Gastrointestinal bleeding the symptoms and treatment

Bleeding from the stomach is characteristics of diseases of the gastrointestinal tract

Gastrointestinal bleeding in adults, as well as gastrointestinal bleeding in children (thankfully more rare) is a serious, often life-threatening condition.

Last bleeding from the stomach was a typical seasonal phenomenon (spring, autumn), but are currently logged quite a lot of patients hospitalized with a diagnosis of "bleeding from the bowels" and in the so-called interim period (summer, winter).

Clinic gastrointestinal bleeding (symptoms) is determined by its localization. Bleeding from the stomach can have lethal effects (mortality) in 6-10% of cases, and in the case of elderly patients and the presence of serious comorbidities, blood in the FCC typical up to 40% of mortality.

Annually internal bleeding in the gut is approximately 100 cases per 100 000 population.

Early treatment of gastric bleeding thought, mostly, surgical methods, because there were minimal resources conservative methods aimed at treatment of gastrointestinal bleeding, the patients having bleeding of the gastrointestinal tract, often subjected to extensive resections.

Today acute gastrointestinal bleeding is resolved in accordance with the latest recommended methods, and in issues such as stomach bleeding treatment and diagnosis, apply conservative and endoscopic therapeutic methods. Only in case when such an important issue as gastro intestinal bleeding treatment showed effectiveness is surgery.

Sources of gastrointestinal bleeding depends on the type of lesions and their endoscopic solutions

The most common sources and causes of intestinal bleeding includes:

• erosion and cracks – superficial damage to the mucosa. In case of bleeding, a suitable method is the use of diluted Epinephrine, Ethoxysclerol, alcohol or their combination. You can use heat coagulation and laser,
• syndrome Mallory-Vasa syndrome gastrointestinal haemorrhage is rupture of the mucous membrane, which is the result of repeated vomiting, often in the cardiac or distal esophagus. The decision regarding diseases similar to solutions with erosions and fissures,
• an ulcer is a deep lesion, extending into the muscle layers. When bleeding, mainly used injection methods and also thermal and mechanical methods with the use of hemoclips. Lipovane useful if you lose nevinnomysskoy tissue, since it does not affect the healing of ulcers and not damage the surrounding tissue. Can be used coagulation by laser or argon-beamer,
• inflammation: benign sources of the disease are nonspecific and specific inflammation (esophagitis, gastritis, bulbit, duodenitis, enteritis, colitis, Crohn's disease, ulcerative colitis, candidiasis, inflammation of the mucous membrane), and often even bleeding from the diverticulum, which affected not only the intestine or the stomach, but virtually the entire gastrointestinal tract. To treat such problems preferred using injection techniques as well as thermal and laser equipment, however, should take into account the increased risk of thermal damage to mucosal inflammation and associated with this, the risk of perforation,
• varicose veins of the esophagus represent a stretching of the venous plexus of the esophagus, causing intestinal bleeding the cause of which lies in portal hypertension. When hemostasis is used sclerotherapy with the use of Polidocanol (Ethoxysclerol). The leading role played by the elastic ligature,preferred when necrobutcher varicose veins acute bleeding varices used hemoclip. They are mechanically compress varices location under and above the source of the problem, they can impose any amount they, unlike sclerotherapy, not cause ulcerations and fibrosis around the injection site. Excellent results described in the case when in this way the child is treated. The easiest, fastest and cheapest method is sclerotherapy, which in our country is used in more than 90% of cases, but its disadvantage is the formation of ulcers, and in the case of sclerotherapy re – stenosis, strictures or brachiopoda. If hemostasis can also be used for acrylic adhesives, the use and manipulation which, however, are quite complex,
• polyps and tumors: less frequent sources of the disease are benign tumors – lipoma, fibroma, leiomyoma, hemangioma, and polyps of different types. They can affect almost all digestive tract and, as a rule, lead to the development of chronic anabisetia. Upon detection of allocation of blood from the polyp should be performed polypectomy, and when bleeding at the base of the polyp, it is advisable to use either an injectable hemostasis, or hemoclip,
• angiodysplasia: it is about the diseased dilated vessels of the mucous membranes. In the solution of bleeding angiodysplasia easiest to use method of hemostasis. Suitable application of the argon laser, which by means of spray effect has a much more pronounced effect on the surrounding vascular plexus.

Type of disease

Acute

Refers to the sudden gastro-intestinal phenomena. We can talk about the arterial bleeding, which occurs most frequently from ulcers, or venous, the most common reasons is varicose veins of the esophagus. This type of the disease is as dangerous as arterial as arterial peptic ulcer bleeding, in most cases, we are talking about otherwise healthy person. In people with varicose veins we can talk about the later stages of hepatopathy, which comes to significant changes in the parameters of coagulation.

Chronic

The symptoms of gastrointestinal bleeding of this type is associated with vague symptoms such as weakness, fatigue, dizziness, pallor. In this situation, comes to the loss of mainly red blood components. These losses are, as a rule, is characteristic for malignant neoplasms of the gastrointestinal tract frequently occur in patients with chronic renal and hepatic insufficiency, or, in some hematologic diseases.

Acute intestinal bleeding symptoms

The symptoms intestinal hemorrhages of this type are divided into the following groups:

1. Hematemesis – vomiting blood – blood is bright red and liquid. Mostly, in such cases, we are talking about a problem in the esophagus. If there is a disease of the stomach, present in the blood clots. Less hematemesis may be a manifestation of ulcer disease, particularly if extensive ongoing bleeding from deep ulcers calloses.
2. Melena – liquid, black stools, which is the most common symptom of disease in the upper gastrointestinal tract, but at a much slower passage, can also be a question of the right half of the colon. The black color is due to exposure to the bacterial flora of the intestine. Maleny symptoms can occur even if there is a leak of 100 ml of blood in the gastrointestinal tract.

In practice, melena is divided into 2 subgroups:

• "fresh melena" – frequent loose stools black, which most likely is a manifestation of the state postactive fresh illness, or current active problems,
• "old or oboronaya melena" is black dry, no more frequent and loose stools is likely to be a manifestation of stop the bleeding and evacuation of the intestinal tract.

Enterorrhagia – perianal waste of red blood is the most common symptom of the disease in the colon or rectum. This characteristic, however, may occur under other circumstances, such as:

• rare bleeding from the small intestine,
• massive bleeding from large ulcers Kalesnik,
• massive bleeding from esophageal varices.

Hemorrhagic shock – we are talking about the General changes of the body, which reacts to blood loss and changes in blood volume in heart rate, blood pressure, cardio-respiratory changes, impaired consciousness and possible change of consciousness.

Options for the treatment of gastrointestinal diseases

Conservative (drug) treatments

Principles of intensive care for patients hospitalized in the ICU, the same and does not depend on the source of the disease in the upper part of the digestive tract. The continuation of care and medication therapy, especially in cases of acute bleeding, has unique characteristics that can be divided,mainly into 2 groups. We are talking about varicose and peptic ulcer disease.

The patient with obvious bleeding in the digestive tract must be filed with underlying hemostatic agents (Remestyp) and possibly intravenous proton pump inhibitors (Losec) in the preliminary stage, preferably, during transport of the patient in the ambulance. After the adoption of patient with bleeding in the gastrointestinal tract prior to endoscopic diagnosis to begin therapy with conservative treatment, which consists, in accordance with the clinical state of the patient in the reception of the following groups of drugs:

Medicines, whose action is directed at stopping bleeding:

• hemostatic agents,
• antifibrinolytic prepared,
• ascorbic acid,
• vasoactive agents,
• fresh frozen plasma,
• platelet concentrate,
• H-2 blockers,
• proton pump inhibitor,
• coagulation factors.

Endoscopic equipment

The injection method

In the area, as well as directly to the source of bleeding hemostatic solutions are introduced:

• substance for sclerotherapy or fibrin glue (Epinephrine, Ethoxysclerol, alcohol, Histoacryl).

Coagulation method

Through the use of monopolar or bipolar coagulation coagulated neighborhood and the center of the disease.

Mechanical method

They focus mainly on the field of varicose veins of the esophagus. In the foreground elastic ligatures, special hemoclip loop and titanium clips, which is mechanical "ligation" is the interruption of blood flow of varicose veins.

Surgical solutions

In most cases, gastrointestinal bleeding stops spontaneously or after successful use of the methods of conservative and endoscopic therapy. There is a small but greatly risk group of patients hospitalized in a serious state of shock with profuse bleeding, which may not influence drug therapy, and endoscopy is not possible for technical reasons or due to the severity of the patient's condition. In these cases, the decision on emergency surgical intervention.

At the time, as in times past, before the era of endoscopy and effective hemostatic drugs (hemostatic drugs) surgical treatment of gastrointestinal diseases were the most common method (used in 25-30% of patients with bleeding in the gastrointestinal tract), at the present time, the era of modern therapeutic methods, surgical intervention is used only in those cases that fail conservative and endoscopic therapy. The operating table, now shown, only about 3-5% of patients with this type of diseases of the gastrointestinal tract.