There are many reasons why gastrointestinal bleeding can occur. This can be a complication of various diseases and pathologies. In this condition, blood is poured directly into the lumen of the stomach and intestines.
Many confuse them with abdominal bleeding, when when damage to the digestive organs, blood is poured into the abdominal cavity. It is worth noting that this condition greatly complicates the diagnosis. Not only the volume of blood loss, but also the life of a sick person depends on how quickly and timely a diagnosis is made and a correct course of therapy is prescribed.
Main reasons
Depending on the source that provoked such a violation, the signs, methods of diagnosis and treatment of pathology can vary significantly. Among the main causes of gastrointestinal bleeding, it is necessary to distinguish such as:
- erosive gastritis and gastric ulcer;
- inflammation of the esophagus, including due to its burn;
- esophageal varicose veins;
- tumors of the esophagus and stomach;
- Mallory - Weiss syndrome.
There are also many other various reasons, but they are quite rare. In particular, among provoking factors, it is necessary to distinguish such as:
- neoplasms and polyps;
- helminthiasis;
- infectious colitis;
- damage to the walls of the intestine with foreign objects;
- complication of infectious diseases;
- hemorrhoids.
Much less common are bleeding in the lower section than the upper. One of the causes of bleeding of the gastrointestinal tract is a blood disease in which its coagulability is significantly impaired.
Classification
The ICD-10 code for gastrointestinal bleeding is K92.2. The disease refers to the pathology of the digestive system. However, it all depends on the age of the patient. If there is a disease in the baby, then the disease is assigned a code according to ICD-10 - P54.3, since it refers to conditions that occur in the perinatal period.
In order to accurately diagnose, one must take into account the existing classification of such a pathology. If the violation occurs in the upper part of the digestive system, bleeding can be such as:
- esophagus;
- duodenal;
- gastric.
In the presence of diseases of the lower digestive organs, bleeding can be large intestinal, small intestinal and rectal. There are many different classifications of gastrointestinal bleeding (ICD code K92.2). Depending on the mechanism of occurrence, they can be ulcerative and non-ulcer.
Prolonged pathological hemorrhages are divided into acute and chronic. Acute accompanied by severe symptoms and lead to a very serious condition. The chronic type of bleeding is accompanied by anemia, which is characterized by a recurring nature.
According to the degree of severity of the existing symptoms, gastrointestinal bleeding can be obvious and hidden. Depending on the number of repetitions, hemorrhage can be single or recurrent.
In addition, there is another classification that divides bleeding into degrees depending on the amount of blood loss. With a mild course, the patient is fully conscious and experiences slight dizziness. The heart rate rises slightly, and pressure often remains normal.
With moderate severity, a sharp decrease in pressure and increased heart rate are observed. A person remains conscious, however, the skin becomes sharply pale and covered with cold sweat.
The presence of a severe degree indicates a weak filling and tension of the heart pulse. The patient becomes inactive, pale, and there is also a decrease in the amount of urine produced or its complete cessation.
General symptoms
Symptoms of gastrointestinal bleeding can be very different, regardless of whether the pathology is acute or chronic. In the acute course of violations, a latent and explicit period is distinguished. The latent period begins from the moment bleeding occurs until the blood is detected in the feces. From the moment of visual detection, an explicit period begins. The severity of symptoms of gastrointestinal bleeding largely depends on the amount of blood loss, as well as its intensity.
With a slight loss of blood, only tachycardia can be the main symptom. In the event of a loss of 10-20% of the blood volume, the symptoms are least pronounced, and at the same time, the following are observed:
- weakness;
- tachycardia;
- pallor of the skin.
As the bleeding of the gastrointestinal tract develops, the symptoms become much more pronounced and appear as:
- anxiety
- severe weakness;
- tinnitus;
- fainting;
- performances of cold sweat.
With a blood loss of 30-40%, a person can fall into a state of stupor, he has a cold sweat, a sharp pallor of the skin is observed. If blood loss is above 40%, then such a condition is accompanied by signs such as:
- coma;
- marble pallor;
- rapid cooling of limbs and the whole body.
Chronic gastrointestinal bleeding (ICD-10 - K92.2) practically does not manifest itself. In some cases, progressive anemia may occur, which occurs with periods of remission. This condition can be delayed for a long time and does not respond to treatment by taking iron preparations. Clinical symptoms fully comply with the main signs of anemia.
Signs of gastrointestinal bleeding in the upper digestive organs manifest as severe nausea and vomiting. In addition, an tarry black stool is an important symptom of this pathological condition.
In the case of bleeding in the lower sections, impurities of red blood in the feces are observed.
Gastric bleeding in children
In newborns, gastrointestinal bleeding (ICD-10-P54.3) refers to the pathology of the perinatal period. In addition, a similar violation can occur in older children. When making a diagnosis, it is necessary to take into account the baby's age, as well as the reasons that provoked the bleeding.
Often in young children, intestinal diverticulosis is a provoking factor. The signs, diagnosis and treatment of the disease will be similar to that in adult patients.
First aid
If the first signs of a pathological condition occur, it is necessary to provide emergency care for gastrointestinal bleeding and for this patient should be hospitalized in the hospital as soon as possible. If there is no way to do this yourself, then you need to call an ambulance, reporting that the person is bleeding.
Before the ambulance arrives, the patient must be laid on a flat surface and slightly raise his legs. It is important to exclude absolutely any physical activity. Apply ice through a towel to the area of suspected bleeding. This will slow down the process of vasoconstriction.
With gastrointestinal bleeding, emergency care is that the patient is strictly forbidden to consume food and drink. With severe thirst, you can only slightly moisten your lips and mouth with a cotton swab dipped in water.
Many patients suffering from diseases of the digestive system should remember that such pathologies can be complicated by bleeding, which is why they should always have hemostatic drugs in the medicine cabinet. The most common are a solution of calcium chloride and aminocaproic acid.
Diagnostics
To make a diagnosis of "gastrointestinal bleeding", you must undergo a comprehensive examination, which begins with a history and evaluation of vomiting and feces. In addition, a rectal-digital examination may be required. Be sure to consider the shade of the skin. Palpation of the abdomen is carefully performed to avoid increased bleeding. Among the additional research methods, determination of the level of urea and creatine, a review of the coagulogram, as well as renal tests are distinguished.
Radiological diagnostic methods may be required, in particular such as:
- celiacography;
- irrigoscopy;
- angiography;
- X-ray
The simplest and most effective way to diagnose is endoscopy. Such an analysis allows us to establish the presence of a superficial mucosal defect, as well as the source of the lesion.
Treatment features
Treatment of internal gastrointestinal bleeding can be conservative and prompt. The therapeutic effect begins immediately after diagnosis and determination of the main source of damage. The general tactic of conservative treatment is determined by the peculiarity of the course of the underlying disease, the complication of which may be bleeding.
The principles of conservative therapy largely depend on the severity of the condition. In the first degree of the course of the disease, it is prescribed:
- vitamin complexes and calcium preparations;
- injections of "Vikasol";
- following a sparing diet.
Dietary nutrition implies the consumption of only pureed food, which does not injure the gastric mucosa. With moderate bleeding, in some cases, a blood transfusion is indicated, and therapeutic endoscopic procedures are required, during the implementation of which there is a chemical or mechanical effect on the source of bleeding.
If a sick person is in a very serious condition, then a number of resuscitation measures are performed, and an emergency operation may also be required. Postoperative rehabilitation is carried out in a hospital.
Drug therapy
Drug treatment of bleeding from the gastrointestinal tract is aimed at normalizing the hemostatic system. For this, such drugs are prescribed as:
- "Vikasol";
- Thrombin
- Omeprazole "
- "Gastrocepin";
- "Somatostatin."
Patients with low hemoglobin levels are prescribed iron supplements. The most popular drugs are:
- Maltofer;
- Ferlatum;
- Sorbifer.
In order to prevent overdose, the patient must strictly comply with all the doctor's prescriptions. In addition, it is worth remembering that the consumption of coffee or tea significantly impairs the absorption of iron preparations in the blood, and if you drink juices, the process accelerates.
Folk techniques
With gastric bleeding, it is imperative to ensure a calm environment. It is necessary to lay the patient on the bed, put ice on his stomach in a cloth or towel. You can also give a few pieces of ice, as their ingestion accelerates the process of stopping bleeding.
Among folk remedies, one can distinguish tea prepared from a grass shepherd's bag. An infusion of raspberry leaves, sumac, wild alum root and snake highlander has good hemostatic qualities. All these healing herbs need to be poured with boiling water (in the proportion of two tablespoons per glass of water), left to infuse for 30 minutes, and then taken as tea.
A yarrow infusion has a good effect, which must be infused for 1 hour, and then taken 4 times a day before eating food.
Surgical intervention
Often the operation is planned and is carried out after a course of conservative therapy. The only exceptions are life-threatening conditions that require urgent surgical intervention.
With bleeding caused by varicose veins of the esophagus, it requires endoscopic stop using the ligation method, that is, the application of special elastic rings or the installation of vascular clips on the area of bleeding vessels. This is a minimally invasive operation, and for its implementation, a gastroduodenoscope is used, in the instrument channel of which special devices are introduced. Having brought the working area of one of the tools to the bleeding vessel, a clip or ligation ring is applied.
Depending on the available evidence, in some cases a colonoscopy with electrocoagulation of bleeding vessels is used. Some patients require surgical stopping of bleeding vessels. In such cases, a resection of the stomach or flashing of the bleeding area is performed. With bleeding provoked by ulcerative colitis, a subotal colon resection is required, followed by a sigmoid.
Dieting
A patient with acute bleeding is recommended to consume food no earlier than a day after its termination. All food consumed must have a liquid or semi-liquid consistency. In this case, liquid cereals, mashed soups, vegetable purees, natural yogurts, jellies, mousses and jelly are well suited.
After normalization of well-being, the patient’s diet can be somewhat varied and boiled vegetables, steam fish, meat souffle, eggs, soft-boiled eggs, scrambled eggs, and baked apples can be introduced. The patient is recommended to consume cream, butter, milk.
When the condition is fully stabilized, which mainly occurs on the 5-6th day, it is recommended to consume a little food every 2 hours. To reduce hemorrhagic syndrome, you need to consume a large number of products containing vitamins, rosehip broth, fruit and vegetable juices.
It is worth remembering that with the consumption of animal fats, blood coagulation increases significantly, which helps to accelerate the formation of blood clots in people suffering from ulcers.
Frequent blood loss provokes the development of anemia, which is characterized by a violation of the production of hemoglobin due to a lack of iron. To eliminate a serious condition, patients are advised to follow a special diet and at the same time they need to consume as much food rich in iron as possible.
Possible complications
Gastrointestinal bleeding can be quite dangerous and provoke the development of dangerous complications, in particular such as:
- hemorrhagic shock;
- anemia;
- acute renal failure;
- polyhedral insufficiency syndrome.
It is worth remembering that in no case should you conduct independent treatment, as untimely hospitalization can lead to death.
Prophylaxis
Such a pathological condition never arises on its own, it is always a complication of a certain disease, and in some cases trauma. All patients suffering from a chronic form of diseases of the digestive system are shown to undergo regular preventive examinations by a doctor. In addition, if there are indications, it is necessary to take tests and carry out endoscopic examination.
In the presence of dangerous diseases, the diet recommended by the doctor is required, since often exacerbation occurs with nutritional errors.
Gastrointestinal bleeding remains a very difficult problem in both diagnosis and treatment. This is especially true for latent forms of bleeding, in which it is necessary to diagnose and treat as quickly as possible.