stomach bleeding
Introduction
Introduction to stomach bleeding Stomach hemorrhage is commonly called upper gastrointestinal bleeding, more than 40% is caused by stomach and duodenal ulcer, overworked, irregular diet, abnormal emotional tension and other people with a history of digestive tract are prone to disease; followed by acute hemorrhagic gastritis The resulting gastric bleeding, the majority of these causes of gastric bleeding can be effectively treated after regular treatment. In addition, it is caused by cirrhosis of the stomach, cirrhosis patients generally develop esophageal and gastric varices, if you eat coarse food, excessive emotional stimulation, rupture of the venous blood vessels of the esophagus and stomach will cause major bleeding. The mortality rate of gastric bleeding is as high as 10%. Anyone who has nausea or vomiting due to blood stimulation after hemorrhage can have hematemesis. If vomiting immediately after bleeding, the blood is bright red; if the blood stays in the stomach for a period of time, and then vomits after gastric acid action, it is brown in brown coffee. In addition to spitting, the blood is more discharged from the intestines. Since hemoglobin forms black iron sulfide by intestinal sulfide, the discharged blood is generally tar-like black stool. Only when the amount of bleeding is large and the blood passes through the intestines quickly, the discharged blood is dark red or occasionally bright red. In general, when the amount of bleeding is large, there is black stool and hematemesis; when the amount of bleeding is small, there is often only black stool. If the bleeding site is in the duodenum, hematemesis is less common. basic knowledge The proportion of disease: 0.05% - 0.07% (incidence rate is about 0.05% - 0.07%, more common in alcoholics) Susceptible people: no special people Mode of infection: non-infectious Complications: anemia shock
Cause
Cause of gastric bleeding
Gastric and duodenal diseases (20%):
Gastric ulcer, duodenal ulcer, acute gastric mucosal erosion, stress ulcer, chronic gastritis, gastric cancer, gastric polyp, gastric leiomyosarcoma, gastric leiomyoma, gastric mucosal prolapse, postoperative anastomotic ulcer, intussusception, Gastric granuloma lesions, duodenal diverticulum.
Esophageal disease (20%):
Esophageal varices, esophageal and gastric mucosal tear syndrome, esophageal hiatal hernia, esophagitis, esophageal ulcer, esophageal cancer, benign esophageal tumor, esophageal diverticulum.
Vascular lesions (15%):
Aortic aneurysm, splenic aneurysm, small aneurysm in the stomach wall, hemangioma, submucosal arteriovenous malformation, hereditary hemorrhagic telangiectasia.
Hepatobiliary and pancreatic diseases (15%):
Cirrhosis with portal hypertension, liver cancer with portal hypertension, portal vein thrombosis, portal vein obstruction syndrome, biliary bleeding, ampullary cancer, pancreatic cancer invasion of duodenum, acute pancreatitis.
Systemic diseases and others (10%):
Epidemic hemorrhagic fever, leptospirosis, pulmonary heart disease, emphysema with infection, coagulopathy, leukemia, cyanosis, hemophilia, disseminated intravascular coagulation, lymphoma, uremia, amyloidosis, Sarcoidosis.
Prevention
Gastric bleeding prevention
Preventive health care
1, regular diet, do not overeating, eat on time, diet should be light, eat less spicy, fried, fried, spirits and other non-digestible and irritating food, eat more fruits, vegetables and fiber food, drink more water.
2, keep the mood good, do not be pessimistic, the stomach is one of the most affected organs.
3, strengthen physical exercise is the key to treatment, jogging, playing Tai Chi and so on.
In addition, you need to pay attention to:
1. Reduce the predisposing factors, including quitting smoking, not drinking hard alcohol, strengthening self-health, paying attention to the rules of life and diet. At the same time, as little as possible to take drugs that are harmful to the gastric mucosa, if you must take it, you should add H2 receptor antagonist or alkaline antacid, gastric mucosal protective agent, proton pump inhibitor and so on.
2, where the number of recurrence of ulcer disease, ulcer healing, and complications (such as gastrointestinal bleeding, ulcer perforation, pyloric obstruction) should adhere to maintenance treatment.
3, for patients with older, more serious concomitant diseases or need to take non-steroidal anti-inflammatory drugs (such as aspirin, indomethacin, etc.), should be given maintenance treatment.
4. For patients with recurrence of ulcer disease, in principle, a gastroscopy should be performed to determine whether there is recurrence and whether it is still a benign ulcer. Be alert to the very few benign gastric ulcers that malignant under the chronic stimulation of repeated destruction and regeneration.
5, in the serious maintenance treatment or shortly after the withdrawal of the ulcer disease, should go to the hospital for follow-up, to see if there is Helicobacter pylori infection or other diseases, so as not to delay diagnosis and correct treatment.
Complication
Gastric bleeding complications Complications anemia shock
1, fever: patients with fever, generally not more than 38.5 ° C, sustainable 3-5 days.
2, hematemesis and melena: stomach bleeding symptoms are mainly hematemesis and blood in the stool. After the patient's bleeding, he may have hematemesis due to nausea and vomiting due to blood stimulation. He has a sense of intention before blood, and then his eyes are black, palpitation, even fainting, pale, thirsty, pulse fast, blood pressure and so on. The patients were all tarred black feces. In general, when the amount of bleeding is large, there is black stool and hematemesis; and when the amount of bleeding is small, there is often only black stool. If the bleeding site is in the duodenum, hematemesis is less common.
3, other systemic accompanying symptoms: If the patient's bleeding rate is slow and blood volume is low, generally no obvious systemic symptoms, only anemia after long-term bleeding. If the amount of bleeding is fast and fast, there will be symptoms such as dizziness, vertigo, fatigue, abdominal pain, diarrhea, tachycardia, pale complexion, and cold sweat.
Symptom
Symptoms of stomach bleeding Common symptoms Hemorrhagic vomiting nausea and vomiting blood pressure drop pale pale blood loss after anemia panic
Most of the symptoms of gastric bleeding are hematemesis and blood in the stool. The patient had a feeling of nausea before hematemesis, and there was a sense of intention before the blood in the stool. Afterwards, his eyes were black, palpitation, and even fainting. His face was pale, thirsty, his pulse was weak, his blood pressure dropped.
1, general clinical performance
Stomach bleeding
The clinical manifestations of gastrointestinal bleeding depend on the nature, location, blood loss and speed of the bleeding lesions, and are related to the patient's age, renal function and other general conditions.
(1) Hematemesis and melena: Anyone who has nausea or vomiting due to blood stimulation after hemorrhage can have hematemesis. If vomiting immediately after bleeding, the blood is bright red; if the blood stays in the stomach for a period of time, and then vomits after gastric acid action, it is brown in brown coffee. In addition to spitting, the blood is more discharged from the intestines. Since hemoglobin forms black iron sulfide by intestinal sulfide, the discharged blood is generally tar-like black stool. Only when the amount of bleeding is large and the blood passes through the intestines quickly, the discharged blood is dark red or occasionally bright red. In general, when the amount of bleeding is large, there is black stool and hematemesis; when the amount of bleeding is small, there is often only black stool. If the bleeding site is in the duodenum, hematemesis is less common.
(2) systemic symptoms caused by bleeding: If the bleeding rate is slow, the amount is small, generally no obvious systemic symptoms, only anemia after long-term bleeding. If the amount of bleeding is fast and fast, there may be acute blood loss such as palpitation, cold sweat and pale, and even blood pressure drop.
(3) Symptoms of primary disease: The most common causes of gastric bleeding are ulcer disease, esophageal varices, gastric cancer, esophageal cancer or duodenal cancer, and acute gastric mucosal injury. If it is bleeding from ulcer disease, there is often a history of upper abdominal pain before bleeding; if it is rupture of esophageal varices, there is a history of cirrhosis and clinical manifestations of cirrhosis.
2. Endoscopic findings of different lesions
(1) Endoscopic manifestations of esophageal varices usually follow the morphology, size (diameter), location and presence or absence of red sign (RC) of the vena cava.
(2) Endoscopic findings of portal hypertensive gastropathy PHG endoscopy showed a pale red fine spot or a scarlet hot rash in the stomach film. The yellow-white fine mesh structure was set in a snake-like shape, that is, a Male lesion. Cases of bleeding in the stomach often have hemorrhagic red spots in the snake skin lesions.
(3) Endoscopic findings of newly diagnosed peptic ulcers. Simple ulcers with newly diagnosed hemorrhage have different endoscopic findings and are important for judging whether or not to rebleed. Endoscopic findings are usually divided into: active bleeding; non-hemorrhagic blood vessels, adhesion to blood clots; non-vascular oozing: flat spots, clean the base.
Examine
Stomach bleeding check
1, X-ray examination: can understand the bleeding site and the nature of the lesion.
2, gastroscopy: the bleeding site and the cause can often make a rapid and correct diagnosis, has been listed as the preferred method of examination.
3, selective angiography: for the above diagnosis failed to confirm the additional examination, more diagnostic value for vascular malformations.
4, radionuclide imaging: detection of markers from the vascular spillover, active bleeding lesions can be found.
5, containing line capsule test: the location of the duodenal distal and proximal jejunal lesions caused by bleeding has a certain value.
Diagnosis
Diagnosis and identification of gastric bleeding
Acute gastric bleeding is the most common cause of upper gastrointestinal bleeding, accounting for about 70%. Common diseases causing acute gastric hemorrhage are acute ulcers caused by drugs such as stomach, duodenal ulcer, gastric cancer, hemorrhagic gastritis and oral aspirin, cortisone, etc., stress ulcers caused by severe burns and major operations, etc. .
1. Hematemesis and melena: Anyone who has nausea or vomiting due to blood stimulation after hemorrhage can have hematemesis. If vomiting immediately after bleeding, the blood is bright red; if the blood stays in the stomach for a period of time, and then vomits after gastric acid action, it is brown in brown coffee. In addition to spitting, the blood is more discharged from the intestines. Since hemoglobin forms black iron sulfide by intestinal sulfide, the discharged blood is generally tar-like black stool. Only when the amount of bleeding is large and the blood passes through the intestines quickly, the discharged blood is dark red or occasionally bright red. In general, when the amount of bleeding is large, there is black stool and hematemesis; when the amount of bleeding is small, there is often only black stool. If the bleeding site is in the duodenum, hematemesis is less common.
2, systemic symptoms caused by bleeding: If the bleeding rate is slow, the amount is small, generally no obvious systemic symptoms, only anemia after long-term bleeding. If the amount of bleeding is fast and fast, there may be acute blood loss such as palpitation, cold sweat and pale, and even blood pressure drop.
3, the symptoms of the primary disease: the most common cause of upper gastrointestinal bleeding is ulcer disease, esophageal varices, gastric cancer, esophageal cancer or duodenal cancer, acute gastric mucosal injury and so on. If it is bleeding from ulcer disease, there is often a history of upper abdominal pain before bleeding; if it is rupture of esophageal varices, there is a history of cirrhosis and clinical manifestations of cirrhosis.
