The stomach is a reservoir for temporary storage of food coming from the esophagus. It synthesizes all the necessary enzymes and biologically active substances, directs the food bolus further along the gastrointestinal tract. This article will discuss emergency care for stomach bleeding.
Features of the blood supply
Arterial vessels go around this hollow organ along the greater and lesser curvature. In the area of the transition of the esophagus to the stomach, there is a venous plexus, which can lead to the development of massive bleeding in case of vein disease, as well as with an excessive increase in load.
Classification of bleeding
Gastric bleeding (ICD-10 code K92.2) is a very dangerous condition that, if not treated promptly, can lead to death.
By etiology:
- Ulcerative (for peptic ulcer of the stomach and duodenum).
- Non-ulcerative, caused by otherreasons.
By duration of bleeding:
- Acute - a rapid, fairly pronounced outpouring of blood over a short period of time.
- Chronic - long lasting, less intense.
Depending on the severity of the symptoms, stomach bleeding can be:
- Explicit. With their presence, of course, we can talk about hemorrhage, making a diagnosis is not difficult.
- Hidden. There are no pronounced symptoms, other diagnostic tests are required to determine the cause of the pallor of the skin.
Emergency treatment for stomach bleeding will be described below.
Reasons
Causes affecting stomach changes are listed below:
- Peptic ulcer. This pathology in more than 20% of cases tends to complication in the form of bleeding, occurs with the aggressive action of gastric juice.
- Thrombosis of vessels, therefore, an increase in pressure, which leads to thinning of the wall and outpouring of the contents into the cavity of the organ.
- Malignant neoplasms. Cancer in this case occurs either primarily (that is, there are no pathological processes predisposing to its development) or is a complication, for example, of the same peptic ulcer. First aid for gastric bleeding should be provided in a timely manner.
- Diverticulum - the presence of a protrusion of the wall or all its layers. This will be a true diverticulum. Or without involving any layer - false. Diagnosis is not difficult: when examining the X-ray picture, a symptom of a "finger" is visible.
- Diaphragmatic hernia, in which the stomach passes through the existing physiological opening in the diaphragm, which communicates the thoracic and abdominal cavity. This is observed in the following pathologies: ulceration of the mucous membrane under the influence of aggressive gastric juice and in combination with ulcerative lesions.
- Polyps are a type of benign tumor. The cause of bleeding, if present, is injury to the active components of gastric juice and disruption of the "nutrition" of the polyp, for example, if the leg is pinched or twisted. Treatment for stomach bleeding will largely depend on the cause.
- Mallory-Weiss syndrome. Occurs when a crack is formed in the transition area of the esophageal mucosa into the gastric mucosa. This can be triggered by the intake of alcoholic beverages in combination with a large amount of food, or if the patient already has a diaphragmatic hernia.
- Hemorrhagic gastritis. With this type of gastritis, ulcerative changes occur on the surface of the upper wall, initially presented in the form of erosion, with the possibility of transition to huge (more than 3 centimeters) ulcers.
- Stress ulcers. They arise from some kind of severe stress, during which the protective reaction of our body becomes "decompensated", inresulting in a sharp release of adrenal hormones. This leads to an increase in the acidity of the juice and, accordingly, the formation of surface defects such as erosions or ulcers. What other causes of stomach bleeding are there?
Vascular disease can lead to bleeding. Varicose veins of the venous plexus of the lower esophagus and the upper part of the stomach are observed when:
- cirrhosis of the liver;
- neoplasms;
- thrombosis of the portal vein, compression of various etiologies;
- chronic lymphocytic leukemia.
Dangerous systemic vasculitis, such as periarteritis nodosa and Henoch-Schonlein purpura. These are autoimmune diseases that occur with damage to the walls of blood vessels.
Atherosclerosis and hypertension can also cause bleeding in the stomach. With this category of pathology, there is a risk in the form of overstrain of the vascular wall and subsequent rupture, accompanied by gastric bleeding.
A bleeding disorder causes a dangerous condition in the stomach:
- Hemophilia - reduced blood clotting. This is a hereditary disease.
- Acute and chronic leukemias, in particular, in violation of the formation of platelets.
- Hemorrhagic diathesis. Combine disorders of both blood coagulation and increased bleeding.
- Lack of vitamin K. Leads to hemorrhages in various groups of organs, including vitalimportant, such as the brain.
Signs of stomach bleeding
General symptoms:
- Feeling weak, lethargic.
- Paleness of the skin and visible mucous membranes.
- Cold sweat.
- Lower blood pressure.
- Frequent weak pulse fluctuations.
- Dizziness and stuffy ears.
- Manifestations of lethargy, confusion up to its loss.
Accordingly, the more massive the blood loss, the faster and brighter the clinical picture appears. If in this situation first aid was not performed for gastric bleeding, then the risk of death is very high.
The distinguishing feature is the nature of the vomit, which resemble "coffee grounds" in color.
Staining in this color is provided by the action of hydrochloric acid. If the blood in the vomit has an unchanged color, then it can be assumed that this is bleeding from the higher sections (for example, the esophagus) or massive bleeding, in which the blood simply does not have time to interact with the acid.
A specific sign is also the presence of black tarry stools - melena.
Degrees of severity
- Mild - minor blood loss. The patient's condition is satisfactory, the pulse is not higher than 80 beats per minute, and the systolic blood pressure does not fall below 110 mm. rt. Art. The patient is conscious.
- Medium degree - increased heart rate up to 90 -100 beats per minute, decrease in blood pressure to100-110 mm. rt. Art. The skin and mucous membranes are pale, covered with sticky cold sweat, the patient experiences severe dizziness.
- Severe degree - severe lethargy, and in some cases unconsciousness with no response to strong stimuli. The pulse is more often than 110 beats, arterial pressure, respectively, is much less than 110 mm. rt. st.
Emergency stomach bleeding
What is the emergency treatment for stomach bleeding? All necessary actions are listed below:
- Providing bed rest to help reduce the rate of bleeding.
- Setting up a cold compress (the algorithm will be discussed below).
- Gastric lavage with ice water, the essence is to spasm the bleeding vessels and then stop or slow down the blood flow.
- Prescribing epinephrine or norepinephrine drugs through a gastric tube. This group of hormones belongs to stress factors that cause compensatory vasoconstriction.
- Replenishment of reserves of the total circulating blood volume (CBV) by administering hemostatic solutions by intravenous drip.
- Using donated blood, blood substitutes and frozen plasma as a replacement for lost blood.
Other therapy if indicated.
Cold compress
A trusting relationship must be established with the patient. He needs to understand the purpose and the coursesetting a cold compress. The algorithm of actions performed with his consent is as follows:
- Hands should be washed and dried.
- Prepare all the necessary items (gauze pads, a basin of water, ice).
- One of the wipes is soaked in cold water, lightly wrung out.
- Applied to the desired area of the body.
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The compress is changed every two minutes, at which time a second napkin is applied.
gastric bleeding
Endoscopic treatment method
This treatment method is carried out:
- By chipping the ulcer with solutions of adrenaline and norepinephrine to achieve vasospasm.
- Moxibustion - electrocoagulation of the mucosa.
- Laser coagulation.
- Installation of clips and stitching of the vascular apparatus.
Using a special medical adhesive.
Indications for surgical treatment
Acute gastric bleeding is an indication for surgery when:
- lack of positive results from previous conservative and endoscopic interventions;
- unstable condition of the patient or severe, which may soon become complicated (for example, coronary disease or stroke);
- rebleeding.
Types of interventions
The following types of surgeries are performed:
- Suturing the defect.
- Resection of part of the stomach.
- Implementation of plastics in the area of the borders of the esophagus and stomach.
- Endovascular interventions.
Rehabilitation activities after surgery
It is important to follow all the doctor's recommendations, then recovery will come faster.
- 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 on your feet.
- Day Eight - postoperative sutures are removed.
- Day fourteenth - discharge from the department with recommendations to limit physical activity for a month and the need to perform a set of physical therapy exercises.
Diet after surgery
The following dietary rules apply:
- Day one - you can not drink and eat, only drain the surface of the lips.
- Day two - it is allowed to drink half a glass of water with a teaspoon.
- Third day - it is possible to increase the amount of liquid consumed (water, broth, juice) up to half a liter.
- Day four - up to four glasses of liquid are allowed, taking into account the division of this amount into 8-12 doses. You can eat slimy soups.
Starting from the fifth day, cottage cheese, semolina porridge are added to the diet, and from the seventh - boiled meat. The transition to normal meals in small portions is allowed from the ninth day.
So, we have considered emergency care for gastric bleeding.
