Gastrointestinal bleeding requires emergency medical treatment, since, even if small, it can quickly lead to death. Causes: peptic ulcer of the stomach and duodenum, rupture of varicose veins of the esophagus and cardia of the stomach during portal hypertension(liver cirrhosis, thrombophlebitic spleen), erosive gastritis, burn of the gastric mucosa due to accidental ingestion of caustic alkalis and concentrated acids, ulcerative lesions small and large intestines, typhoid fever, dysentery, ulcerative colitis, terminal ileitis, intestinal intussusception, bleeding Meckel's diverticulum, anal fissures. Gastrointestinal bleeding may occur when various diseases blood (hemophilia, hemorrhagic vasculitis, Werlhof's disease, leukemia, aplastic anemia, etc.).
Symptoms. Main feature this state- bloody vomiting or bloody stools. Often they are combined. When diagnosing gastrointestinal bleeding, it is necessary to exclude diseases in which blood may enter the gastrointestinal tract from other organs (upper respiratory tract, lungs, etc.). With hematemesis, the blood is thick, dark in color, or has the appearance coffee grounds with clots. Sometimes it contains residues undigested food. After 8-10 hours, “black” stool appears. In all cases of gastrointestinal bleeding, monitoring of blood pressure and hemoglobin content in the blood is necessary.
Heavy bleeding is accompanied by thirst, dryness of the mucous membranes of the oral cavity, rapidly progressing weakness with dizziness, and sometimes loss of consciousness. The skin becomes pale, covered in cold sweat, and the extremities become cold. The patient is either excited or in prostration. Facial features become sharper. Sometimes yawning, nausea and repeated vomiting appear. The pulse quickens, has weak filling, and then becomes thread-like. Blood pressure decreases, breathing quickens.
In addition to these general signs, depending on the causes of bleeding, certain specific symptoms Yes, when peptic ulcer stomach and duodenum there is a pain syndrome with a specific localization and a typical daily seasonal rhythm with an appropriate medical history. Bleeding can occur both during exacerbation of the disease and during remission. Heavy bleeding observed in 5-12% of children with peptic ulcer.
With portal hypertension due to liver cirrhosis, a long “hepatic” history, exhaustion of the patient, enlargement of the liver and spleen, a pronounced pattern of collateral saphenous veins, spider veins on the skin, less commonly ascites and intermittent jaundice. Functional status the liver is severely impaired. At x-ray examination esophagus with a contrast mass reveals varicose veins, which can cause profuse, sometimes fountain, bloody vomiting.
With thrombophlebitic spleen there is a rapid, sometimes with pain syndrome enlargement of the spleen, with an equally rapid decrease after bleeding; recurrent nosebleeds and undulating enlargement of the spleen with a history of fever. A combined enlargement of the spleen and liver is often observed.
At erosive gastritis and burns of the gastric mucosa with caustic alkalis and concentrated acids - pain along the esophagus, in the epigastric region, gastric history or traces of burns with these substances on the oral mucosa. If alkalis or acids are ingested, shock may occur.
Intussusception has a typical clinical picture acute abdomen.
Bleeding from the stomach and intestines in cases hemorrhagic diathesis combine with others clinical symptoms these diseases: skin hemorrhages, changes in blood clotting, duration of bleeding, retraction of a blood clot, changes in the quantity and quality of platelets, etc. Other diseases accompanied by gastrointestinal bleeding (nonspecific ulcerative colitis, typhoid fever, dysentery), have a clinical symptomatology well known to doctors. When bleeding from the stomach, bloody vomiting is often observed; from the upper intestines, including the duodenum, black tarry stools; from lower sections intestines - stool containing little changed blood.
Treatment. In all cases of bleeding from gastrointestinal tract hospitalization of the patient is indicated, since even slight bleeding can turn into profuse bleeding. It is better to hospitalize children in multidisciplinary hospital, where, along with therapeutic, infectious and other departments, there is a children's surgical department.
The patient is provided with absolute rest. The patient is transported carefully. The child should lie on his back. An ice pack is placed on the upper half of the abdomen.
A single-group blood transfusion is performed at the rate of 10-15 ml per 1 kg of body weight (it is better to transfuse freshly citrated blood or directly from the donor to the recipient). At rapid decline hemoglobin level up to 70 g/l, large amounts of blood are drip-transfused (up to 250-400 ml). 3-10 ml (depending on age) of 10% sodium chloride solution and 5-10 ml of calcium chloride are administered intravenously.
At the same time, large doses of ascorbic acid, vitamins PP, K, etc. are used. Ascorbic acid is administered intravenously or intramuscularly in the form of a 1% or 5% solution of sodium ascorbate up to 100-300 mg, depending on age. Vitamin PP is prescribed orally at 0.025-0.05 g 2-3 times a day. In the first days of bleeding, it is better to administer vitamin K intramuscularly at 0.5-1 ml (1% solution) per day for 3 days.
In case of profuse bleeding from varicose veins of the esophagus or cardia of the stomach, drip transfusions of the same group or 0 (I) blood group or plasma are immediately started. To narrow the preportal arterioles and thereby reduce the pressure in the portal vein, 5-10 units are injected dropwise. pituitrin in 100 ml of 5-10% glucose solution. You can also inject a 6% solution of aminocaproic acid (50-100 ml) dropwise. When blood pressure decreases, a 10% caffeine solution, a 1% mezaton solution or a 25% cordiamine solution in an age-specific dosage is prescribed.
For burns of the esophagus and burns of the stomach, vigorous anti-shock therapy is carried out. In case of a burn with ammonia or caustic soda, wash the stomach with a 0.1% solution hydrochloric acid or warm water; vinegar essence - boiled water until the smell of vinegar disappears; acids - 2-3% solution of bicarbonate of soda through a probe, which is pre-lubricated with well-boiled vegetable oil.
On the first day after the bleeding stops, you should refrain from feeding the child - glucose mixed with saline is administered intravenously. Starting from the 2nd day, the Meulengracht diet is prescribed, consisting of chilled milk, cream, eggs, butter, well mashed vegetable purees with carefully chopped and pureed meat or fish. Along with the measures taken, vigorous therapy of the underlying disease is carried out.
If therapeutic measures are ineffective and bleeding continues, consultation with a surgeon is necessary to decide on surgical treatment.
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Gastric bleeding in children is extremely severe and dangerous disease, is a source of disruption of the functionality of not only the digestive system, but also the entire body. Gastrointestinal bleeding is dangerous because in most cases it leads to fatal outcome.
There are various factors, which contribute to the occurrence of hemorrhages in the intestines:
The most common symptoms are stool and vomiting with blood. There are also additional signs:
Symptoms can be different, it all depends on the cause of the gastrointestinal tract lesion. Availability pain in a certain area of the abdomen indicates an ulcer; pain in the esophagus may mean that poisoning has occurred during the use of medications.
Bleeding poses a serious health threat, so you need to be extremely careful.
The child urgently needs help to stop the bleeding before doctors arrive. First aid is aimed at reducing pain and, if possible, stopping hemorrhage completely. The patient needs absolute rest and bed rest.
If heavy bleeding occurs:
Ambulance doctors will have to carefully transport the patient to the hospital department. The baby should lie quietly, while placing an ice compress in the abdomen.
Under no circumstances should you give your baby food or rinse the stomach; this is very dangerous and will lead to irreversible consequences.
In case of gastrointestinal bleeding, immediate surgery . It is also necessary to carry out a transfusion of additional blood as follows - blood identical to the patient’s blood is injected at 15 ml per kilogram of the child’s weight. The donor is usually one of the relatives.
It is urgent to check your blood for hemoglobin levels. If the level is too low, large amounts of blood transfusion will be required.
Additionally, 10 ml of sodium chloride solution is injected along with calcium chloride in the amount of 5 ml. If a decrease in pressure is observed during the process, then a 10% caffeine solution is introduced.
Vitamins and minerals such as PP, K and ascorbic acid, which help replenish energy and saturate the body with useful and nutritious substances.
Vitamins must be administered following the dosage:
In case of malfunction digestive system, the doctor prescribes the administration of a mixture of glucose and saline solution. Intestinal bleeding Children are required to follow a long-term strict diet. You can use pureed vegetables, butter, eggs.
Article publication date: 06/08/2017
Article updated date: 12/21/2018
From the article you will learn: what internal bleeding is, why it is dangerous and by what signs it is recognized. Types of internal bleeding and first aid algorithm.
Internal bleeding is an acute life-threatening condition in which, through a rupture in the vessel wall, blood flows from the bloodstream either into the lumen of a hollow organ (uterus, stomach, lungs) or into a cavity artificially created by the volume of leaked blood (for example, intermuscular space). Such bleeding is never an isolated independent disease - but only either a sign or a consequence of the underlying pathological condition.
This pathology often develops as a result of injury or chronic illness. Heavy types Such bleeding with large blood loss (more than 1.5 liters) is very dangerous and can lead to death. Bleeding with less blood loss (less than 1.5 liters) is still very serious. Spilled blood can compress nearby vessels, disrupting the function of internal organs, come out through the mouth, for example, with gastric bleeding, and are accompanied by other serious manifestations.
Internal bleeding is called because the spilled blood does not flow outside the body. Therefore, uterine, gastric or are not always interpreted as internal; although, given that blood sometimes does not immediately exit through physiological openings - mouth, anus, vagina - it is advisable to classify them as internal.
The general causes, symptoms and treatment of internal bleeding are the same in men and women.
The elimination is carried out by a gynecologist, intestinal - by a proctologist, pulmonary - by a thoracic surgeon, post-traumatic - by a traumatologist, intracranial - by a neurosurgeon.
Late provision of medical care when a person contacts doctors late or has difficulties with differential diagnosis increase the risk to his health, and even life.
Internal bleeding is classified into many types based on location, cause, time of occurrence, amount of blood loss, etc.
| Bleeding categories | Types, description |
|---|---|
| By location | Intestinal – blood is flowing from intestinal vessels Gastric - into the lumen of the stomach Gastrointestinal – blood loss into the cavity of the esophagus or other hollow organ Hemopericardium - filling the pericardial sac with blood Hemothorax - between the layers of the pleura, i.e. in the slit-like space between the special membranes surrounding each lung Intracranial Hemarthrosis – in the joint |
| According to the area of blood accumulation | Interstitial - into tissues adjacent to the vessel Abdominal - into the cavity of the peritoneum, pleura |
| According to the signs and characteristics of detection | Hidden - hemorrhage into the cavitary organs and cavities that communicate with external environment, For example bladder or lungs. But there are no obvious symptoms of bleeding; it can only be detected with the help of special diagnostics Explicit – easily determined by visual inspection |
| By origin | Mechanical - with traumatic injury tissues and vessels of internal organs Arrosive - when the vascular wall is damaged due to the germination or disintegration of a neoplasm, a destructive or necrotic process (with tissue death) Diapedetic - with blood leaking through the vascular wall during scurvy, scarlet fever, malaria |
| By volume of leaked blood | Lung – blood loss no more than 500 ml Average – 0.5–1 l Severe – blood loss is no more than one and a half liters of blood Massive – up to 2.5 l Lethal - from 2.5 to 3 l Absolutely lethal – over 3–3.5 l |
| Taking into account the type of damaged vessel | Capillary - from capillaries Venous – when the vein wall ruptures Arterial - from an artery Mixed - from different vessels Parenchymatous - blood pours out from the vessels of a parenchymal organ (these are the spleen, liver, lungs, pancreas, kidneys and others - these are internal organs built from solid tissue) |
| According to development period | Primary – immediately after injury Secondary – some time after the injury. In the first 1–5 days it is considered early, after 10–15 days – late |
Hemothorax Each type of bleeding has its own causes, the most common of which are injuries and illnesses in acute or chronic form.
Hemorrhage is caused by:
Symptoms depend on the amount of blood loss and its location. There are general signs and characteristic of a particular species.
Common signs of internal bleeding are weakness, darkening or clouding of the eyes, drowsiness, dizziness, cold sweat, and thirst. Loss of consciousness is possible. The intensity of blood loss is determined by pulse rate, blood pressure and characteristic complaints of the patient.
Hemothorax is the entry of blood into the pleural cavity. In addition to general symptoms, it manifests itself as sharp pain in the problem area, difficulty in breathing, cough with foamy bloody sputum. On an x-ray, the mediastinum (the space in the middle of the chest cavity) is shifted towards the healthy lung.
Symptoms of internal bleeding in women can be pulling, bursting or sharp pains lower abdomen with irradiation to the lower back and anus, the urge to defecate, a feeling of swelling of the mucous membranes.
For any type of internal blood loss, you should immediately call an ambulance. Although with mild blood loss a person himself can reach medical institution and get help, but it’s better not to risk it, because it’s unknown whether the bleeding has stopped or whether it will get worse general condition further or not.
From the correctness of rendering first aid often a person's life depends. Before the doctors arrive, the patient must be laid down; further actions must be carried out only after he has assumed a horizontal position, and in case of hemothorax, a semi-sitting position. Apply ice to the area of the suspected source of the problem, focusing on complaints. Then, as quickly as possible, transport the victim in this position to the nearest medical facility. institutions or wait for the ambulance to arrive.
It is strictly forbidden to: heat the bleeding area, apply pressure bandage, insert suppositories, use a laxative, do an enema (for intestinal bleeding), offer to drink painkillers and medications that stimulate the heart.
Neglecting the above steps can lead to increased blood loss and death.
Based on symptoms and primary medical examination, presumably they find out which organ was damaged, and the patient is hospitalized in the appropriate department. If there are objective symptoms of large blood loss, go to intensive care.
Main goals of treatment:
Often massive blood loss can be stopped by performing emergency surgery:
To replenish the bcc, intravenous drips are administered infusion solutions, blood substitutes, blood products. The remaining funds are used for their intended purpose.
The prognosis depends on the competent provision of pre-medical and timely medical care.
Detecting internal bleeding is very difficult. On initial stage its symptoms are very vague and similar to those of other diseases. Something is wrong can be suspected if there are severe external injuries, but some chronic diseases also cause a similar condition. The danger is that a person does not always experience pain. However, if urgent measures are not taken, the life of the sufferer will be at risk. How to recognize signs of internal bleeding and how to help before doctors arrive? Read about this later in the article.
Significant internal blood loss occurs for two reasons:
No matter how much blood is poured out, the body strives to push it out. She goes out with feces, stomach contents, from the internal genital organs in women, expectorated with sputum from the bronchi and lungs. However, you should not think that the bleeding will stop on its own; the wound will heal on its own. At the first manifestations of internal blood loss, you should consult a doctor as soon as possible.
According to doctors, cirrhosis of the liver, ulcers, varicose veins of the stomach or duodenum provoke every third internal bleeding. In this case, you can recognize the problem by vomiting mixed with bloody clots of a dark, almost black color. Another characteristic feature internal bleeding into the digestive organs - stool that resembles tar in color and consistency. It can appear 1–2 or even 9–10 hours after the onset of blood loss.
Otherwise, this type of internal bleeding is called a stroke. In this situation, the fluid does not find a way out and accumulates in the skull. Delete blood clots you can only surgically. The danger of blood clots in the brain cannot be underestimated: they can cause complete or partial paralysis, disruption of the functioning of those organs for which the affected area is responsible, and even death. In addition to severe head injury, stroke often results from:
It's about uterine bleeding. It can occur in women various reasons. Changes hormonal levels, tumors, ectopic pregnancy, miscarriage, placental abruption during pregnancy, rupture of the uterus or ovaries - all these factors hidden from human eyes provoke internal bleeding. They may open after or during your period. One of the signs of internal bleeding is blood coming out profusely in the form of large dark clots. Accompanied by the process aching pain in the lower abdomen.
Severe internal bleeding in this area is possible for various reasons:
What makes bleeding of this type special is the fact that a person, experiencing sharp pain in the peritoneum, in order to calm it down a little, I have to sit with my knees pulled up to my chest. Most often, doctors encounter external mechanical damage:
The accumulation of blood in the lungs and its release is associated with complications after certain diseases (tumors in the chest, tuberculosis), with injuries to the ribs, heart and respiratory organs themselves. At the same time, along with the typical characteristics, there are also some specific signs:
Along with specific ones, experts note numerous general symptoms internal bleeding, regardless of which specific organ or part of the body is affected. These signs include:
By some signs you can judge which vessels are damaged. Capillary bleeding is very weak and does not pose any particular danger to life. Parenchymal, in which all channels are involved, is very long-lasting and abundant. Arterial is characterized by the release of bright red blood, and it flows jerkily. The main signs venous bleeding– slow, uniform flow of dark-colored blood.
It is difficult to determine the source of internal bleeding without examining a doctor. However, if the sufferer is left without help at all, the situation can significantly worsen. Some simple actions will alleviate the condition of the victim and give him a chance for a successful outcome:
By watching the video below, you will learn how to properly assist a person suffering from internal bleeding on the street. A professional doctor tells how to competently, armed with the familiar items at hand, ease the patient’s pain before the emergency doctor appears. You will learn about the first symptoms of internal bleeding, which will give you a signal to act, because such a problem should never be left to chance.
During the newborn period, the child has not yet had time to “earn” any diseases and has not been in contact with the outside world, but despite this, life-threatening conditions may develop after birth. Gastrointestinal bleeding in children a few days after birth occurs as a result of imperfections in the blood coagulation system, which most often occurs in premature infants.
There are several main reasons why a baby develops gastric bleeding. They are quite different from those of adults. This is due to insufficient development all systems and the child’s body as a whole. This problem is more pressing for premature babies. For infants, hereditary pathologies and organ malformations are specific.
Gastric bleeding in a newborn occurs most often when hemorrhagic disease, which occurs in 0.25-0.5% of cases. The causes of this disease lie in the deficiency of vitamin K, which is directly related to the synthesis of blood coagulation factors, namely Ⅱ, Ⅶ, Ⅸ, Ⅹ - prothrombin complex. In the structure of ICD 10, these pathologies have the following codes:
There is such a classification depending on the appearance of clinical signs:
There are several risk factors for developing hemorrhagic disease of the newborn:
Enough common cause stomach bleeding, vomiting streaked with blood is esophagitis. It develops as a result of reflux, or the reflux of stomach contents into the esophagus. This provokes inflammation and ulceration of the mucous membrane. No significant blood loss is observed.
The development of DIC syndrome in newborns can be caused by:
Classic hemophilia is the result of a mutation in the gene that controls the activity of clotting factor Ⅷ. Hemophilia B is a deficiency of factor Ⅸ, or Christmas factor. To this group hereditary pathologies von Willebrand's disease may also be considered. It is these nosologies that make up 99% of all congenital deficiencies of the coagulation system.
The development of gastrointestinal bleeding in children after birth with hemophilia is extremely rare. As a rule, the first manifestations of hereditary factor deficiency occur when the child begins to crawl and actively move.
But if bleeding from the gastrointestinal tract has developed in a newborn boy and the only change in the coagulogram is an increase in aPTT, then you should think about hemophilia and perform quantitative researchⅧ and Ⅸ factors.
A decrease in platelets in newborns of less than 30*10 9 /l leads to clinically significant manifestations. Bleeding and petechiae appear on the body. The causes of such conditions may be:
The liver is a producer of almost all blood coagulation factors, fibrinogen, and other protein elements that participate in hemostasis. Violation of the synthetic function of the liver occurs in newborns when:
If the birth canal is ruptured during childbirth or nipples are cracked, the baby may swallow a certain amount of the mother's blood. To determine whose blood is present in the vomit, an Apta-Downer test should be performed:
Melena.
Gastrointestinal bleeding in newborns is manifested by several symptoms.
The basis of symptoms of gastrointestinal bleeding in children and adults are signs of blood loss:
But, in addition to specific signs, they may be accompanied by general symptoms of insufficiency of the blood coagulation system:
The necessary diagnostic criteria are:
Ultrasound examination of organs will help with diagnosis abdominal cavity.
Most often, when gastric bleeding develops in newborns, they are still in the maternity hospital (on days 2-5). This increases the chance of quality delivery emergency care to such a child.
The basis of treatment is the implementation of hemostasis and replenishment of lost fluid. Algorithm for emergency care for gastrointestinal bleeding in newborns according to clinical guidelines:
If a child develops gastrointestinal bleeding, then after stabilization of the condition and hemostasis, he is in the hospital. Treatment is carried out according to the underlying pathology. Mothers need to express their milk and cool it before starting feeding. Vikasol is prescribed 0.3-0.5 ml 2 times a day for 3 days.
