Gastrointestinal bleeding is an extremely dangerous condition that, if left untreated, can lead to complications such as shock and multiple organ failure. The causes of blood loss can be very different. That is why many people are interested in additional information about this pathology.
What are the symptoms of blood loss? What are the causes of pathology? What does emergency care for stomach bleeding look like? What methods of treatment does modern medicine offer? The answers to these questions will be helpful to many readers.
Bleeding due to stomach disease
In fact, there are many diseases of the digestive system that can lead to bleeding.
- First of all, it is worth talking about peptic ulcer, since in 15-20% of patients this pathology is complicated by bleeding. Against the background of this disease, thrombosis of the vessel is possible (its wall bursts due to a sharp increase inpressure) or its damage under the influence of gastric juice.
- The list of reasons should include the presence of malignant tumors in the stomach. The constant growth of the neoplasm can lead to damage to the vessels. In addition, bleeding may be due to trauma to the tumor itself.
- A risk factor is the presence of a diverticulum - a kind of protrusion of the stomach wall. Inflammation or injury to this structure is often accompanied by vascular damage and blood loss.
- During a diaphragmatic hernia, the cardia or fundus of the stomach can move into the chest cavity. As a result of such a pathology, gastric juice begins to be thrown into the esophagus. Damage to the mucous membrane of this organ is sometimes accompanied by bleeding.
- A stomach polyp can lead to the same result. Despite the fact that this is a benign formation, its injuries or ulceration of the walls under the influence of gastric juice are accompanied by blood loss. In addition, the polyp can twist around its stalk or become pinched, which also leads to damage to small vessels.
- The cause may be hemorrhagic gastritis. This form of the disease is accompanied by inflammation of the gastric mucosa and the formation of erosive areas on it.
- There is also the so-called "stress" ulcer. As you know, nervous tension and strong emotions affect all organ systems. Against the background of stress, the adrenal glands synthesize a huge amount of glucocorticosteroids, which leads to an increase in the production of gastric juice. Under the influence of hydrochloric acid wallsstomach can ulcerate, which is accompanied by damage to blood vessels and the appearance of bleeding.
It is worth noting that each of these diseases has its own unique clinical picture. The presence of nausea, heartburn, pain in the epigastric region - all these are important symptoms that you should definitely report to your doctor.
Vascular diseases
Gastric bleeding is not always directly related to diseases of the digestive organs. Blood loss may be due to vascular damage.
- Risk factors include varicose veins in the upper stomach and esophagus. With such a pathology, the walls of the vessels become very weak, which increases the risk of damage to them and, consequently, the occurrence of bleeding. In turn, varicose veins can be the result of tumors and cirrhosis of the liver, thrombosis or compression of the portal vein, chronic lymphocytic leukemia.
- Systemic vasculitis can also cause hemorrhage. This is an autoimmune disease that is accompanied by damage to the vascular walls as a result of exposure to specific antibodies produced by the immune system. Veins and arteries become weak, which increases the risk of rupture.
- Atherosclerosis is a pathology characterized by the formation of atherosclerotic plaques on the walls of blood vessels. As a result of this process, the lumen of the vessel decreases. Any injury or sudden increase in blood pressure can damage the artery wall.
Coagulation problemsblood
In some cases, gastric bleeding is associated with a violation of blood clotting processes. The list of risk factors is quite long.
- Hemophilia is a hereditary pathology that is accompanied by a violation of blood clotting. Blood clots do not form, so it is very difficult to stop the bleeding.
- Leukemias (acute and chronic forms) are blood cancers in which the process of hematopoiesis in the bone marrow is disturbed, in particular, there are problems with the formation of platelets.
- Hemorrhagic diathesis is also accompanied by increased bleeding and clotting problems.
- Vitamin K plays an important role in the formation of blood clots when blood vessels are damaged. With its deficiency, there are hemorrhages in the internal organs, increased bleeding.
- Hypoprothrombinemia is a pathology accompanied by a deficiency of prothrombin in the blood.
Gastric bleeding: symptoms
The sooner qualified assistance is provided to a person, the lower the likelihood of complications incompatible with life. So what does the clinical picture look like with gastric bleeding? Symptoms vary widely.
- First, there are general signs of blood loss. The person becomes lethargic, complains of dizziness, tinnitus. The patient's pulse is weak, blood pressure gradually decreases. The patient's skin turns pale, cold sweat often appears. There is lethargy, confusion. It is difficult for the patientconcentrate, difficult to answer questions. Possible loss of consciousness.
- Of course, there are other features that characterize gastric bleeding. A sign of pathology, and very characteristic - vomiting with blood. Most often, vomit in consistency resembles coffee grounds, because the blood, entering the stomach, is affected by hydrochloric acid. If scarlet un altered blood is present in the vomit, then this may indicate massive arterial bleeding from the stomach (blood loss is so rapid and massive that the blood does not have time to react with acidic gastric juice).
- Traces of blood are also present in the fecal matter. Feces acquire a black color and a tar-like consistency. If streaks of scarlet un altered blood are visible in the discharge, then this indicates the presence of intestinal, and not gastric bleeding.
If a person has these symptoms, they should be taken to the hospital immediately. First aid for stomach bleeding is very important. Lack of timely therapy may result in the death of the patient.
Complications
Internal gastric bleeding is an extremely dangerous condition that can provoke the development of complications.
- Profuse blood loss often leads to hemorrhagic shock.
- High risk of developing acute anemia. The number of red blood cells in the blood decreases sharply, as a result of which cells and tissues do not receive enough oxygen (namelyred blood cells ensure its transportation).
- Acute renal failure often develops against the background of gastric bleeding.
- There is a risk of multiple organ failure. This is the body's response to stress caused by blood loss, resulting in a malfunction of several organ systems at once.
It is worth noting that late assistance with gastric bleeding, as well as attempts to cope with the problem on their own, can result in the death of the patient.
Diagnostic measures
A patient with bleeding symptoms needs to be taken to the hospital. Diagnosis of gastric bleeding includes a number of procedures.
- As a result of a general blood test, you can notice that the number of red blood cells and platelets is significantly lower than normal - this indicates a possible internal bleeding.
- A coagulogram is performed if there is a suspicion of a violation of normal blood clotting.
- Fibrogastroduodenoscopy is a procedure during which a doctor examines the mucous membrane of the esophagus, stomach and upper intestines using a special probe. This technique sometimes allows you to accurately determine the location of bleeding and assess its extent.
- X-ray of the stomach is done to determine the possible cause of bleeding. For example, in the picture, the doctor can see ulcerative lesions, diaphragmatic hernia, existing tumors, etc.
- Angiography is a procedure thatallows you to evaluate the blood flow in a particular vessel. Using a special catheter, a contrast agent is injected into the vessel, after which a series of x-rays are taken. On them, the colored vessel is perfectly visible, while you can track the blood flow.
- Scanning using isotopes involves the introduction of labeled red blood cells into the patient's body. Red bodies accumulate at the site of bleeding - it can be visualized on the pictures.
- Magnetic resonance imaging allows the doctor to obtain three-dimensional images of organs, assess the degree of damage, detect the site of bleeding, etc. This procedure is mandatory if the patient is indicated for surgery.
First aid for stomach bleeding
Noticing the above symptoms in a person, you need to urgently call a medical team. First aid for gastrointestinal bleeding is extremely important. Its algorithm looks like this.
- The patient needs to be laid down, you can put a small pillow under your feet.
- The patient should not move, it is recommended to remain at rest.
- When bleeding, do not eat or drink, as this stimulates the stomach, causing increased blood loss.
- Put something cold on your belly, like pieces of ice wrapped in a towel. Cold constricts blood vessels, thereby stopping bleeding.
Conservative Therapy
All other activities aimed at stopping the bleeding of the gastrointestin altract, are already carried out in a hospital.
- As a rule, the stomach is washed with ice water first - this helps to narrow the blood vessels. A special probe with a tube is inserted directly into the stomach through the mouth or nasal cavity.
- This is how epinephrine and norepinephrine are delivered to the stomach. These substances are stress hormones that cause vasospasm and make it possible to stop blood loss.
- Intravenously, patients are given drugs that increase blood clotting. As a result of such therapy, blood clots form in damaged areas of blood vessels, which helps to stop or slow down blood loss.
- If gastric bleeding has led to the loss of a large volume of blood, the patient is shown a transfusion (donor blood, frozen plasma, blood substitutes can be used).
Endoscopic treatments
If bleeding is small, it can be controlled with endoscopic procedures. These include the already described chipping of damaged areas with adrenaline and norepinephrine. In addition, other techniques may be used.
- Electrocoagulation is a procedure in which a special endoscope is inserted into the stomach and the damaged walls of the organ and blood vessels are cauterized using electric current.
- Laser coagulation - tissues are cauterized using a laser beam.
- Sometimes, applications of special medical glue are applied to the walls of the stomach.
- It is also possible to apply endoscopic metal clips and suture damaged vessels with threads.
When is surgery needed?
Unfortunately, in some cases, gastric bleeding can only be stopped during a full surgical intervention. Operation is shown in the following cases:
- there is massive bleeding and a rapid drop in blood pressure;
- attempts to stop blood loss with medication have failed;
- patient has systemic disorders (e.g. ischemic heart disease, cerebral circulation problems);
- after successful medical or endoscopic treatment, bleeding started again.
Stomach surgery can be performed both through an incision in the abdominal wall, and through laparoscopic equipment (only small punctures are made in the abdominal region). There are many procedures designed to eliminate bleeding:
- stitching the damaged area of the organ;
- removal of the stomach or some part of it (it all depends on the cause of bleeding);
- endovascular procedures in which a tube is inserted through the femoral artery to reach the bleeding vessel and close off its lumen.
The appropriate technique can only be determined by the attending physician, since everything here depends on the general condition of the patient, the degree of blood loss, the cause of bleeding, the presence of concomitant pathologies, etc.
