Update: February 2019 Gastrointestinal bleeding is
the flow of blood into the cavity of the stomach and intestines followed by
discharge only with feces or feces and with vomiting. It is not
independent disease, and the complication of the set – more than a hundred –
Gastrointestinal bleeding is a dangerous symptom
telling you to urgently find the cause of the bleeding and
eliminate it. Even if a very small amount is allocated
blood (and there are even situations where blood is not visible without special
research), it may be as a result of quite small, but
a rapidly growing and extremely malignant tumor.
Note! JCC and internal bleeding is not the same
same In both cases, the stomach may serve as a source of bleeding.
or different parts of the intestines, but when the gallstones are, blood is released in
the cavity of the intestinal tube, and with internal bleeding into the abdominal
cavity. JCC can in some cases be treated conservatively, then
like internal bleeding (after injury, blunt trauma and so
further) it is treated only operatively.
What happens when more than 300 ml of blood is lost
Massive gastrointestinal bleeding is caused in
The following changes in the body:
- decreases blood volume, while the diameter of the vessels remains
- blood does not press blood vessels on walls as before, therefore
arteries can no longer keep blood moving so well –
blood circulation rate decreases;
- a decrease in blood flow in the center of the body means too
slow movement of blood in the capillaries and smaller
vessels (microvasculature), the task of which is to ensure
tissues with oxygen and necessary substances, the collection of them spent
- slowing blood flow in the microvasculature
leads to the development of stagnation here (here and so the vessels are small and
blood velocity is always low);
- at stagnation in the microvasculature, gluing occurs in
these red blood cells. If you start treatment at this stage, then besides
blood transfusions and blood substitutes, you need to enter salt
solutions and blood-thinning drugs (heparin). Otherwise clots
formed in the capillaries, will go massively in a common direction and
can, having gathered, clog any larger artery;
- the exchange between clogged glued cells blood capillaries
and the tissues become very difficult and may cease altogether.
This situation is observed in almost all tissues. The first to suffer
microcirculation in the skin, subcutaneous tissue, then gradually
�”Disabled” and internal organs. Heart and brain long
work in “economy mode”, but if blood is lost quickly, or
the total amount of blood loss exceeds 2.5 liters, it is “switched off” and
- impaired microcirculation in the liver leads to the fact that it
ceases to neutralize toxins from the blood, poorly produces
blood coagulation factors. As a result, the blood becomes liquid and
does not fold. This is a very dangerous condition. At this stage
it is not enough one blood transfusion – it is necessary to enter factors already
blood coagulation. They are contained in the blood plasma (it is ordered for
transfusion stations) and in separate preparations.
Causes of the gastrointestinal condition
The causes of acute gastrointestinal bleeding,
so much that they are divided at once according to two classifications. One of
classifications indicates the type of causes, the second – depending on the reasons
from localization in the gastrointestinal “tube”.
So, depending on the nature of the reasons, the HCL may be caused by:
- Inflammatory, erosive and ulcerative formations of the gastrointestinal tract, in
as a result of which the vessels feeding one or another are “eaten away”
structure. Not all of these pathologies are due to a violation of the diet or
Helicobacter pylori infection. Erosive and ulcerative lesions
occur in any serious illness (this is called stress-ulcers).
They are caused by burns with strong alcoholic drinks, acids and
alkalis, drunk by mistake or intentionally. Also often eroded and
ulcers occur as a result of taking painkillers and
- Gastrointestinal tumors of any degree of malignancy.
- Injuries and injuries of the digestive tract.
- Болезнями blood coagulation.
- Increased pressure in the vessels of the digestive tract. It mostly happens
only with portal hypertension syndrome caused by cirrhosis,
blood clots in the portal vein or squeezing it from the outside.
Depending on the location, bleed from the upper
departments (until the end of the 12-duodenum) and bleeding from the lower
departments (starting with the small intestine) gastrointestinal tract. Upper divisions suffer
more often: they account for about 90% of housing and communal services, on the lower ones, respectively
accounts for just over 10% of cases.
If we consider the frequency of lesions of individual organs,
bleeding from the stomach – this is every second of the LCD, bleeding from
Duodenal ulcer is found in every third case. Thick and
the rectum is every 10 bleeding, the esophagus is every
twentieth. The small intestine in adults rarely bleeds – in 1%
Causes of HCL from upper gastrointestinal tract –
- erosive esophagitis, whose main cause is oral intake
acids or alkalis;
- erosive and hemorrhagic gastritis, including those that have arisen
while taking painkillers;
- peptic ulcer of gastric or 12 duodenal localization;
- increased pressure in the veins of the esophagus (portal syndrome
hypertension). It develops with liver cirrhosis, thrombosis in
hepatic or other veins communicating with the portal vein,
compression of the portal vein at heart level – with constrictive
pericarditis or at any other level – for tumors and scars
- penetrating wounds of the chest or upper parts
- Mallory-Weiss syndrome;
- stomach polyps;
- injury to the esophagus or stomach by foreign bodies or stiff
(metal) medical equipment during
- bleeding from diverticula (“pockets”) and esophageal tumors,
stomach or duodenum;
- грыжа пищеводного отверстия diaphragm;
- aortic intestinal fistula;
- injuries of the biliary tract (mainly during operations and
manipulations) in which blood along with bile enters the
Causes of gastrointestinal bleeding from the lower divisions –
- тупые травмы belly;
- ранения belly;
- thrombosis of mesenteric vessels;
- worms infection;
- an increase in pressure in the veins of the rectum that is caused
portal hypertension with the same causes as in the case of
- неспецифический язвенный colitis;
- Crohn’s disease;
- anal fissures;
- инфекционные colitisы;
- intestinal tuberculosis.
Causes of gastrointestinal bleeding that may cause
bleeding from any part of the gastrointestinal tract is
vascular lesion in:
- systemic lupus erythematosus;
- avitaminosis C;
- nodular periarteritis;
- Randu-Osler disease;
- congenital malformations, telangiectasias and other malformations
- coagulation disorders (for example, hemophilia);
- decreased platelet count or impaired structure
In addition to acute bleeding, there are chronic nature ZhKK.
This means that in a certain location there are damaged
vessels of small caliber, from where they periodically “leak”
small, non-life threatening blood volumes. Main reasons
chronic bleeding is gastric and duodenal ulcers,
polyps and tumors.
How to recognize gastrointestinal bleeding
The first signs of bleeding are weakness, which increases with
different speed (depending on the speed of blood loss), dizziness,
sweating, feeling of palpitations. With severe
blood loss a person becomes inadequate, and then gradually
falls asleep, turning pale. If blood is lost quickly, the person experiences
strong feeling, fear, pales, loses consciousness.
These symptoms are characteristic of any acute bleeding with
loss of more than 300 ml of blood, as well as for any conditions that
may end in shock (intoxication, antibiotics in the background
significant bacterial infection, taking the product or
It is about the housing and communal complex that you should think about the symptoms:
- cirrhosis or hepatic vein thrombosis. It is yellow color dry
skin, slimming arms and legs with an increase in the abdomen, in which
accumulates fluid, redness of the palms and feet,
- coagulation diseases. It is bleeding when brushing your teeth,
bleeding from the injection site and so on;
- gastritis, duodenitis and peptic ulcer. This pain in the upper
sections of the abdomen immediately after eating (characteristic of the defeat of the stomach)
or 2–4 hours after it (typical of 12-prong lesions
guts), nausea, belching;
- infectious bowel disease. This is a rise in temperature
nausea, vomiting, chills, weakness. In this case, a person can remember
that he was eating something “dangerous”: raw water, meat on the bus station,
three-day salad with mayonnaise, cake or cream cake. Need to
сказать, что инфекционные гастроэнтероcolitisы не вызовут обильного
JCC, perhaps, it will be dysentery, at which (but not in the
early disease) ulcers are formed in the lower intestine.
Most manifestations have no manifestations, diverticula
or gastrointestinal polyps. Therefore, if gastrointestinal bleeding
developed acutely against the background of complete health (or you can recall
only alternating constipation and diarrhea, unexplained weight loss),
you need to think about it.
Why do we not immediately describe the appearance of blood, after all:
necessarily accompanied by her? Yes, indeed, blood has
laxative effect, it will not remain in the lumen of the gastrointestinal tract and
sucked back. She will not stagnate, except that the utilities infrastructure has coincided
with acute intestinal obstruction (for example, intestinal overlap
tumor), which can rarely coincide
But in order for the blood to “appear” outside, it must pass
time until it overcomes the distance from the damaged vessel to
rectum or to the mouth. Immediately describe the appearance of blood can
only when bleeding from the sigmoid or rectum. Then
the first symptoms are not weakness and dizziness, and defecation,
when red blood was detected in the feces (most often it is
hemorrhoids or anal fissure, so defecation will be
Further symptoms of gastrointestinal bleeding vary.
depending on which vessels of the department turned out to be
So, if the source of bleeding is in the upper sections
stomach, and the volume of blood lost exceeds 500 ml, then there will be vomiting with
- scarlet blood – if the source is an artery in the esophagus;
- similar to the coffee grounds (brown) – when the source is in
the stomach or duodenum, and the blood was able to mix with
gastric juice and oxidize;
- dark (venous) blood – if the source is dilated vein
In addition, for any volume of blood loss from the upper part of the feces
тоже будет окрашен in blood: он приобретет более темный цвет. Than
more blood will be lost, the stool will be more black and more
liquid. Than больше объем кровотечения, тем раньше появится этот
ZhKK from upper parts of a gastrointestinal tract should be distinguished from conditions,
when blood has come from the respiratory tract. Need to remember: blood from
the respiratory tract will be excreted with a cough, it contains very
a lot of foam. The chair at the same time practically does not darken.
There are also conditions, the source of bleeding was in the mouth,
in the nose or upper respiratory tract, blood was swallowed,
after which vomiting was observed. Then the victim needs to remember
whether the fact of injury to the nose, lips or teeth was swallowed
foreign body, was there a frequent cough.
For bleeding from the small and large intestine vomiting blood
not typical. They are characterized only by darkening and thinning.
the chair. If bleeding:
- from the rectum or anal sphincter – on the surface of the feces
scarlet blood will appear;
- from the caecum or ascending colon – feces can be as
dark and look like brown feces mixed with
dark red blood;
- from the descending colon, sigmoid or rectum – feces
normal color, it shows streaks or blood clots.
Severity of housing
To know how to assist with gastrointestinal
bleeding in a particular case, a classification has been developed, in
which takes into account several indicators, their changes are divided
by 4 degrees. To determine the need to know the pulse, arterial
pressure, and using blood tests to determine hemoglobin and
hematocrit (percentage ratio of the liquid part of the blood and its cells),
according to which circulating blood deficiency is calculated
- The number of heartbeats – within 100 per minute, arterial
pressure is normal, hemoglobin is more than 100 g / l, DCC is 5% of normal.
The man is conscious, frightened, but adequate;
- The number of heartbeats 100-120 per minute, “upper” pressure 90
mm Hg, hemoglobin 100-80 g / l, DCC 15%. Man is conscious but
lethargic, pale, dizziness. Pale skin.
- Pulse usually 120 per minute, poorly detectable. �”Top”
pressure 60 mm Hg Consciousness confused, the patient asks all the time
drink. The skin is pale, covered with cold sweat.
- The pulse is not detectable, the pressure is not determined or once
palpable within 20-30 mm Hg. DCC 30% or more.
Bleeding in children
Bleeding in children – это очень серьезная причина для обращения
in a medical institution. �”Itself” it will not work, even if the child
pulled out with blood, and after that behaves usually, plays and asks
there is. Before addressing, remember if he could eat chocolate
hematogen or red coloring products (beets, cakes with
red dye). Also eliminate injuries in the mouth and nose.
(they can be seen with the naked eye).
There are a lot of reasons for childrens lungous diseases in children. In search of a diagnosis doctors in
first of all pay attention to the age of the child: there is
diseases most characteristic of a particular age
|2-5 days of life||Hemorrhagic disease of the newborn – vitamin K deficiency.
It is characterized by abundant dark stool 3-4 p / day
|Up to 28 days of life||Stomach ulcers (more often), duodenal ulcer (less),
|From 14 days to 1 year of life||Duodenal ulcers (more often), stomach ulcers (less often)|
|1.5-4 months||Bowel invagination|
|1-3 years||Juvenile intestinal polyps, Meckel’s diverticulum, disease
Dielafua, familial colon polyposis (in 5% of untreated children
by 5 years transformed into cancer)
|Above 3 years old||Varicose veins of the esophagus|
|5-10 years||Portal hypertension syndrome, non-specific ulcerative
|10-15 years||Peutz-Jeghers syndrome when detected in the intestine
many small polyps. In this case, the skin, lips, eyelids have
characteristic feature is multiple brown spots
At any age of a child, from the neonatal period,
- gastritis: can cause severe illness, hypoxia
(for example, in newborns);
- esophagitis. Most often it occurs in children with shortening
esophagus, achalasia of the cardia, hernia of the esophageal opening
- doubling of the stomach;
- doubling of the small intestine;
- Mallory-Weiss syndrome;
- грыжи пищеводного отверстия diaphragm;
- eosinophilic gastroenteropathy;
- vices development of gastrointestinal vessels: hemangiomas and vascular
Diagnosis and emergency care for children is provided on the same
principle as an adult.
The algorithm for gastrointestinal bleeding is as follows:
- Call the ambulance.
- Lay the patient, raise the legs, returning the maximum possible
the amount of blood from the depot in the veins to the bloodstream.
- Provide fresh air.
- Put cold on the stomach. Be sure to wear not to
cause frostbite. Keep 15-20 minutes, remove for 10 minutes, then
- From drugs inside you can give only 50 ml of solution
aminocaproic acid and / or 1-2 tsp. calcium chloride.
- To drink and not to give: it can further strengthen
- To go to the toilet – on the ship, pampers or some kind of container to
he did not have to get up. At the same time it is impossible to allow.
What do in the hospital
From the moment of admission the patient is assisted: infused
colloidal solutions of blood substitutes (gelatin solutions or
starches), having defined a blood group – transfuse blood and plasma (at
necessary). This is because, if necessary,
operations in the operating room, even in an emergency, you need to take
only trained patient. This patient is more likely
Hemostatic preparations are necessarily entered
(“Tranexam”, “Tugina”, “Vikasol”, “Etamzilat”) into a vein, is given
�”Aminocaproic acid” in the mouth. When erosive ulcers are detected
lesions in the vein are also injected drugs that reduce acidity
(“Contralock”, “Kvamatel” or “Ranitidine”).
All this time he is examined in the emergency room or department
resuscitation (the second option – if the patient was brought in a very severe
condition, with 3-4 degrees of bleeding):
- take a complete blood count from a finger or look only at “red
blood “(erythrocytes and hemoglobin);
- blood is taken from a vein for hematocrit, determining the percentage
the ratio of the liquid part of the blood and its formed elements, and the blood on
coagulogram (state of coagulation system;
these indicators are judged on the degree of housing and communal services and develop tactics
- FEGDS – examination of the stomach and duodenum using
fiber optic technology to determine the source of bleeding.
If such a source is found in the esophagus, stomach, or
Duodenum, try to burn it right during the procedure.
If this succeeds, no surgical intervention is undertaken;
- if necessary, and if the patient’s condition allows,
Uninformative FEGDs can perform angiography.
Next, they look at the results of the survey, as much as possible prepare
the patient to the operation and perform it by one of the methods: or open
operation, or the introduction of a vascular blocking fragment with
intravascular method, or clipping (overlay clips) under
control of the endoscope or laparoscope.
With portal hypertension syndrome try to stop
bleeding by a conservative method: setting a special probe
Blackmore and Intensive Drug Hemostatic
therapy. If this does not help, perform shunting operations –
send blood from high-pressure veins to veins with more