Bleeding gastrointestinal

Bleeding gastrointestinal . In 85% of cases, the source of bleeding is located in the esophagus, stomach or duodenum, in 14% in the colon and in 1% in the small intestine. Bleeding from the upper part of the digestive tract may be caused by peptic ulcer of the stomach or duodenum (68%), varicose veins of the esophagus and cardiac part of the stomach (12%), erosive gastritis, Mallory-Weiss syndrome, polyps, cancerous tumors, etc. (20 %). In the small and large intestine, bleeding can be caused by diverticula of the small and large intestine, polyps, cancer, sarcoma, angioma, myoma, carcinoid, ulcerative colitis, Crohn's disease, ruptured aortic aneurysms or mesenteric vessels, thrombosis and embolism of mesenteric vessels.

Symptoms are caused by local manifestations of bleeding (vomiting "coffee grounds" or tarry stools) and common phenomena caused by a decrease in the volume of circulating blood. Local manifestations of bleeding: when the source of bleeding is localized in the proximal part of the stomach, vomiting first "coffee grounds", and then unchanged blood with clots. When the source is localized in the prepiloric and antral parts of vomiting, only the "coffee grounds". At the post-piloric source of bleeding, a tarry stool is characteristic; Vomit "coffee grounds" does not happen, if there is no massive transfer of blood through the gatekeeper into the stomach. When bleeding from the small intestine and the right half of the colon in the feces contains dark blood. Bleeding from the left side of the colon is accompanied by the release of unchanged blood. Massive hemorrhage is often manifested by syncope, tachycardia, a sharp decrease in blood pressure, up to a collapse. In the first hours after bleeding, its severity can be judged by the level of hematocrit and the deficiency of BCC; Reduction in the number of erythrocytes in the peripheral blood and hemoglobin level occurs within 12-24 hours. The simplest method for determining the deficit of bcc is the Algover method, which consists in evaluating the shock index, which is a fraction of the pulse rate divided by the magnitude of systolic pressure From 20 to 60 years). Shock index 0.5 indicates a loss of bcc of 15%, an index of 1.0-30%, an index of 2.0-70%. It is also informative to study the dynamics of central venous pressure.

Treatment should include several concurrent activities: 1) replenishment of BCC, i.e., control of hypovolemic shock; 2) clarification of the source of bleeding and its localization; 3) the final stop of bleeding.