The stomach is a reservoir for temporary storage of food received from the esophagus. It synthesizes all the necessary enzymes and biologically active substances, directs the food lump further along the gastrointestinal tract. This article will discuss emergency care for stomach bleeding.
Features of blood supply
Arterial vessels envelop this hollow organ along the greater and lesser curvature. A venous plexus is located in the area of transition of the esophagus into the stomach, which can cause the development of massive bleeding in case of vein disease, as well as with an excessive increase in load.
Classification of bleeding
Gastric bleeding (according to ICD-10 its code K92.2) is a very dangerous condition that, if not treated promptly, can lead to death.
By etiology:
- Peptic ulcer (with peptic ulcer of the stomach and duodenum).
- Non-ulcer, arising for other reasons.
By the duration of bleeding:
- Acute - fast, fairly pronounced outflow of blood over a short period of time.
- Chronic - long, less intense.
Depending on the severity of the signs, gastric bleeding can be:
- Explicit . With their presence, of course, we can talk about hemorrhage, making a diagnosis is not difficult.
- Hidden . There are no pronounced symptoms, other diagnostic studies are required to determine the cause of pallor of the skin.
Emergency care for gastric bleeding will be described below.
Causes
Causes affecting changes in the stomach are listed below:
- Peptic ulcer. This pathology in more than 20% of cases has a tendency to complication in the form of bleeding, occurs with the aggressive effects of gastric juice.
- Vascular thrombosis, therefore, increased pressure, which leads to thinning of the wall and the outflow of contents into the cavity of the organ.
- Malignant neoplasms. In this case, cancer occurs either primarily (that is, there are no pathological processes predisposing to its development) or is a complication, for example, of the same peptic ulcer. First aid for gastric bleeding should be provided in a timely manner.
- Diverticulum - the presence of protrusion of the wall or all its layers. This will be a true diverticulum. Or without involving any layer - false. Diagnosis is not difficult: when examining the x-ray picture, the symptom of the "finger" is visible.
- Diaphragmatic hernia, in which the stomach passes through the existing physiological opening in the diaphragm, communicating chest and abdominal forgiveness. This is observed with the following pathologies: ulceration of the mucous membrane under the influence of aggressive gastric juice and in combination with peptic ulcer.
- Polyps are a type of benign tumor. The cause of bleeding, if any, is injury to the active components of the gastric juice and a violation of the "nutrition" of the polyp, for example, when the legs are pinched or twisted. Treatment of gastric bleeding will largely depend on the cause of its occurrence.
- Mallory Weiss Syndrome. It occurs when a crack forms in the area of transition of the esophagus mucosa to the gastric mucosa. This can be triggered by the intake of alcoholic beverages in combination with a large amount of food or in the presence of a diaphragmatic hernia that has already arisen in the patient.
- Hemorrhagic gastritis. With this type of gastritis, ulcerative changes occur on the surface of the upper wall, initially presented in the form of erosion, with the possibility of transition to huge (more than 3 centimeters) ulcers.
- Stress ulcers. They arise from any severe stress during which the protective reaction of our body becomes “decompensated”, as a result of which there is a sharp release of adrenal hormones. This leads to an increase in the acidity of the juice and, consequently, the formation of surface defects such as erosion or ulcers. What other causes of gastric bleeding are?
Vascular disease can lead to bleeding. Varicose veins of the venous plexus of the lower esophagus and upper portion of the stomach are observed with:
- cirrhosis of the liver;
- neoplasms;
- portal vein thrombosis, compression of various etiologies;
- chronic lymphocytic leukemia.
Systemic vasculitis, such as periarteritis nodosa and Shenlein-Genoch purpura, are dangerous. These are autoimmune diseases that occur with damage to the walls of blood vessels.
Atherosclerosis and hypertension can also cause bleeding in the stomach. With this category of pathology, there is a risk in the form of an overstrain of the vascular wall and a subsequent rupture, accompanied by gastric bleeding.
Clotting disorder causes a dangerous condition in the stomach:
- Hemophilia - decreased blood coagulability. This is a hereditary disease.
- Leukemia is acute and chronic, in particular, with impaired platelet formation.
- Hemorrhagic diathesis. Combine disorders both from the side of blood coagulation, and from the side of increased bleeding.
- Lack of vitamin K. It leads to hemorrhages in various groups of organs, including vital ones, for example, the brain.
Signs of gastric bleeding
General symptoms:
- Feeling of weakness, lethargy.
- Pallor of the skin and visible mucous membranes.
- Cold sweat.
- Decreased blood pressure.
- Frequent weak pulse fluctuations.
- Dizziness and a feeling of stuffiness in the ears.
- Manifestations of inhibition, confusion of consciousness up to its loss.
Accordingly, the more massive the blood loss, the faster and brighter the clinical picture appears. If in this situation first aid for stomach bleeding has not been performed, then the risk of death is very high.
A distinctive feature is the nature of the vomit, which resembles the "coffee grounds" in color.
Staining in this color is provided by the action of hydrochloric acid. If the blood in the vomit has an unchanged color, then we can assume that this is bleeding from the upstream departments (for example, the esophagus) or massive bleeding, in which the blood simply does not have time to interact with the acid.
A specific sign is also the presence of a black tarry stool - melena.
Severity
- Light - minor blood loss. The patient's condition is satisfactory, the pulse is not higher than 80 beats per minute, and the systolic blood pressure does not fall below 110 mm. Hg. Art. The patient is conscious.
- The average degree is an increase in heart rate to 90-100 beats per minute, a decrease in blood pressure to 100-110 mm. Hg. Art. The skin and mucous membrane are pale, covered with a sticky cold sweat, the patient experiences severe dizziness.
- Severe - severe inhibition, and in some cases, an unconscious state with no reaction to strong stimuli. Pulse more often than 110 beats, blood pressure, respectively, significantly less than 110 mm. Hg. Art.
Gastric bleeding emergency
What is emergency care for bleeding from the stomach? All necessary actions are listed below:
- Providing bed rest, which helps to reduce the rate of bleeding.
- Setting a cold compress (we will consider the algorithm below).
- Rinsing the stomach with ice water, the essence is to spasm the bleeding vessels and then stop or slow the flow of blood.
- Prescribing adrenaline or norepinephrine drugs through a gastric tube. This group of hormones refers to stress factors that cause compensatory narrowing of the lumen of blood vessels.
- Replenishment of reserves of the total volume of circulating blood (BCC) by introducing hemostatic solutions by the intravenous drip method.
- Use as a substitute for lost donated blood, blood substitutes and frozen plasma.
Other therapy is given if indicated.
Cold compress
A trust relationship should be established with the patient. He needs to understand the purpose and course of setting a cold compress. The algorithm of actions performed with his consent is as follows:
- Hands must be washed and dried.
- Prepare all the necessary items (gauze napkins, a basin with water, ice).
- One of the napkins is wetted in cold water, slightly wrung out.
- Applied to the desired area of the body.
- The compress is replaced every two minutes, at this time a second napkin is applied.
Endoscopic treatment
This treatment method is carried out:
- By chipping a peptic ulcer with solutions of adrenaline and norepinephrine to achieve vasospasm.
- Cauterization - electrocoagulation of the mucosa.
- Laser coagulation.
- Installation of clips and flashing of the vascular apparatus.
Use of special medical adhesive.
Indications for surgical treatment
Acute gastric bleeding is an indication for surgery with:
- lack of positive results from previous conservative and endoscopic events;
- unstable condition of the patient or serious, which may soon become complicated (for example, coronary disease or stroke);
- repeated bleeding.
Types of Interventions
The following types of surgical interventions are carried out:
- Suturing a defect.
- Resection of a part of the stomach.
- The implementation of plastic in the area of the borders of the esophagus and stomach
- Endovascular interventions.
Rehabilitation after surgery
It is important to follow all the doctor's recommendations, then recovery will come faster.
- Day one - you can move your arms and legs.
- Day two - the beginning of the introduction of breathing exercises.
- Day three - you can try to get on your feet.
- Eighth day - postoperative sutures are removed.
- Day fourteen - an extract from the department with recommendations for limiting physical activity during the month and the need to perform a set of exercises for physiotherapy exercises.
Diet after surgery
The following rules apply to diet:
- Day one - you can’t drink and eat, just drain the surface of the lips.
- Day two - it is allowed to drink water in half a glass with a teaspoon.
- Day three - it is possible to increase the amount of fluid consumed (water, broth, juice) to half a liter.
- Day four - up to four glasses of liquid are allowed when taking into account the separation of this amount into 8-12 doses. You can eat mucous soups.
Starting from the fifth day, cottage cheese, semolina is added to the diet, and from the seventh - boiled meat. Switching to regular meals in small portions is allowed from the ninth day.
So, we considered emergency care for gastric bleeding.