THE SYSTEM DISEASES OF THE DIGESTIVE SYSTEM : BLEEDING GASTROINTESTINAL (ACUTE) (HAEMORRHAGIA GA - STRICA ACUTA) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Etiology. Organic disease of the stomach (gastric ulcer, ulcerative gastritis, polyps of the stomach, gastric cancer), diseases of other organs, causing poor circulation in the stomach (atrophic cirrhosis of the liver, varicose veins of the esophagus, thrombosis of the portal vein, mesenteric and salutenight of the blood vessels), blood diseases and blood vessels, predisposing to bleeding (hemorrhagic diathesis, scurvy, jaundice, and others).
The pathogenesis. Violation of the integrity of the vessel wall due to ulcerative process or stomach tumor, rupture of the vessel wall of the stomach or esophagus on the soil of this stagnation if the blood circulation, increase the permeability of vascular walls of the stomach in diseases of the blood, or the blood vessels flowing in the cavity of the stomach, the blood may be entirely fill it; partly blood erupts vomiting, giving in some cases gag mass color of coffee grounds; part of the blood is brought out through the intestines, giving the stool degteobrazny.
Depending on the degree of bleeding can be reduced to dizziness, syncope, the pale face, the cold sweat, profuse bloody vomiting, often repeated; the pulse becomes small, frequent; blood pressure falls; chair detained, sometimes for several days; in the presence of the chair the last is black, tar-like, pasty consistency. If gastrointestinal bleeding preceded and pain in the epigastric region, usually after bleeding pain disappear; this is especially true when gastric bleeding on the ground ulcers; continuing after bleeding pain say about the involvement of the abdominal integument.
Course and complications depend on the nature of the process, from the condition of vessels and caliber of the affected vessel; power flow and timeliness of the measures taken, determine the outcome of bleeding. Minor and repeated gastrointestinal bleeding was observed in stomach cancer and hemorrhagic diathesis; more abundant bleeding usually occurs when the ulcer. Bleeding subsides due to thrombosis of the vessel, especially (ate its small caliber, with the defeat of vessels larger caliber of a blood clot, and therefore, stop bleeding difficult. Similarly, stopping the bleeding is difficult when the pitting of vessels lying in the thick unyielding infiltrate or ulcer in elderly patients with sclerotic-modified the walls of blood vessels, which are not spadats.
Recognition of the stomach bleeding usually presents no difficulty; to set at the appearance of the first symptoms etiological factor is not always easy. As ulcers and cancer of the stomach sudden onset of stomach bleeding may be the only symptom of a hidden proceeding of the disease. To differentsirovat have primarily between gastric ulcer, gastric cancer and liver cirrhosis. Along with consideration of anamnestic data and physical examination, recognition facilitates x-ray examination of the stomach, which is known precautions may be made immediately after cessation of bleeding.
It all depends on the main suffering, sizes bleeding and timely adoption of appropriate measures.
Treatment of bleeding requires first of all a complete physical and mental rest to the patient. Strict bed rest, calm and confident behavior doctor immediately soothe the patient. To combat kollaptoidnoe condition of the patient, and to stop bleeding the transfusion of hemostatic dose single-group blood in the number of 75-100 ml; if necessary, a blood transfusion may be repeated. On my stomach, put an ice pack. During the first two days of the famine, and further a liquid buffet cold.
The use of cardiac and stimulants are not shown, since any increase in blood pressure may prevent the formation of thrombus. Delay chair during the first 3-4 days you not to resort to enemas. For feeding patients during bleeding, it is recommended that intravenous infusion of glucose and drip enema of grape sugar. After stopping stomach bleeding start planning to conduct dieticheskogo treatment (see peptic Ulcer and duodenal ulcer, treatment). Emergency surgery is required only in the presence of repeated bleeding, accompanied by a considerable loss of strength and growing secondary anemia. In these cases, to prepare the patient for surgery shows massive blood transfusion.