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Acute and chronic bleeding from the gastrointestinal tract

There are many causes of gastrointestinal bleeding. Bleeding develops according to one of two primary mechanisms:

1. Violation of the integrity of the mucous membrane, leading to exposure of deep vessels, their erosion. For example, bleeding from a stomach ulcer, bleeding from the intestines during infectious or idiopathic processes, from the small and large intestines during ischemia.

2. Rupture of the vessel with a sharp increase in pressure in it and extensive damage to the intestinal wall. For example, bleeding from a diverticulum, damage to Dieulafoy (rupture of an ectatically dilated vessel of the submucous layer of the stomach).

The clinical picture of bleeding depends on its severity and localization. Screening of patients with chronic bleeding reveals iron deficiency anemia, blood in the stool. In more severe cases of chronic bleeding, anemia, pallor of the skin, weakness, shortness of breath, anginal pain are observed. In acute bleeding, the clinical picture is very bright. Bleeding from the upper gastrointestinal tract is usually manifested by vomiting of blood, and with fresh bleeding the vomit is colored red, and with repeated bleeding it is the color of "coffee grounds". Melena is a black, mushy or hard, fetid stool. Its dark color is due to the breakdown of hemoglobin and serves as a marker of bleeding from the upper sections of the gastrointestinal tract or from the right (ascending) sections of the transverse colon (it must be borne in mind that black staining of the stool is possible when taking bismuth and iron preparations). Hematoshesia is the allocation of unchanged blood from the rectum with stool, which serves as an indicator of bleeding from the lower parts of the gastrointestinal tract. If hematosia occurs with a source of bleeding installed in the upper gastrointestinal tract, then this indicates that the bleeding is massive.

When examining a patient with bleeding, it is necessary to quickly assess the severity of his condition. Excitation, pallor, lowering blood pressure, tachycardia, as a rule, indicate the development of shock. In this case, immediate replacement fluid transfusion is required. In patients with severe bleeding, instead of tachycardia, bradycardia may develop, which develops as a result of the increased effect of the vagus nerve on the heart. Shock occurs with a loss of 40% of the volume of circulating blood.
In the absence of severe hypotension, the presence of orthostatic manifestations allows you to suspect bleeding: a decrease in blood pressure of 10 mm RT. Article and more with a change in body position (transition to an upright position) indicates a decrease in the volume of circulating blood by 20%. In case of acute bleeding, it is important to provide intravenous access, and with signs of shock and ongoing bleeding, it is best to have access to the central veins. It is necessary to immediately determine the hematocrit, platelet count, blood coagulation factors, blood group and immediately start the administration of replacement solutions (physiological 0.9% sodium chloride solution) until it is possible to administer blood products or whole blood, since in shock the body primarily suffers from a decrease in perfusion pressure, and ye from insufficient oxygen supply to organs.

In acute bleeding, the hematocrit level weakly reflects the actual volume of blood loss, because hematocrit is a percentage ratio of the total volume of red blood cells to the total blood volume expressed as a percentage. Therefore, the hematocrit value will decrease only after the restoration of the volume of circulating fluid. This recovery begins immediately due to extravascular fluid, but the volume of circulating blood is fully restored after 24-48 hours. Thus, when diagnosing blood loss, blood pressure, pulse, visible signs of bleeding are more reliable than laboratory tests. The hematocrit accurately reflects the degree of anemia in chronic blood loss, but the more reliable criteria for chronic bleeding are iron deficiency, determined by its serum content, and microcyte index.

The need for blood transfusion depends on the age of the patient, the presence of cardiopulmonary pathology, the continuation or termination of bleeding. In patients without concomitant pathology, the hematocrit should be maintained at 30% in the elderly and 20% in young people. To make a decision on blood transfusion with ongoing bleeding, you can not focus only on the hematocrit value. It is necessary to take into account the presence of vomiting with blood, blood in a nasogastric aspirate, hematosia. Due to a significant increase in blood plasma volume after transfusion, the hematocrit level is below the real value.
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Acute and chronic bleeding from the gastrointestinal tract

  1. Vascular ectasia as an example of chronic bleeding from the gastrointestinal tract
    Vascular ectasia, or angiodysplasia, is one of the common causes of both profuse and minor prolonged bleeding from the lower gastrointestinal tract. Most of them are associated with age-related degenerative changes in the vascular wall in the elderly. In other age groups, vascular wall disorders can be congenital. Two thirds of patients with angio dysplasia
  2. Gastrointestinal bleeding
    Gastrointestinal bleeding is a problem that is often encountered by doctors in the United States (300 thousand hospitalizations annually). The degree of hemorrhage varies from small slow bleeding to life-threatening conditions that contribute to the development of iron deficiency anemia. Mortality from upper gastrointestinal tract in the USA is 8%. This indicator has not changed much.
  3. Bleeding in gastric ulcer as an example of bleeding from the upper gastrointestinal tract
    Gastric and duodenal ulcers cause about 50.% of cases of bleeding from the upper gastrointestinal tract (Table 9-2). Despite the introduction of new effective methods of treating peptic ulcer in the past 15 years, the frequency of bleeding with this pathology has not practically decreased. One of the reasons for this situation is the fact that often peptic ulcer
  4. Acute gastrointestinal bleeding
    The main causes of gastrointestinal bleeding are chronic and acute ulcers of the stomach and duodenum, neoplasms, erosive hemorrhagic gastritis, portal hypertension with varicose veins of the esophagus. DIAGNOSTICS = For the bleeding of ulcerative etiology, the identification of pain and dyspeptic syndrome in the past, exacerbation of pain several days before
  5. Bleeding from the upper gastrointestinal tract
    It is customary to talk about bleeding from the upper gastrointestinal tract (GIT) in cases where the source of bleeding is located either in the esophagus, or in the stomach, or in the duodenum (duodenum). Pathophysiology The most common causes of bleeding in adults are: duodenal ulcer; erosion of the stomach and duodenum; varicose veins
  6. Acute gastrointestinal bleeding
    Complications of many diseases of various etiologies. Their most common causes are chronic and acute gastric ulcers to the duodenum, neoplasms, erosive hemorrhagic gastritis, portal hypertension. D - ka: The identification of pain and dyspeptic syndrome in the past, exacerbation of pain a few days or weeks before hemorrhage,
  7. Acute gastrointestinal bleeding
    Clinical characteristics of acute gastrointestinal bleeding Gastrointestinal bleeding is divided into ulcerative and non-ulcer. Ulcerative bleeding occurs with ulcers of the stomach and duodenum. These are the most common causes of gastrointestinal bleeding. A small proportion of bleeding is accompanied by non-ulcer bleeding: benign and malignant tumors of the stomach,
  8. Acute gastrointestinal bleeding
    The most common causes: ulcers of dilated veins of the esophagus, ulcers and erosion of the stomach and duodenum, tumors of various localization, diverticula, ulcerative colitis, hemorrhoids. Symptoms of Bleeding in the lumen of the gastrointestinal tract have two periods: latent and explicit. The latent period begins when blood enters the digestive tract, and appears common
  9. Acute gastrointestinal bleeding
    DIAGNOSTICS The main sign of latent bleeding is “causeless” anemia. Massive bleeding is characterized by a decrease in blood pressure, increased heart rate and a decrease in minute volume, generalized spasm of the vessels. With bleeding into the lumen of the gastrointestinal tract, two periods are distinguished. = The latent period is manifested by common signs of blood loss: fainting, tinnitus, dizziness,
  10. Prognosis for bleeding from the upper gastrointestinal tract
    There are several criteria for poor prognosis for bleeding from the upper gastrointestinal tract. The most important is the cause of the bleeding. So, for bleeding from varicose veins, the highest frequency of repeated bleeding (relapses) and deaths is characteristic. In primary hospitalization, mortality in this type of bleeding is 30%, with repeated - 50-70%.
  11. The principles of treatment of bleeding from the gastrointestinal tract with portal hypertension
    Bleeding from varicose nodes is the most abundant of all types of bleeding that occurs in the upper parts of the gastrointestinal tract, in which the patient requires emergency medical care. In more than 90% of cases of such bleeding, the hematocrit level drops sharply and becomes less than 30% of normal, resulting in the need for
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