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Bleeding localization

When bleeding from the upper gastrointestinal tract, accompanied by vomiting with blood, it is necessary to use a nasogastric tube to assess blood loss. If there is a suspicion of bleeding from the upper gastrointestinal tract in patients with melanoma and with a clinic of epigastric pain, a history of aspiration of the contents is carried out through a nasogastric tube. Detection of blood in an aspirate indicates the presence of bleeding. With bleeding

Fig. 9-5. (A)

An endoscope with a device for suctioning a varicose node and its local dressing

. (B) Putting a rubber loop on the base of the varicose vein. (B) The endoscope was removed. (By: Yamada T., Alpers D. I., Owyang S., Powell DW, Silverstein F. E., eds. Textbook of Gastroenterology, 2nd ed. Philadelphia:.!. B. Lippincott, 1995; 1: 679. )



The pyloric sphincter prevents blood from entering the stomach from the duodenum, and there is no blood in the nasogastric aspirate. An objective examination of such patients determines melena. Therefore, the lack of blood in the aspirate does not make it possible to completely eliminate the presence of bleeding. Melena usually appears with bleeding from the upper gastrointestinal tract (above the Treitz ligament), but can also occur with bleeding from the small intestine and proximal colon. Melena occurs due to the conversion of hemoglobin to hematin and other hemochromes under the influence of the bacterial flora of the intestine. Experimentally, melena can be obtained if you drink 100-200 ml of blood. When bleeding from the small intestine, proximal part of the colon, the amount of blood entering the intestinal lumen is usually insufficient for unchanged blood to appear in the stool, but it is enough for melena to appear.
Bleeding from the small intestine is quite rare. With small bleeding from the colon, feces usually have a positive reaction to blood, and with severe bleeding, hematoschia is noted (the appearance of blood in the stool). Another marker of bleeding from the upper gastrointestinal tract is an increase in blood urea nitrogen. Such azotemia cannot be explained only by the absorption of blood, since it has been experimentally proved that blood intake per os is accompanied by an increase in nitrogen level to a much lesser extent than with bleeding. It is assumed that azotemia appears secondary to hypovolemia. In nasogastric aspirates, blood is usually determined visually, so there is no need for any tests. However, it must be borne in mind that some foods may produce aspirate in the form of "coffee grounds". Sometimes traces of blood in the aspirate appear due to trauma to the nasogastric tube. When using standard tests for occult blood, it is necessary to take into account the likelihood of false negative results in an acidic environment.

The presence of hepatoschia usually indicates that the source of bleeding is localized in the lower gastrointestinal tract. However, in 11% of patients with severe bleeding from the upper gastrointestinal tract, fresh blood in the rectal discharge may appear against the background of a quick passage of blood through the intestines. As a result of this, the use of a nasogastric tube and / or endoscopic treatment methods is required to localize the source of bleeding in patients with hematoschia.
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Bleeding localization

  1. 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
  2. OBSTETRIC BLEEDING (CONTINUED) BLEEDING IN THE EARLY POST-PERIOD PERIOD
    Causes of bleeding that develops in the early postpartum period: 5. delayed parts of the placenta 6. soft birth trauma 7. impaired uterine contractility: - hypotonic bleeding - atonic bleeding 8. development of DIC. Retention of parts of the placenta. - occurs when the third period of labor is unreasonably active.
  3. OBSTETRIC BLEEDING (CONTINUED) COAGULOPATHIC BLEEDING (DIC-SYNDROME).
    The process of blood coagulation constantly occurs in the body, but it is local, balanced in nature. Normally, there is a constant dynamic equilibrium with the fibrinolytic system. Excessive fibrinogen is captured by the cells of the reticuloendothelial system. DIC-syndrome (disseminated intravascular coagulation syndrome) is a pathological condition of hemostasis,
  4. LESSON 15 First aid after bleeding. Rules for stopping external bleeding. Technique for performing anterior nasal tamponade. Blood transfusion. Patient care (technique for performing intradermal and intramuscular injections).
    Objective: To teach students to identify symptoms of internal bleeding, to determine the amount of blood loss, to determine the blood group and Rh factor, to master various methods of stopping external bleeding, to perform intravenous, sc, intramuscular injections (from patient care skills). Test questions 1. Bleeding. Definition Classification of bleeding. 2. Signs of arterial, capillary,
  5. Cancer specific localization
    In the previous sections, the general principles of carcinogenesis were examined. However, the nature of the course of neoplastic processes in the gastrointestinal tract depends on their location. The development of gastrointestinal cancer was considered as an example of colon cancer, but tumors of other locations can have their own flow characteristics. Therefore, in this section, the features of development and
  6. Heart attack localization
    The above listing of ECG signs of myocardial infarction allows you to understand the principle of determining its localization. So, myocardial infarction is localized in those anatomical areas of the heart, in the leads from which 1, 2, 3, and 5 signs are recorded; 4th sign plays a role
  7. Apudomas of different localizations.
    Apudomas are tumors from apudocytes (see above). There is no generally accepted classification of apoud. Therefore, a working classification of these tumors can be used, according to which apudomas are divided by localization, features of hormone production, histological structure, degree of differentiation, and clinical course features. The most common localization of apud are the airways and
  8. Analysis of the anatomical features of the localization of atherosclerotic lesions in the coronary bed
    The experience of performing intracoronary therapeutic interventions in coronary atherosclerosis showed that their results are significantly affected by the anatomical features of the localization of atherosclerotic obstruction: damage distal to the significant tortuosity of the coronary artery (2 bends or more) (Fig. 1.75); localization at the site of a significant bend of the vessel (Fig. 1.76); at the bifurcation site
  9. Tumor localization in Zollinger-Ellison syndrome
    The localization of gastrinomas is rather difficult to establish. Approximately 30-50% of patients with Zollinger-Ellison syndrome do not show a tumor during surgery, and more than 20% find metastases. The use of antisecretory drugs significantly reduced mortality associated with excessive hypersecretion of gastric juice. Thus, there is rarely a need for urgent
  10. Localization of functions in the cerebral cortex
    The study of the structure of the forebrain, naturally, could not be divorced from studying the functional significance of individual regions of the cortex. The problem of localization of functions in the cerebral cortex has long been one of the most difficult sections in scientific natural science. In the second half of the XIX century. the cellular structure of the body was discovered, evolutionary theory in well-known works was fully confirmed
  11. Benign tumors with characteristic localization
    1. The villous adenoma of the colon. Often found in the colon. Macroscopic picture: looks like a large polyp (usually more than 1 cm) on a stalk or wide base (often has a villous surface). Microscopic picture: the adenoma is represented by numerous long papillae (villi) formed by highly differentiated epithelium with a large number
  12. Non-invasive determination of the localization and nature of disorders
    The contribution of invasive electrophysiological studies and electrography of the His bundle to understanding intracardiac conduction is so great and fundamental that the use of these methods in cases of atrial ventricular and intraventricular conduction disorders has become truly irreplaceable [7]. Speculation regarding the determination of the type and localization of AV block without receiving beam electrography data
  13. Benign tumors without characteristic localization
    1. Papilloma. Benign tumor from the integumentary (multilayered squamous or transitional) epithelium. • Often occurs in the skin, larynx, oral cavity, bladder, etc. Macroscopic picture: spherical formation on a wide base or thin leg, soft elastic consistency, mobile. The surface of the tumor is covered with small papillae. Microscopic picture: tumor
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