The optical apparatus and the diagnostic method of fibrogastroduodenoscopy help determine the amount of blood loss that is fixed in the organs of the upper gastrointestinal tract. This classification is facilitated by the classification of bleeding according to Forest. This gradation, as you will see, is quite simple and convenient. In particular, it helps doctors to notice all pathological changes in the vessels (both venous and arterial), determine the stage of the disorder, the amount of blood that the patient loses. We will talk more about gastric bleeding and their classification in more detail below.
What causes such bleeding?
Before analyzing the classification of bleeding by Forest, let's talk in more detail about them.
What is the cause of bleeding in the upper gastrointestinal tract? Here you can highlight several points:
- Injuries to internal organs.
- Intoxication of the body.
- Inflammatory processes.
- The defeat of the digestive tract infection.
- An ulcer or swelling of the stomach, esophagus or duodenum.
- A more rare reason is hereditary pathologies that affect blood vessels and blood. In particular, Randu-Osler disease, hemophilia.
Main symptoms
It is important for the patient to know not only the classification of bleeding according to Forest, but also the symptoms of this pathological condition. These will include the following:
- Blood streaks to be observed in the vomit.
- Unusual shade of vomit. Most often the color of coffee grounds.
- Fatigue, chronic feeling of weakness.
- Constant feeling of thirst.
- Low blood pressure
- Dizziness.
- Before the eyes, "flies fly."
- Pale skin.
- Tachycardia.
- Feces in black.
Danger to the patient
Together with the classification of bleeding according to Forest, many are interested in how dangerous this pathological condition is to humans. If such a loss of blood occurs in a patient for the first time, then statistics will show a small risk - 10% of cases are fatal. But here a relapse of bleeding in the organs of the upper gastrointestinal tract is already dangerous. Here, 50% of fatal cases from all diagnosed are noted. Moreover, the age of the patients does not significantly affect this figure.
However, it is noted that the risk of bleeding in the upper organs of the gastrointestinal tract is most typical for older people. The reason is that they are more likely to develop serious complications of any pathological processes in the body. And most often it affects the upper sections of the digestive system - this is 70% of all cases.
Diagnostics
Classification of gastric bleeding by Forest is used by doctors precisely in the diagnosis of such cases. The doctor begins his work with the following:
- The patient’s medical history is being collected - an anamnesis. The doctor analyzes the symptoms of the pathological process.
- First of all, laboratory methods for studying the patient’s state of health are prescribed - a general analysis of a blood sample, the study of its coagulability.
- FGDS - fibrogastroduodenoscopy is prescribed to the patient. If a person was admitted to a hospital with gastric, intestinal bleeding in a critical condition, then this diagnostic method will be the only one for him.
The classification of Forest with gastrointestinal bleeding will explain the results of the examination obtained using the FGDS technique. Its recognized effectiveness is immediately confirmed by several factors:
- Helps fix an episode of gastrointestinal bleeding.
- Locates a damaged vessel.
- Sets the intensity of bleeding. And this helps specialists understand how much blood a person has lost.
Another plus is the convenience of the procedure. It is produced both at the patient's bedside and in a specialized treatment room.
While analyzing the endoscopic classification of bleeding according to Forest, I would like to draw the reader's attention to another useful function of FGDS. The technique allows you to affect the defect of the "leaky" vascular wall:
- clipping;
- coagulation;
- fibrin filling;
- chipping of the damaged area with drugs that stop bleeding.
Contraindications for fibrogastroduodenoscopy
The classification of ulcerative bleeding according to Forrest, therefore, is applied only on the basis of diagnostic data that were obtained by fibrogastroduodenoscopy. The results of other studies, this gradation cannot explain.
Contraindications to FGDS, therefore, make it impossible to use the classification in relation to pathological gastrointestinal bleeding of an individual patient. These include the following:
- Stroke.
- Acute stage of myocardial infarction.
- The state of agony.
Forest bleeding classification, its significance
This classification was developed by Dr. Forest in 1974. It was intended for gradation of bleeding, which were established during fibroscopy of the gastric department, duodenum. The classification was based on clinical studies that were directly conducted by Forest themselves.
The significance of gradation today is that it introduced into medical practice that unified protocol compilation system that is done by a specialist after each FGDS procedure. In particular, this is a technique for visualizing a pathological focus of bleeding. It is important to emphasize that it helps to choose the most suitable treatment tactics for the patient, which directly affects the speed and quality of his recovery.
Presentation of Forest Classification
Let us introduce readers a classification of ulcerative bleeding according to J. A. F. Forrest.
The first group is F1 (bleeding in the active stage). Two additional categories will be highlighted inside it:
- F1a - in this case, blood will flow out of a damaged vessel by a stream (sometimes a pulsating stream).
- F1b - here the blood mass flows out of the vessel drop by drop. Another name is sweating of a vessel.
The second group is F2. In these cases, the bleeding has already stopped. The group also has its own subcategories:
- F2a - at the bottom of the ulcer, the apparatus determines a thrombosed vessel. Diameter - less than 2 mm.
- F2b - a fixed blood clot was found at the bottom of the ulcer. The diameter here will be more than 2 mm.
- F2c - black spots are detected at the bottom of the ulcer. It looks like a network of small, already thrombosed vessels.
The last group is F3. There are no subcategories here - so the specialist will indicate the result of the examination, in which no gastric and intestinal bleeding was detected (the bottom of the ulcer is clean).
Thus, the classification allows us to determine both the stage of pathological bleeding and its activity. The peculiarity of the gradation is that it helps to choose the right therapy for a particular patient:
- If hemorrhage is observed, then the specialist first of all takes measures for hemostasis (stopping bleeding).
- If vascular bleeding is stopped, then help to the patient is aimed at replenishing the volume of fluid lost by his body, restoring normal blood counts, blood pressure, and pulse.
- If bleeding was not detected, then this fact indicates either the absence of defects in the vascular wall or the healing stage.
Further treatment
Diagnostic results allow you to choose the best treatment option for a particular patient:
- Conservative. This is a drug therapy.
- Operational. This is a surgical intervention of various specificities and volumes - from excision and suturing of the ulcer itself to the resection of the gastric section.
Today, as progress develops, Forest classification is applied in various modifications and variations. However, the entire gradation system of gastrointestinal bleeding is still aimed at determining the activity of the pathological process, selecting the best treatment option for the patient. Classification helps and identify the likelihood of a relapse of the pathology, which can be deadly for the patient.