with secretions (vomiting, feces) in a changed or unchanged form.

Classification

Bleeding from the digestive tract is divided into groups depending on the etiology, source of hemorrhage and severity. According to the etiology of bleeding, they are divided into:

• for diseases caused by the gastrointestinal tract (ulcerative and non-ulcerative origin);
• for blood circulation disorders in the portal vein ();
• for bleeding in vascular diseases;
• on pathologies of the hematopoietic system, incl. hemorrhagic diathesis.

In accordance with the classification of bleeding by localization, the following types of this disorder are distinguished:

• bleeding from the upper parts of the digestive tract (stomach, esophagus, duodenum);
• bleeding from the lower digestive organs (small and large intestines, rectum, hemorrhoids).

Most often, bleeding occurs from the upper gastrointestinal tract. Esophageal, duodenal and gastric bleeding are diagnosed in 8-9 out of 10 patients with hemorrhages in the digestive tract.

Classification of bleeding according to severity

Pathology severity	Decreased circulating blood volume	External manifestations	Systolic blood pressure and pulse rate	Blood counts
Lightweight	Less than 20%	The patient's condition is satisfactory: the patient has normal urine output (diuresis), slight weakness and dizziness are possible. The patient is conscious.	Blood pressure - 110 mm Hg. Heart rate - no more than 80 beats/min	The concentration of erythrocytes is above 3.5*1012, the hemoglobin level is more than 100 g/l, the hematocrit is at least 30%.
Average	20-30%	The patient's skin turns pale, there is severe sweating (cold sweat), and urine output is moderately reduced. The patient is conscious.	Blood pressure - 100-110 mm Hg. Heart rate - 80-100 beats/min	The concentration of erythrocytes is above 2.5*1012, the hemoglobin level is 80-100 g/l, the hematocrit is 25-30%.
Heavy	Over 30%	The patient's condition is serious: he experiences a loss of strength, dizziness, severe muscle weakness, severe pallor of the skin, sweating, and a decrease in the volume of urine excreted (to complete anuria). The patient's reactions are inhibited, and loss of consciousness may occur.	Blood pressure - below 100 mm Hg. Heart rate - more than 100 beats/min	The concentration of erythrocytes is below 2.5*1012, the hemoglobin level is less than 80 g/l, the hematocrit is less than 25%.

Some experts also distinguish the fourth, most severe stage of bleeding. It is characterized by complete loss of consciousness in the patient and the development of coma.

Massive, accompanied by severe blood loss, is called profuse.

Additionally, bleeding in the gastrointestinal tract can be classified according to the following criteria:

• duration of bleeding (acute or chronic bleeding);
• the presence of external manifestations of pathology (hidden or obvious);
• frequency and number of cases of blood loss (single or repeated, recurrent).

What are the signs and symptoms

Early symptoms of bleeding in the gastrointestinal tract include:

• general weakness, adynamia;
• dizziness, fainting, confusion and loss of consciousness;
• ringing in the ears, flickering spots in the eyes;
• nausea, vomiting;
• change in color of gastric and intestinal secretions (vomit and feces);
• sweating;
• strong thirst;
• increased heart rate;
• pallor of the skin, cyanosis of the lips, blue discoloration and decreased temperature of the fingertips.

The severity of the symptoms of the pathology depends on the intensity of bleeding, the volume of blood volume and the amount of blood lost. Due to the larger initial volume of circulating blood, signs of bleeding in adults may manifest later and less clearly than in children. Even minor blood loss in a small child may require immediate resuscitation.

Symptoms of internal bleeding in the stomach often appear simultaneously with signs of massive blood loss and a decrease in circulating blood volume. Against the background of manifestations of blood loss, pain may be observed in the affected part of the gastrointestinal tract, an increase in the volume of the abdomen due to the accumulation of fluid (ascites), fever caused by intoxication, loss of body weight, a sharp change or loss of taste and other pathological phenomena indicating the cause of the gastrointestinal tract.

The main symptom of gastric bleeding is bloody vomiting, the nature of which may indicate the cause of the pathology and the duration of the bleeding.

Vomiting in various pathologies of the upper gastrointestinal tract, which lead to blood loss:

“Coffee grounds” are a product of treating blood from the stomach with hydrochloric acid.

With ulcerative lesions, stomach pain is reduced during vomiting. Bleeding is not accompanied by irritation of the peritoneum and tension of the muscles of the anterior abdominal wall. With massive blood loss and stomach cancer, the color of the stool also changes.

Repeated vomiting with blood 1-2 hours after the first episode indicates continued bleeding, and vomiting after 4-6 hours indicates its relapse.

With gastric bleeding, the symptoms of blood loss in most cases are more pronounced than with bleeding in the intestines. This is due to the fact that common causes of damage to the walls of the small, large and rectal intestines are injuries to hemorrhoids, polyposis and small cracks in the mucosa. They can provoke prolonged but insignificant blood loss, which is accompanied by a slight decrease in hemoglobin concentration and the development of compensatory tachycardia while maintaining normal blood pressure and the patient’s well-being.

Symptoms of intestinal bleeding, accompanied by massive blood loss, may include:

• black feces;
• discharge of melena (unformed, tarry stool with a strong unpleasant odor);
• weakness, loss of consciousness, pale skin and other manifestations of acute blood loss.

Visual changes in the color and structure of stool are visible only with blood loss of more than 100 ml/day and damage to the rectum and colon (cracks, polyps, bleeding hemorrhoids). In case of a one-time leakage of blood (with a stomach ulcer and pathologies of the lower parts of the digestive tract), the blood is excreted unchanged in the stool. With prolonged massive bleeding, a few hours after it starts, tarry stools (dark stool with small clots) are released.

The nature of stool changes in various intestinal pathologies:

In the chronic course of the pathology, symptoms of anemia may occur:

• weakness, fatigue;
• decreased performance;
• frequent dizziness;
• inflammation of the mouth and tongue;
• pallor of the mucous membranes and skin.

Diagnostics

Determining the cause of gastrointestinal bleeding syndrome requires a thorough clinical examination, laboratory tests, as well as the use of hardware and instrumental diagnostic methods.

Clinical examination

For the primary diagnosis of internal bleeding in the stomach or intestines, a clinical examination of the patient is performed, during which the following data are analyzed:

• patient history;
• list of medications taken;
• color and consistency of discharge;
• skin color (pallor, yellowness);
• the presence of spider veins, hemorrhagic manifestations and other vascular pathologies on the skin.

If there is a suspicion of intestinal or gastric bleeding, palpation of the painful part of the abdomen and rectal examination are carried out with caution. Careless procedure can significantly increase blood loss.

Laboratory research

Laboratory tests that are performed for bleeding in the stomach, esophagus, and lower gastrointestinal tract include:

• general blood analysis;
• blood biochemistry (liver and kidney tests, markers of inflammatory processes, etc.);
• coagulogram;
• coprogram;
• analysis of antibodies to double-stranded DNA, etc.

Instrumental methods

The most informative hardware diagnostic methods that are used when intragastric and intraintestinal hemorrhage are suspected are:

• X-ray examination of the esophagus and stomach;
• celiacography;
• MR angiography of gastrointestinal tract vessels;
• static and dynamic scintigraphy of the digestive tract;
• CT scan of the abdominal cavity;
• X-ray of the nasopharynx, bronchi and lungs.

Gastric bleeding can be most quickly diagnosed using upper gastrointestinal endoscopy. For pathologies of the lower parts of the tract, irrigoscopy, sigmoidoscopy and colonoscopy are used.

If it is impossible to determine the source of hemorrhage using endoscopy and hardware methods, a diagnostic laparotomy is performed.

How to stop bleeding

Stopping bleeding should be carried out by doctors from a medical institution or an emergency medical team. Even before emergency assistance is provided, it is necessary to call an ambulance, describing the patient’s condition and the nature of the discharge.

The algorithm for providing emergency first aid for suspected bleeding includes the following steps:

• Place the patient on his back with his legs elevated using folded clothing or a pillow;
• do not allow the victim to drink or eat;
• apply a compress of ice wrapped in cloth to the painful area;
• When providing first aid, monitor your breathing pattern and heart rate;
• in case of loss of consciousness, bring the patient to his senses using cotton wool soaked in ammonia;
• when waiting for a long time for an ambulance, carry the patient on a stretcher towards the medical team.

During emergency care for gastric bleeding, it is forbidden to lavage the stomach. If you suspect intestinal pathology, you should not give the patient an enema.

An attempt to stop the bleeding without the help of doctors can lead to the death of the patient.

How to treat

For gastrointestinal bleeding, treatment is aimed at stopping it, eliminating the root cause of the pathology, restoring hemostasis of the body and normal blood volume.

The danger for the patient is not only the loss of red blood cells that carry oxygen, but also a sharp decrease in blood volume, which leads to massive thrombosis of small vessels and the development of disseminated intravascular coagulation syndrome.

Conservative treatment

Conservative treatment of gastric bleeding and intestinal blood loss is carried out as an adjunct to surgery. As the main method of therapy, it is used for the following indications:

• hemorrhagic syndromes;
• cardiovascular diseases;
• inoperable malignant tumors;
• congenital pathologies of the hematopoietic system.

Therapy may include hemostatic agents, cytostatics, anti-inflammatory and other drugs.

If a large volume of blood is lost, the patient is prescribed IVs with saline solutions and transfusions of blood components.

Surgery

If bleeding in the gastrointestinal tract is suspected, the patient is taken to the surgical department of the clinic, where diagnosis and treatment tactics are determined.

Depending on the diagnosis, the patient may undergo the following operations:

• endoscopic sclerosis, electrocoagulation and ligation of dilated vessels of the intestine, esophagus, etc.;
• suturing of the ulcer and partial resection of the stomach;
• suturing duodenal ulcer;
• subtotal resection of the large intestine with stoma.

Diet

Treatment tactics using diet therapy depend on the underlying disease. For pathologies of the stomach, the patient is prescribed table No. 1, No. 1a (immediately after stopping the bleeding), No. 1b or No. 2. For intestinal diseases, diet No. 3 or No. 4 is recommended.

If bleeding is a complication of liver pathology, the patient is prescribed table No. 5 and its variations.

Consequences and complications

Complications of bleeding from the gastrointestinal tract include:

• DIC syndrome;
• moderate to severe anemia;
• acute organ failure;
• coma.

The risk of severe consequences and death increases if you do not consult a doctor in a timely manner.

How to prevent the phenomenon

To prevent the development of this dangerous pathology, it is necessary to undergo regular medical examinations, follow the rules of taking medications and lead a healthy lifestyle.

Contacting a gastroenterologist at the first manifestations of ulcerative and vascular diseases (malaise, nausea, stomach pain, etc.) increases the likelihood of a favorable prognosis for the effectiveness of therapy.

To detect intestinal bleeding in the early stages, it is recommended to regularly take a stool occult blood test.