bleeding stomach ulcer
Introduction
Introduction to gastric ulcer bleeding Gastroduodenal ulcer bleeding is also a common complication of ulcer disease, a small amount of bleeding often has no clinical symptoms, only found in the fecal occult blood test. When the amount of bleeding is more than 500ml, it is massive hemorrhage, mainly manifested by hematemesis, blood in the stool and varying degrees of anemia. About 10% of inpatients with ulcer disease are hospitalized due to major bleeding. Although bleeding accounts for the largest proportion of all complications, recent bleeding has increased in the proportion of complications of peptic ulcer. basic knowledge The proportion of the disease: the probability of the population is 0.48% Susceptible people: no special people Mode of infection: non-infectious Complications: shock, gastric perforation
Cause
Cause of gastric ulcer bleeding
Ulcer basement vessel rupture (55%):
Gastric ulcer bleeding is caused by erosion of ulcerated basal vessels, mostly arterial hemorrhage. Ulcers of major hemorrhage are usually located in the small curve of the stomach or the posterior wall of the duodenum. Therefore, the source of gastric ulcer bleeding is usually the left and right branches of the stomach. Or blood vessels in the liver and stomach ligaments.
Digestive ulcers (35%):
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. Bleeding is the most common complication of peptic ulcer. 20% to 30% of patients with ulcers have had a history of bleeding. Duodenal ulcer bleeding is more common than gastric ulcer.
Pathogenesis
The pathophysiological changes caused by ulcer bleeding are related to the amount of bleeding and the bleeding rate. Bleeding 50-80ml can often cause tar-like stools without causing other significant symptoms. A large number of rapid blood loss causes hypovolemic shock, anemia, and hypoxia. Circulatory failure, death, a large amount of blood in the gastrointestinal tract often also cause blood biochemical changes, manifested as increased non-protein nitrogen.
Prevention
Gastric ulcer bleeding prevention
Actively treat the primary disease and do a good job in stomach health.
1. Pay attention to the law of life, pay attention to climate change: patients with stomach ulcers must have certain rules of life, not excessive fatigue, overwork will not only affect the digestion of food, but also hinder the healing of ulcers. Patients with ulcers must pay attention to rest and regular life. The onset of ulcer disease has a certain relationship with climate change. Therefore, patients with ulcers must pay attention to climate change, and add and reduce clothes according to the warmth and warmth of the economy.
2. Avoid taking drugs that are harmful to the gastric mucosa: Some drugs, such as aspirin, dexamethasone, prednisone, indomethacin, etc., have a stimulating effect on the gastric mucosa, which can aggravate the condition of gastric ulcer and should be avoided as much as possible. If you need to take it because of the disease, or explain to the doctor, use other medicine, or follow the doctor's advice, cooperate with other auxiliary drugs, or take it after meals to reduce adverse reactions to the stomach.
3. Eliminate the cause of bacterial infection: In the past, it was thought that gastric ulcer was related to gastric juice digestion and related to neuroendocrine dysfunction. Therefore, traditional therapy is to make acid, relieve pain and relieve pain. In recent years, according to research by related scholars, some stomach ulcers are caused by bacterial infections, the most common being Helicobacter pylori. Therefore, it is necessary to reduce the sharing of tableware with people, pay attention to food hygiene, and avoid infection with Helicobacter pylori.
Complication
Gastric ulcer bleeding complications Complications, shock, stomach perforation
It can also cause bloody shock.
Symptom
Gastric ulcer bleeding symptoms Common symptoms Digestive tract perforation benign ulcer changes stomach cramps pale pale prolapse ulcer secretions stench limbs wet cold bowel left abdominal pain dizziness
Symptom
The main symptoms of gastroduodenal ulcer hemorrhage are hematemesis and blood in the stool. Most of them only have blood in the stool without hematemesis. Those who have hematemesis indicate that the amount of bleeding is large or fast. After hematemesis or blood in the stool, it can be manifested as collapse, weakness, sweating or even syncope. .
2. Signs
Depending on the speed and amount of bleeding, such as 400ml of bleeding, often manifested as circulatory system compensatory response, such as pale skin, fine pulse, normal or slightly elevated blood pressure; if blood loss is above 800ml, there are signs of shock, including blood pressure drop The pulse is fast, the breathing is short, the sweat is sweating, the limbs are wet and cold, and the abdominal signs are often only active in the bowel sounds, and half of the patients have increased body temperature.
Examine
Gastric ulcer bleeding check
Blood test
Blood tests associated with GU bleeding, including hemoglobin, hematocrit, reticulocyte count, bleeding, and clotting time.
2. Fecal occult blood test.
For patients with difficulty in diagnosing the cause of bleeding and bleeding, the following methods can be used to assist in the diagnosis:
1. Fiber endoscopy
Fiberoptic endoscopy is the first choice for upper gastrointestinal bleeding examination. It has been proved that this method has more than 90% accuracy in the diagnosis of gastric ulcer bleeding.
The time of examination should be carried out within 6~12h after the bleeding. If the patient's general condition permits, the earlier the examination time, the better. If the examination time exceeds 12h, the bleeding can be stopped, the mucosal healing is not easy to be found, and there is a blood clot in the stomach. Agglutination, although washed with iced water, is not easy to remove, affecting the inspection results.
For some patients with gastric ulcer and bleeding who are difficult to diagnose before surgery and difficult to find lesions, you can use fiberoptic gastroscopy during surgery, that is, through the stomach stoma, first absorb the blood in the stomach, and then put it into the immersed disinfection. Fiber gastroscope, tightening the stoma, and examining it piece by piece, often find lesions that are difficult to detect before surgery.
2. Selective angiography
It has high accuracy in diagnosing the bleeding site of gastric ulcer. The bleeding speed can be displayed at 0.5~2ml/min. When the fiber endoscopy can not clearly indicate the bleeding site, angiography can often show the location and extent of bleeding, such as blood vessels. The angiography showed that most of the small bleeding points in the left gastric artery distribution area can be hemostasis by perfusion of the vasoconstrictor through the left gastric artery; and when it is confirmed that a large blood vessel is bleeding, it should be treated early.
3. Barium meal check
Barium meal examinations for acute bleeding often cause illusions or influence diagnosis due to the presence of clots, and other tests are affected by the presence of tincture shadows.
Diagnosis
Diagnosis and differentiation of gastric ulcer bleeding
Inspection diagnosis
1. Qualitative diagnosis
Have a history of ulcers, found that there is massive bleeding in the gastrointestinal tract, the first should be considered for gastroduodenal ulcer bleeding, domestic literature statistics of gastroduodenal ulcer bleeding accounted for 50% to 75% of upper gastrointestinal bleeding, but there are still 10% ~15% of patients with ulcer bleeding, no history of ulcers, diagnosis is more difficult, need to make a detailed differential diagnosis.
2. Evaluation of the amount of bleeding
Gastric ulcer bleeding more than 50ml stool can be black, so it is not possible to judge whether there is major bleeding by black stool. The clinically simple method is to observe the patient's complexion and measure blood pressure and pulse to estimate the blood loss.
(1) Face: If the face is pale, dizzy, nausea, or even fainting, it is estimated that the amount of blood loss exceeds 15% of the blood volume, but it is necessary to rule out the paleness and other symptoms caused by mental stress during hematemesis.
(2) Blood pressure: a patient with normal blood pressure, such as systolic blood pressure after bleeding is 12.0 ~ 13.3kPa (90 ~ 100mmHg), bleeding volume is 200 ~ 300ml; when systolic blood pressure is 10.7 ~ 12.0kPa (80 ~ 90mmHg), then There is 500 ~ 1000ml of bleeding; if the systolic pressure is below 8.00kPa (60mmHg), the amount of bleeding can reach more than 1000ml.
(3) Pulse: Pulse changes, individual differences are very large, such as athletes usually pulse is relatively slow, although there is major bleeding, heart rate can be less than 100 times / min or increase is not obvious, in general, such as a patient's usual heart rate 70 After about /min, the heart rate rises to 90-100 times/min after hematemesis, and the amount of bleeding is about 500ml. If the heart rate reaches 100-110 times/min, the amount of bleeding is about 500-1000ml; if the heart rate reaches 120 times/min Above, the amount of bleeding can be above 1000 ml.
(4) Hematocrit (HCT): The ratio is generally parallel to the amount of bleeding, but if measured prematurely, due to the reflexive contraction of peripheral blood vessels and redistribution of red blood cells, the actual situation of blood loss, such as blood cell ratio, cannot be accurately reflected. If the volume is between 30% and 40%, there may be about 500ml of bleeding; if it is below 30%, the amount of bleeding may be above 1000ml. It can also be calculated by the following formula:
Blood loss = (normal HCT - HCT after hemorrhage) / normal HCT
(5) Central venous pressure: normal value is 0.49 ~ 0.981 kPa (5 ~ 10cmH2O), such as below 0.49kPa (5cmH2O), indicating blood volume reduction, central venous pressure of patients with major bleeding is often below 0.29kPa (3cm H2O).
It should be pointed out that these observations can only be used as a reference for estimating the amount of bleeding. It is closely related to the physical condition, responsiveness and bleeding rate of patients before hemorrhage, and should be fully considered in the prediction.
(6) Nuclide method: The amount of blood loss can be measured by 51 chrome (chromium51Cr) labeled red blood cells by taking 40 ml of venous blood from the patient, labeling with 51 of 20051Ci, then injecting it intravenously, then collecting the feces for 24 hours, and measuring the radiation. Quantity, under normal circumstances, the content of 51Cr in the feces is extremely small. If the content is increased, it means there is bleeding. According to the amount of 51Cr in the feces, the blood loss is calculated. This method is more accurate, but the method is complicated and the method is cumbersome. Can not be widely adopted.
Differential diagnosis
Often need to be associated with esophageal varices bleeding, gastritis hemorrhage, gastric cancer and gastric leiomyoma, gastric hemangioma hemorrhage, biliary bleeding, etc., Mallory-Weiss syndrome, ie esophageal cardia mucosal tear syndrome can also be severe Major bleeding after vomiting.
