Today, the problem of treating gastroduodenal bleeding in surgery is one of the most important, as it is a severe complication of peptic ulcer and is diagnosed in 20% of patients with this disease. In modern medicine, the tactics of treating patients with this pathology have not been sufficiently developed. In addition, the methods of endoscopic hemostasis used are unsafe, insufficiently effective and reliable, as a result of which there is a high risk of human death before and after surgery. In men, this pathology occurs three times more often than in women.
Problem description
Gastroduodenal bleeding – is a dangerous disease in which blood from an area affected by a pathological process (stomach or duodenum) or a damaged vessel enters the lumen of the gastrointestinal tract. Such a dangerous phenomenon can be observed with the development of ulcerativediseases, Crohn's syndrome, acute intestinal infections, pathologies of the pancreas and gallbladder, as well as blood diseases. In this case, bleeding can form in different parts of the tract, starting from the upper esophagus and ending with the rectum. But most often (60% of cases), the source of bleeding is the stomach and duodenum.
Ulcerative gastroduodenal bleeding is always a dangerous symptom and condition that provokes a threat to the life of the patient, the occurrence of death. Therefore, it is recommended to carefully study the causes of development and the clinical picture of the disease, so that when the first signs appear, immediately contact a medical institution.
Causes of disease development
In 70% of cases, acute gastroduodenal bleeding develops as a result of duodenal ulcer and stomach ulcer, erosive gastritis. With the same frequency, pathology is formed due to a cancerous tumor or varicose veins in the stomach as a result of hypertension syndrome. Rarely, the disease is observed in pathologies of the circulatory system, injuries, Rendu-Osler syndrome and others.
In medicine, there are more than eighty reasons for the development of this disease. They are conditionally divided into three large groups:
- Diseases of the stomach and duodenum. The main symptom of peptic ulcer disease is occult bleeding, and extensive ulcerative gastroduodenal bleeding is a complication of this disease. The occurrence of such a pathology is often provoked by strong physical exertion during the period of exacerbation of the underlying disease, stress, smoking and alcohol consumption, treatment of the disease with drugs that contain acetylsalicylic acid. Bleeding can develop as a result of a peptic ulcer of various origins, a decaying malignant tumor, erosive gastritis, duodenitis, as well as abdominal trauma, severe vomiting, gastric varicose veins, heart failure.
- Diseases of the cardiovascular system. In some cases, acute gastroduodenal bleeding occurs due to myocardial infarction, Rendu-Osler disease, periarteritis, septic endocarditis, vasculitis, and scurvy.
- Blood diseases. Pathology can occur as a result of thrombosis, an overdose of anticoagulants, aplastic anemia, congenital pathologies of the circulatory system.
The risk group includes:
- Older people.
- Persons who use NSAIDs, anticoagulants and glucocorticosteroids for a long period of time.
- Nicotine and alcohol abusers.
Symptoms and signs of illness
In some cases, the pathology is hidden. With bleeding of the affected mucous membranes, very little blood is observed, usually it can be detected only when examining feces. In such cases, the symptoms of the underlying disease, such as ulcers or gastritis, predominate. But it also happens that the pathology does not show signs, so the detection of blood in the feces during the analysis is the maina symptom of diseases of the digestive tract.
The greatest danger is chronic gastroduodenal bleeding, which lasts for a long period of time, provoking the development of anemia. The danger of such phenomena is that they can mimic the symptoms of many other diseases that are not related to the gastrointestinal tract.
The most typical manifestations of pathology are blood discharge with vomiting or feces (black feces) and acute vascular insufficiency. In this case, the patient has weakness, fainting, pallor of the skin, impaired vision and hearing, a drop in blood pressure, tachycardia, shortness of breath, and rapid heartbeat. Symptoms are aggravated when a person takes a vertical position of the body. In some cases, the pathology develops so quickly that death can occur from shock before symptoms appear.
Symptoms of venous bleeding
As a result of varicose veins, bleeding may develop. In this case, the color of the blood during vomiting will be changed due to the interaction of hemoglobin with hydrochloric acid. With this interaction, brown hematin hydrochloride is formed, so the vomit will resemble coffee grounds. In the absence of hydrochloric acid in the gastric juice, the vomit will contain an admixture of unchanged red blood.
Bleeding from the duodenum
Gastroduodenal bleeding from the duodenum or other parts of the intestine shows symptoms in the form of blacktarry feces (melena). This phenomenon is observed as a result of the formation of iron sulfide from hemoglobin under the influence of digestive enzymes that act on the blood as it moves through the intestines. Melena can also be observed due to the fact that not all the blood came out along with the vomit, but some of it entered the intestines. Sometimes heavy bleeding that occurs in the upper intestines moves rapidly through it, so a person may have stools of blood in its unchanged form.
Severity of pathology
In medicine, there are several degrees of severity of pathology depending on the amount of blood loss:
- Mild degree, in which there is a slight loss of blood (about half a liter). The patient's condition is satisfactory, moderate tachycardia is observed, blood pressure is within the normal range.
- Moderate severity is characterized by moderate blood loss, in which a person loses from seven hundred to one liter of blood. The patient has lethargy, dizziness, nausea, low blood pressure, pale skin, tachycardia, fainting.
- Severe degree is caused by abundant blood loss - about one and a half liters. In this case, the skin becomes pale, there is cold sweat, thirst, a person constantly yawns, the pulse increases, and blood pressure drops.
- Extremely severe blood loss, in which a person loses about two liters of blood. The patient's condition is very serious, there is a prolonged loss of consciousness, pulse and blood pressurecannot be determined.
Diagnostic measures
In surgery, ways to optimize the diagnosis and treatment of gastroduodenal bleeding are constantly being developed. Of great importance here is the determination of the clinical stages of the disease and the degree of bleeding activity. An integrated approach to the problem makes it possible to choose more effective methods of treating patients.
When the victim is hospitalized, diagnostic measures begin with an assessment of the severity of blood loss, then esophagogastroscopy is performed. But its implementation often aggravates the patient's situation, as it provokes the formation of new gaps, the urge to vomit, or an increase in an existing gap. Therefore, the procedure is performed after the administration of drugs against vomiting and intravenous administration of a small dose of anesthesia to relax the person.
Always the diagnosis of gastroduodenal bleeding should pursue several goals:
- Establishing the exact localization of bleeding. If bleeding from the digestive tract is confirmed, the patient is transferred to the surgical department and further diagnostics are carried out.
- Determination of the duration of this pathology.
- Identification of the cause of the disease and the degree of its manifestation.
- Differentiation of pathology from myocardial infarction, pulmonary hemorrhage and other diseases with similar symptoms.
Then, the tactics for gastroduodenal bleeding comes down to what the doctor prescribesthe following studies:
- Laboratory blood and urine tests.
- FGDS, which makes it possible to determine the source and nature of bleeding.
- Radionuclide research.
- Colonoscopy.
- ECG.
- Probe test, which involves a long gastric lavage with clean water. If it is not possible to reach clean water, this indicates incessant bleeding.
Properly designed and carried out optimization of the diagnosis and treatment of gastroduodenal bleeding makes it possible to reduce the risk of relapses and save a person's life. If a pathology is detected, it is immediately eliminated. If signs of pathology appear, you cannot self-medicate, you must urgently go to a medical facility to undergo an examination and stop bleeding.
Therapy of disease
Treatment of gastroduodenal bleeding will depend on the condition of the patient, the endoscopic picture, the degree of blood loss, its duration, the location of the source of the pathology, and the age of the person. It is necessary to hospitalize the patient in the surgical department on a stretcher.
Therapy tactics necessarily include endoscopic hemostasis in gastroduodenal bleeding to stop blood loss and prevent relapse. Then intensive treatment is carried out, which is aimed at stabilizing the person's condition, correcting hemodynamic parameters and surgical intervention. Biggest Riskrecurrence (94%) occurs in the first four days after bleeding stops. At this time, the doctor must exercise control over the patient, prevent the development of bleeding.
Usually recurrence of pathology occurs in 30% of cases. Therefore, it is reasonable to perform a second endoscopy a day after the primary procedure. This approach makes it possible to reduce the risk of death by several times.
Preoperative treatment
Before surgery, the following activities are carried out:
- A patient is urgently admitted to the surgery department on a stretcher.
- Carry out complex hemostatic therapy. At the same time, the patient must comply with bed rest, he is given a gastric lavage, a Blackmoore probe is inserted, through which adrenaline or norepinephrine will enter the stomach.
- Therapeutic endoscopy is performed by chipping the ulcer with an adrenaline solution, as well as electrocoagulation, laser coagulation, flashing the vessel with a metal clip.
- An artificial embolus is inserted through the femoral artery to embolize the vessel that bleeds.
Surgical treatment of gastroduodenal bleeding
Indications for emergency surgery are:
- Bleeding that won't stop.
- Severe blood loss.
- High risk of pathology recurrence.
Elective surgery is usually performed on the second day after the bleeding stops. Preparation for surgery should include a set of conservative therapeutic measures. Mainthe objectives of surgical treatment are: achieving hemostasis, eliminating the cause of bleeding, resection of the stomach or duodenal vagotomy.
In severe cases of gastroduodenal bleeding, surgery involves excision of the bleeding area on the front wall of the organ, and stitching it on the back wall. With vagotomy, pyloroplasty is additionally performed. In case of bleeding from the veins of the stomach or esophagus, they are stitched from the side of the epithelium using special forceps. For malignant tumors or metastases, palliative resection is used.
When gastroduodenal bleeding is prescribed by a doctor, it is necessary to adhere to a special diet, to prevent stress ulcers. Your doctor may prescribe antacids, protein pump inhibitors, and other drugs to prevent future bleeding.
Post-operative period
After the operation, treatment is carried out depending on the degree of blood loss, the volume of surgical intervention and the presence of concomitant pathologies. Patients must remain on bed rest for five days. During this period, they are given a blood plasma transfusion, protein and albumin, glucose, vitamin C and other drugs are administered. Antiulcer treatment is also carried out under the supervision of a gastroenterologist with the help of drugs such as Amoxicillin and Metronidazole. The doctor prescribes and antibacterial drugs to prevent the development of infectious processes. With gastroduodenalbleeding, clinical guidelines are directed towards adherence to the Meilengracht diet.
Rehab
During the rehabilitation period, patients should follow a sparing diet and moderate exercise for eight months after surgery. For those who have been operated on for gastroduodenal bleeding, the recommendations are to undergo follow-up examinations every six months. It is necessary to carry out treatment aimed at preventing the development of relapses. With a complication of peptic ulcer, the issue of a planned surgical intervention is decided.
Forecast
Among the factors that influence the risk of bleeding are the age of patients, the presence of concomitant pathologies, the severity of blood loss, the size of the ulcer and its location. Many doctors say that the risk of bleeding is high in people who are over sixty years old. An unfavorable prognosis will be if a collapse occurs in a person before admission to a medical institution, as well as the development of anemia.
Prevention
In order to prevent the development of bleeding, it is recommended to carry out timely treatment of peptic ulcer and other pathologies that can provoke them. Such patients should be under the supervision of a gastroenterologist. Usually, an exacerbation of diseases is observed in autumn and spring, so at this time it is recommended to undergo scheduled examinations and take the necessary tests. Over time, such procedures can be carried out once a day.year.
In the absence of recurrence of pathology for two years of continuous treatment, therapy is prescribed once every two years for one month. This approach reduces the risk of bleeding to a minimum.
It is also necessary to constantly monitor the condition of the gastrointestinal tract, apply therapeutic diets No. 1 and No. 5. This will make it possible to gradually reduce the degree of thermal, mechanical and chemical sparing of the epithelium of the stomach and intestines.
Gastroduodenal bleeding is a dangerous condition that provokes the occurrence of death. Modern medicine today owns insufficiently developed methods of treating patients with such a disease. All these methods are not effective enough, so the risk of a fatal outcome always exists. To prevent the development of pathology, it is necessary to follow all the prescriptions and recommendations of doctors, lead a he althy lifestyle and eliminate bad habits. An integrated approach to this problem will help solve the difficult tasks set for surgeons during the treatment of such a dangerous pathology.
