Emergency care for gastric bleeding: an algorithm of action. Causes, symptoms and treatment of gastric bleeding

Stomach is a reservoir for temporary storage of food 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 consider emergency care for gastric bleeding.

Features of the blood supply

Arterial vessels round this hollow organ along the large and small curvature. In the area of ​​passage of the esophagus into the stomach is located the venous plexus, which can serve the development of massive bleeding in the case of venous disease, as well as an excessive increase in the load.

Classification of bleeding

Gastrointestinal bleeding( ICD-10 code K92.2) is a very dangerous condition which, if not treated in a timely manner, can lead to death.

For etiology:

• Ulcerous( with peptic ulcer of stomach and duodenum).
• Non-ulcerated, arising for other reasons.

For bleeding duration:

• Acute is a rapid, fairly pronounced outflow of blood for a short period of time.
• Chronic - long, less intense.

Depending on the severity of the symptoms, gastric bleeding may be:

• Explicit .If they are available, of course, we can talk about hemorrhage, the diagnosis is not difficult.
• Hidden .There are no clearly expressed symptoms, other diagnostic studies are required to determine the cause of pallor of the skin.

Emergency care for gastric bleeding will be described below.

Reasons for

The reasons for 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 when aggressive exposure to gastric juice.
• Vascular thrombosis, therefore, increases the pressure, which leads to a thinning of the wall and the outflow of the contents into the cavity of the organ.
• Malignant neoplasms. Cancer in this case arises either initially( 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, it is false. Diagnosis is not difficult: when examining an x-ray picture, a symptom of a "finger" is seen.

• Diaphragmatic hernia, in which the stomach passes through the existing physiological opening in the diaphragm, which communicates the thoracic and abdominal prostheses. This is observed in the following pathologies: ulceration of the mucosa under the influence of aggressive gastric juice and when combined with ulcerative lesions.
• Polyps are a kind of bona fide tumor. The cause of bleeding, if present, is the trauma of the active components of the gastric juice and a violation of the "feeding" of the polyp, for example, when the pedicle is infringed or twisted. Treatment of gastric bleeding will largely depend on the cause of its occurrence.
• Syndrome of Mallory-Weiss. Occurs when a crack is formed in the area of ​​transition of the esophagus mucosa into the gastric mucosa. This can be triggered by taking alcoholic beverages in combination with a large amount of food, or in the presence of a diaphragmatic hernia already present in the patient.
• Hemorrhagic gastritis. With this type of gastritis on the surface of the upper wall, ulcerous changes occur, initially presented as erosions, with the possibility of transition to large( more than 3 centimeters) ulcers.
• Stress ulcers. Arise from any strongly pronounced stress, during which the protective reaction of our body becomes "decompensated," resulting in a sharp release of adrenal hormones. This leads to an increase in the acidity of the juice and, accordingly, the formation of surface defects, such as erosion or ulcers. What other causes of gastric bleeding happen?

Bleeding can result in vascular disease. Varicose expansion of the venous plexus of the lower part of the esophagus and the upper portion of the stomach, are observed with:

• of liver cirrhosis;
• neoplasm;
• portal vein thrombosis, compression of various etiologies;
• chronic lymphocytic leukemia.

Systemic vasculitis, such as nodular periarteritis and purple Shenlaine-Genocha, are dangerous. These are autoimmune diseases that occur with the 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 overstrain of the vascular wall and a subsequent rupture accompanied by gastric bleeding.

Blood clotting causes a dangerous condition in the stomach:

• Hemophilia-reduced blood clotting. This is a hereditary disease.
• Leukemia is acute and chronic, in particular, in the violation of platelet formation.
• Hemorrhagic diathesis. Combine the violations from the side of blood clotting, and from the side of increased bleeding.
• Lack of vitamin K. Causes hemorrhages in various groups of organs, including vital, for example, the brain.

Signs of gastric bleeding

General symptomatology:

• Feeling of weakness, lethargy.
• Pale skin and visible mucous membranes.
• Cold sweat.
• Decrease in the value of 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. If, in this situation, first aid was not performed with gastric bleeding, the risk of death is very high.

A distinctive feature is the nature of vomit, which resembles "coffee grounds" in color.

Coloration in such a 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 bleeding from the upper divisions( for example, the esophagus) or massive bleeding, in which the blood simply does not have time to interact with the acid.

A specific feature is also the presence of black tar-like stool - melena.

Degree of severity

• Light - slight blood loss. The patient's condition is satisfactory, the pulse does not exceed 80 beats per minute, and the systolic blood pressure does not fall below 110 mm.gt;Art. The patient is conscious.
• Average degree - increased heart rate to 90 -100 beats per minute, decrease in blood pressure to 100-110 mm.gt;Art. Skin and mucous pale, covered with a sticky cold sweat, the patient experiences severe dizziness.
• Severe degree - a strong inhibition, and in some cases, an unconscious state with a lack of response to strong stimuli. Pulse more often 110 strokes, blood pressure, respectively, much less than 110 mm.gt;Art.

Emergency Care for Gastric Bleeding

What is the emergency help for bleeding from the stomach? All the necessary actions are listed below:

• Providing bed rest, which helps reduce the rate of bleeding.
• Setting a cold compress( we'll look at the algorithm below).
• Rinsing the stomach with ice water, the essence is to spasmodic bleeding vessels and then stop or slow the flow of blood.
• Administration of adrenaline or norepinephrine with a gastric tube. This group of hormones refers to stress factors that cause compensatory narrowing of the lumen of blood vessels.
• Replenishment of total circulating blood volume( BCC) by injecting hemostatic solutions with an intravenous drip method.
• Use as a replacement for lost blood of donor, blood substitutes and frozen plasma.

Another therapy is performed if there is evidence.

Cold compress

A patient relationship should be established with the patient. He needs to understand the purpose and the course of setting up a cold compress. The algorithm of actions performed with his consent is as follows:

• Hands should be washed and dried.
• Prepare all necessary items( gauze napkins, pelvis with water, ice).
• One of the wipes 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 the second napkin is applied.
  

Endoscopic method of treatment

This method of treatment is carried out:

• By cutting the ulcer defect with adrenaline and norepinephrine solutions to achieve vessel spasms. Moxibustion - electrocoagulation of the mucosa.
• Laser coagulation.
• Installation of clips and flashing of the vascular apparatus.

Use of a special medical adhesive.

Indications for surgical treatment of

Acute gastric bleeding is an indication for surgery when:

• no positive results from previous conservative and endoscopic interventions;
• patient's unstable condition or severe, which may soon worsen( eg, ischemic disease or stroke);
• repeated bleeding.

Types of interventions

The following types of surgical interventions are carried out:

• Stitching of a defect.
• Resection of a part of the stomach.
• Exercise of plastic in the region of the esophagus and stomach.
• Endovascular interventions.

Rehabilitation after operation

It is important to follow all the recommendations of the doctor, then recovery will come sooner.

• 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.
• Day eight - postoperative sutures are removed.
• Day fourteenth - an extract from the department with recommendations for limiting physical activity during the month and the need to perform a set of exercises of physical therapy.

Diet after operation

The following rules apply to the diet:

• Day one - it is impossible to drink and eat, only to drain the surface of the lips.
• Day two - it is allowed to drink water in half a cup of tea spoon.
• Day three - it is possible to increase the amount of consumed liquid( water, broth, juice) to half a liter.
• Fourth day - the use of up to four glasses of liquid is allowed, taking into account the division of this quantity into 8-12 receptions. You can eat mucous soups.

Beginning with the fifth day, cottage cheese, semolina porridge is added to the diet, and from the seventh - boiled meat. The transition to normal meals in small portions is allowed from the ninth day.

So, we considered emergency care for gastric bleeding.