Gastrointestinal bleeding. Emergency care for ventricular -intestinal bleeding
The causes of gastrointestinal bleeding are many and varied.
Classification of acute gastrointestinal bleeding :
Non-ulcer bleeding: tumor nature, erosive hemorrhagic gastritis, from the veins of the esophagus, mechanical damage to the mucosa, with systemic blood diseases, others.
History of the disease : age, what drugs and foods were taken (aspirin, NSAIDs, iron supplements, activated charcoal, spinach).
General status : skin (pallor, low body temperature, reduced skin turgor); cardiovascular system (pulse rate, blood pressure), respiratory rate, signs of dehydration, symptoms of concomitant diseases (spider veins, ascites).
Most common causes of gastrointestinal bleeding
|Diseases of the gastrointestinal tract||Peptic ulcer of the stomach and duodenum; erosive gastritis; varicose veins of the esophagus and stomach; cancer of the stomach, esophagus, intestines; polyposis; diverticulosis of the stomach, intestines; nonspecific ulcerative colitis; Crohn’s disease, hemorrhoids|
|Infectious diseases||Dysentery (bacterial, amoebic), typhoid fever, hemorrhagic fever, etc.|
|Diseases of the blood system and hemostasis||Leukemia, hemorrhagic diathesis; mesenteric thrombosis|
|Other diseases||Bacterial endocarditis, periarteritis nodosa, pancreatic necrosis, uremia, cholemia, etc.|
Vomit and stool : quantity, color (of coffee grounds for the upper gastrointestinal tract), composition. Stool – color (black – melena, chestnut shade – hematochez , bright red blood).
An important sign of gastric bleeding (along with the general symptoms of acute anemia is hematemesis. Hematemesis usually does not occur immediately after the onset of bleeding, but only when the stomach overflows with blood. food; excreted blood is usually dark in color (sometimes dark brown), with clots.
However, with heavy bleeding , the blood may also be scarlet, as it does not have time to be exposed to the action of gastric juice.
In addition to vomiting, gastric bleeding appears (usually on the 2nd day) black stools, liquid, mushy; sticky stools with a fetid odor.
It is difficult to diagnose bleeding from the duodenum, as in these cases, hematemesis is usually absent.
Additional examination methods for ventricular -intestinal bleeding.
Digital rectal examination – tumor of the rectum, hemorrhoids complicated by bleeding, anal fissure. In the case of hematochezia , a proctosigmoid or colonoscopy is
performed . X-ray methods of research in ventricular -intestinal bleeding : studies using barium in the presence or suspicion of perforation of a hollow organ are CONTRAINDICATED!
EGD is the most sensitive and specific study to determine the source of bleeding from the upper gastrointestinal tract; it identifies an obvious or potential source of bleeding in more than 80% of cases.
The severity of bleeding is determined by the following criteria.
Criteria for severity of bleeding
Immediate measures for bleeding from the digestive tract
General hemostatic conservative therapy .
– The patient is assigned a strict bed rest, it is forbidden to take water and food, it is recommended to put an ice pack on the stomach: you should know that the ice pack does not give a vasoconstrictor effect, but it has a disciplining effect on the patient.
Means with hemostatic and angioprotective properties :
– Dicinon is administered intravenously in 2-4 ml of 12.5% solution , then every 4-6 hours, 2 ml. Can be administered intravenously by drip , adding to conventional infusion solutions.
– 5% solution of epsilon-aminocaproic acid, 100 ml every 4 hours; 5-10% solution of ascorbic acid, 1-2 ml IV – 10% calcium chloride solution up to 50-60 ml / day IV – 1% or 0.3% solution vikasol, respectively, 1-2 and 3-5 ml.
– Intravenous administration of histamine H2-blockers ( ranitidine ) 50 mg 3-4 times a day, famotidine ( quamatel ) 20 mg 2 times a day, proton pump inhibitors ( omeprozole 40 mg 1-2 times a day).
Other measures for the management and treatment of this group of patients are the responsibility of surgeons.