lower gastrointestinal bleeding
Introduction
Introduction to lower gastrointestinal bleeding Lower gastrointestinal bleeding refers to the intestines less than 50cm from the duodenal suspensory ligament, including jejunum, ileum, colon and rectal lesions. It is customary not to include hemorrhage caused by sputum and anal fissure. Blood is the main type, and the light is only fecal occult blood or black feces. When the amount of bleeding is large, blood is discharged, and in severe cases, shock occurs. When inflammation or ulceration occurs in the mucosa of the digestive tract, mucosal congestion, edema, and ulceration may occur. When inflammation or ulceration erodes blood vessels or blood vessels, and small blood vessels rupture, blood in the stool may occur. Treatment plans should be developed for different causes. When the cause of bleeding is not clear, supportive therapy such as anti-shock should be given first. Absolutely rest in bed, closely observe blood pressure, pulse, respiratory and peripheral circulation perfusion, accurately record the number and number of black feces or blood in the stool, regular review of hemoglobin, red blood cell count, hematocrit, blood urea nitrogen, electrolytes and liver function. The whole blood is supplemented so that the hemoglobin is not less than 10 g/dl and the pulse is less than 100 times per minute. basic knowledge The proportion of illness: 0.003%--0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: shock anemia
Cause
Cause of lower gastrointestinal bleeding
Anal canal disease (35%):
, anal fissure, anal fistula. Rectal disease Rectal injury, non-specific proctitis, tuberculous proctitis, rectal tumors, rectal carcinoids, adjacent malignant tumors or abscesses invade the rectum.
Colonic disease (35%):
Bacterial dysentery, amoebic dysentery, chronic non-specific ulcerative colitis, diverticulum, polyps, cancer and vascular malformations. Small intestinal disease acute hemorrhagic necrotic enteritis, intestinal tuberculosis, Crohn's disease, jejunal diverticulitis or ulcer, intussusception, small intestine tumor, gastrointestinal polyposis, small intestinal hemangioma and vascular malformation.
Prevention
Lower gastrointestinal bleeding prevention
1, should actively treat the primary disease under the guidance of a doctor, such as peptic ulcer and cirrhosis.
2, life should be regular, diet should be regular, avoid overeating, avoid alcohol, avoid smoking, do not drink strong tea and coffee.
3, pay attention to the use of drugs, should be used with little or no irritating drugs, if necessary, should be used to maintain gastric mucosal drugs.
4, regular physical examination, in order to find early lesions, timely treatment, in the presence of symptoms such as dizziness, should be checked in the morning.
Complication
Lower gastrointestinal bleeding complications Complications, shock anemia
Acute hemorrhage can occur in shock, chronic bleeding can be complicated by anemia and other symptoms.
Symptom
Lower gastrointestinal bleeding symptoms Common symptoms Repeated bleeding Gastrointestinal bleeding Bloody sputum Hemorrhage Blood hypoxia Intestinal vascular malformation Low heat abdominal pain Abdominal inflated intussusception
Most of the lower gastrointestinal bleeding is caused by the digestive tract disease itself. A few cases may be local bleeding of systemic diseases. Therefore, medical history and physical examination are still necessary diagnostic steps. Generally speaking, the higher the bleeding site, the blood in the stool. The darker the color; the lower the bleeding site, the brighter the blood of the blood in the stool, or the blood, which of course depends on the speed and number of bleeding, such as the rapid bleeding rate and the large amount of bleeding, the short time the blood stays in the digestive tract. Even if the bleeding site is higher, the blood in the stool may be bright red. Careful collection of medical history and positive signs is helpful for judging the cause of bleeding. For example, blood is dripped after defecation, and it is more common in sputum and anal fissure. Or rectal polyps.
Moderate or more blood in the stool is more common in mesenteric and portal vein thrombosis, acute hemorrhagic necrotic enteritis, ileal colonic diverticulum and ischemic colitis, and even upper gastrointestinal lesions can also be characterized by a large amount of blood in the stool, differentiated in diagnosis, blood and Feces mixed, with mucus, should consider colon cancer, colon polyposis, chronic ulcerative colitis; stool is pus-like blood or bloody stool with mucus and pus, should consider bacillary dysentery, colonic schistosomiasis, chronic colitis, Colonic tuberculosis, etc.; blood in the stool with severe abdominal pain, and even shock phenomenon, should consider mesenteric vascular embolism, hemorrhagic necrotic enteritis, ischemic colitis, intussusception, etc.; blood in the stool with abdominal mass, should consider colon cancer, Intussusception, etc., blood in the stool accompanied by signs of bleeding on the skin or other organs, should pay attention to blood system diseases, acute infectious diseases, severe liver disease, uremia, vitamin C deficiency and so on.
Examine
Examination of lower gastrointestinal bleeding
1. Fecal examination: microscopic examination shows that red blood cells are mostly lower gastrointestinal bleeding; cells or pus cells are inflammatory bowel diseases; finding eggs or trophozoites, or cultivating pathogenic bacteria is conducive to diagnosis. Fecal occult blood test can help to find asymptomatic colon cancer and other gastrointestinal malignant tumors. The commonly used methods are guaiacol method and immunochemical method. The former can be positive for hemoglobin, but other types of non-hemoglobin. Specific oxidants or non-hemoglobin peroxidase can be positive, therefore, the meat should be fasted for 3 days before the test, a variety of vegetables, especially raw vegetables, non-steroidal anti-inflammatory drugs and vitamin C, etc. Although the immunochemical method is simple and inexpensive, it can be positive for a small amount of bleeding in the lower intestinal tract, but the upper digestive tract may not be positive even if it has a large amount of bleeding, which may be caused by the immunogenicity of hemoglobin which has been digested.
2, hemoglobin and hematocrit: help to estimate the degree of blood loss.
3, blood urea nitrogen determination: more than increased, can be identified with upper gastrointestinal bleeding, it has been reported that patients with lower gastrointestinal bleeding, blood urea nitrogen / serum creatinine mm01, ratio meaningful, 95% lower nitrification bleeding 4, anal Refers to the examination: anal, rectal disease can be found.
5, small intestine or colon barium enema: the diagnosis of tumors, diverticulum and inflammation and other intestinal diseases.
6, enteroscopy or fiber colonoscopy: lesions difficult to find for barium meal or barium enema, such as small intestine or colon dysplasia, small intestine leiomyoma or sarcoma, Meckel's diverticulum, radiation enteritis, rectal ulcer, Portal hypertensive colon varices, radiation colitis, faecal steering colitis, ischemic colitis and other diagnostics are helpful, but the application of enteroscopy is not common.
7, celiac artery and superior mesenteric artery angiography: the value of vascular malformation and tumor diagnosis.
8, radionuclide scanning: 99mTc labeled red blood cells, after intravenous injection, abdominal scan can determine the bleeding site, 15Cr labeled red blood cells into the vein, determination of 51Cr content in the stool can determine the amount of bleeding.
Diagnosis
Diagnosis and diagnosis of lower gastrointestinal bleeding
Can be diagnosed based on clinical performance and laboratory tests.
In the nasal cavity, when the oral cavity is bleeding, the blood can also flow out from the mouth, or the black stool can be seen after the blood is swallowed, but it can be identified according to the history of oral and nasopharynx diseases. In addition, it should be combined with oral tincture, bone charcoal, The black stools caused by iron and other substances are differentiated. The color of such black stools is lighter than that of the digestive tract, and the fecal occult blood test is negative. It should also be noted that eating animal liver, blood products and lean meat, and spinach can also cause black stools.
