Gastric and duodenal ulcer bleeding
Introduction
Brief introduction of gastric and duodenal ulcer bleeding Gastric, duodenal ulcer combined with bleeding is one of the common causes of upper gastrointestinal bleeding. Bleeding is caused by erosion, rupture, etc. of the blood vessels. When the capillaries are damaged, occult blood is found only during stool examination, and when the larger blood vessels are damaged, black stools and hematemesis appear. Generally, the symptoms are aggravated before the bleeding, and the upper abdominal pain is relieved or disappeared after the bleeding. Invasion of the basal vessels of the ulcer leads to rupture and bleeding, mostly arterial bleeding. The hemorrhagic ulcer is usually located in the small curvature of the stomach or the posterior wall of the duodenum. Therefore, the source of gastric ulcer bleeding is usually the left and right gastric artery and its branches, and the bleeding of the duodenal ulcer is mostly from the superior pancreaticoduodenal artery or stomach. The duodenal artery and its branches. The clinical manifestations of massive hemorrhage of gastroduodenal ulcer depend on the amount of bleeding and the rate of bleeding. The main symptoms of the patient are hematemesis and tar-like black stools. Most patients have only black stools without hematemesis, and rapid bleeding is a large amount of hematemesis and purple blood. basic knowledge The proportion of illness: 0.12% Susceptible people: no specific population Mode of infection: non-infectious Complications: shock, hemorrhagic shock
Cause
Gastric, duodenal ulcer bleeding cause
Stomach ulcer (30%):
Ulcer disease or peptic ulcer is a common digestive tract disease that can occur in the esophagus, stomach or duodenum. It can also occur in the stomach-jejunum anastomosis or in the Meckel room containing the gastric mucosa because of gastric ulcer and Duodenal ulcers are the most common, so the so-called peptic ulcers generally refer to gastric ulcers and duodenal ulcers.
Duodenal ulcer (30%):
Duodenal ulcer due to a variety of factors caused by duodenal mucosal and muscular layer defects. Although it is similar to gastric ulcer in terms of clinical manifestations and drugs, it has significant differences in terms of incidence, age, sex, and pathogenesis. Refers to chronic ulcers that are only found in the contact area between the gastrointestinal tract and gastric juice, also known as ulcer disease. Traditional Chinese medicine refers to the category of "stomach pain", "heartache", and "stomach pain".
Gastric perforation (30%):
Gastric perforation is one of the most serious complications in patients with ulcer disease. Gastric perforation is mainly caused by overeating on the basis of gastric ulcer. Overeating can cause gastric acid and pepsin to increase, and it is easy to induce gastric perforation. Sudden abdominal pain suddenly occurs in the patient. The pain begins in the upper abdomen or perforation. It often has a knife-cut or burning-like pain. It is generally persistent and the pain spreads quickly to the entire abdomen.
Pathogenesis:
The ulcer bleeding is the result of ulcer erosive basal vascular rupture, mostly moderate arterial hemorrhage. The hemorrhagic ulcer is usually located in the small curve of the stomach or the posterior wall of the duodenum. The bleeding of the small curvature of the stomach often comes from the branch of the right and left artery. Duodenal ulcer bleeding mostly comes from the pancreaticoduodenal artery or the gastroduodenal artery and its branches. The rupture of the side wall of the blood vessel is not easy to stop bleeding by the bleeding of the broken end. Sometimes the blood volume is reduced due to hemorrhage, blood pressure. Lowering, blood clots in the rupture of blood vessels, bleeding can stop by itself, but about 30% of cases can have a second major bleeding.
Prevention
Gastric and duodenal ulcer bleeding prevention
In order to prevent ulcers and bleeding, the following should be done:
1, life should be regular, pay attention to work and rest, keep a good mood, avoid overwork, mental stress, keep warm during the season change, quit smoking and alcohol, eat less or not eat irritating food.
2, try not to use or use drugs that are irritating to the gastric mucosa, such as hypertensive patients should try to avoid using blood and equal blood pressure drugs, such as arthritis and other diseases must take hormones or indomethacin and other non-steroidal anti-inflammatory drugs . Should take gastric mucosal protective agents or drugs that inhibit gastric acid secretion (H2 receptor blockers, proton pump inhibitors, etc.), such as Thai stomach, it belongs to H2 receptor blocker, is a more commonly used acid suppression It can moderately inhibit gastric acid secretion and has fewer side effects.
3, once the patient has upper abdominal pain, abdominal distension, nausea and other symptoms of dyspepsia, should go to the hospital in time, and carry out some necessary examinations, once you find peptic ulcer, you should follow the doctor's advice for regular treatment and regular review until the ulcer is fully healed until.
Complication
Stomach, duodenal ulcer bleeding complications Complications, shock, hemorrhagic shock
Short-term bleeding > 400ml, there may be circulatory system compensation phenomenon; bleeding volume > 800ml, you can have shock.
Symptom
Gastric and duodenal ulcer bleeding symptoms Common symptoms Internal bleeding Repeated bleeding Abdominal tenderness Blood pressure drops Black hunger When the upper abdominal pain ball After the ulcer Abdominal pain Cold sweat Abdominal discomfort
1, symptoms
1 small amount of repeated bleeding, manifested as anemia, stool stable blood test positive.
2 massive bleeding, hematemesis and melena.
3 The amount of bleeding in the short term is >400ml, and there is a compensation phenomenon of the circulatory system; if the amount of bleeding is >800ml, shock can occur.
2, other symptoms
In patients with hemorrhagic disease, it is not suitable for complicated examinations in the shock stage, but rapid and gentle examination is still necessary. There is peritoneal irritation, which may be accompanied by ulcer perforation.
Examine
Stomach, duodenal ulcer bleeding check
Auxiliary inspection:
1, fiber gastroscopy, the positive rate can reach more than 90%.
2, selective celiac angiography, sometimes visible contrast agent spilled into the digestive tract from the bleeding point of the ulcer.
Most patients have a history of ulcers before hemorrhage, about 10 to 15% of patients with ulcer bleeding, no ulcer symptoms before bleeding. Once a patient with major bleeding has the following signs:
1, tar-like stool and hematemesis: most ulcers and bleeding cases suddenly, bleeding is not accompanied by abdominal pain, most patients first feel nausea, dizziness and upper abdominal discomfort, then hematemesis or tar-like stool, or both. Hematemesis is more than duodenal gastrointestinal bleeding, and tar-like forms can appear in any part of the digestive tract, but there are bound to be tar-like stools. In the case of ulcer disease, such as sudden hematemesis, there is no black blood clot, mostly gastric ulcer bleeding, and only tar-like will be duodenal ulcer bleeding.
2, shock: when the blood loss is 400 ml, there is a shock compensation period, pale, thirsty, rapid pulse, normal or slightly higher blood pressure. When the blood loss is 800 ml, there may be obvious shock phenomenon, cold sweat, rapid pulse, shallow breathing and blood pressure drop.
3, anemia: a large number of bleeding, hemoglobin, red blood cell count and hematocrit decreased. In the early stage, due to blood concentration, the decrease may not be obvious. Therefore, it is necessary to repeat the measurement in a short period of time. Repeated measurement can show the severity of the bleeding, and it can also indicate whether the bleeding is still continuing or has stopped, and whether the treatment effect is good.
4, other symptoms: patients with massive bleeding in the shock stage, it is not appropriate to do complicated inspections, but rapid and gentle physical examination is still necessary. There is peritoneal irritation, which may be accompanied by ulcer perforation.
Diagnosis
Diagnosis and diagnosis of gastric and duodenal ulcer bleeding
Diagnose based on
1. A history of typical ulcers (10%-15% of patients may have no);
2, hematemesis or tar-like stools;
3, there is reflux compensation or shock performance;
4, upper abdominal tenderness, bowel sounds active;
5, gastroscopy can find the source of bleeding;
6, selective celiac angiography, sometimes visible contrast agent spilled from the ulcer bleeding point into the digestive tract.
Differential diagnosis
Ulcer bleeding should be associated with various upper gastrointestinal bleeding diseases such as portal hypertension complicated with major bleeding, acute biliary bleeding, and gastric cancer hemorrhage.
