Gastrointestinal bleeding

Gastrointestinal bleeding in medicine is considered an outpouring of blood into the lumen of the gastrointestinal tract. The definition is important to remember and distinguish from bleeding into the abdominal cavity when the source is the digestive system (an example is a bowel rupture).

The most developed vasculature in the esophagus, stomach and duodenum. Therefore, bleeding from the upper part of the gastrointestinal tract is characterized by massive blood loss, rapid formation of anemia, and severe shock state of patients.

What diseases cause bleeding?

The source of bleeding can be in different parts of the digestive tract. A complication in the form of perforation of the vessel wall occurs in many diseases, differ in frequency. In the first place – esophageal and gastroduodenal bleeding. They are considered life threatening to the patient.

Of the lower sections, represented by a small, large intestine, bleeding is less common, accompanied by chronic diseases, does not cause acute blood loss and anemia. Group No. 1 – is represented by the most common causes, in practice it is she who is the “supplier” of all severe cases. It includes:

  • peptic ulcer of the stomach and duodenum (55–80% of all bleeding);
  • the development of acute ulcers amid stress, medication;
  • Mallory-Weiss syndrome;
  • decaying tumors;
  • erosive or hemorrhagic form of gastritis and duodenitis;
  • portal hypertension with cirrhosis of the liver with varicose veins of the esophagus, the initial section of the stomach.

Group No. 2 – combines the more rare causes of bleeding: diverticulums and polypous growths in the stomach and duodenum, infringement of a hernia in the esophagus of the diaphragm and Zollinger-Ellison syndromes.

Group No. 3 – consists of a pathology representing casuistic cases: blood diseases (hemophilia, thrombocytopenic conditions,), the result of radiation sickness, vitamin deficiency diseases, rare cases of tuberculosis or syphilis of the stomach, vasculitis and hemorrhagic diathesis.

Development mechanism

Bleeding from the upper gastrointestinal tract with peptic ulcer, Mallory-Weiss syndrome, a decaying tumor of the stomach comes from arterial vessels or mixed (arterial-venous). When blood flows from the dilated veins of the esophagus by massiveness, the venous form is comparable to arterial. These species are characterized by severe blood loss, shock.

Erosive gastroduodenitis first causes a small discharge of blood from superficial ulcers due to damaged capillaries. But with a significant area of ​​damage, a deepening of the destruction process, large vessels are affected. It can also cause severe blood loss. Such life-threatening bleeding causes death, according to various sources, in 6–20% of cases.

As a result of blood loss, a picture of hemorrhagic shock develops against a background of a decrease in the volume of circulating blood. With impaired microcirculation, acid residues accumulate in the tissues, acidosis and oxygen starvation occur. The process goes on in all organs and systems. If the blood loss is not replenished for a long time, the functions of the organs are violated, partial cell death occurs.

Physiologists call the process a transition from a labile to a torpid stage. Necrosis provokes continued bleeding. In the stomach, the appearance of new ulcers and erosions of hypoxic origin. A “vicious circle” is forming. With prolonged bleeding, changes in the coagulation system occur. In 50% of patients, coagulation and recalcification times are reduced by a factor of 2.

At the same time, plasma resistance to heparin increases. The condition indicates the development of hypercoagulation. The continuation of the disease leads to the activation of the anticoagulation system, a decrease in the content of fibrinogen. Prolonged bleeding from the gastrointestinal tract passes into the DIC syndrome (massive intravascular coagulation).

Symptoms

Cases of bleeding from highly located sections of the gastrointestinal tract are very similar in their manifestation. The differences are minor, but you can more correctly establish the source from them. Symptoms consist of signs of hemorrhagic shock and acute anemia (anemia), external symptoms.

In acute anemia, which turns into hemorrhagic shock, patients experience:

  • sudden dizziness;
  • weakness intensifies;
  • small spots flicker before the eyes;
  • short-term attacks with loss of consciousness are possible;
  • pain in the heart;
  • labored breathing.

The initial stage activates the protective mechanisms: blood leaves the depot, blood circulation is centralized to ensure the functions of vital organs. Blood pressure remains normal or rises. A drop in pressure indicates a depletion of reserve capacity and continued bleeding, so it is a bad prognosis.

Blood counts change steadily only after 12-24 hours after the onset of blood loss: hematocrit, the number of red blood cells, the amount of hemoglobin and color indicator can be used to judge the degree of blood loss. External manifestations include the following manifestations.

Bloody vomiting – more often with damage to the esophagus and stomach. If blood flows from the esophagus, then it has a cherry color, liquid or with clots. With gastric vomiting, erythrocyte hemoglobin reacts with hydrochloric acid and forms brown hematin hydrochloride. Therefore, vomiting resembles “coffee grounds”.

Blood from the duodenal bulb rarely causes vomiting. It occurs only with gastroduodenal reflux.

Black tarry stool – it can be without vomiting, accompanies bleeding from the duodenum. When the source is localized in the esophagus or stomach, it is combined with bloody vomiting. The more massive the bleeding, the faster melena appears. Blood when it enters the intestines enhances its peristalsis.

By the color of feces, a differential diagnosis of the source from the upper gastrointestinal tract and large intestine is carried out. In the lower part of the digestive tract, hematin hydrochloride does not form, so the stool is painted in a bright raspberry color. And the presence of mucus makes feces look like “raspberry jelly.”

Features in diseases of the digestive tract

We will focus on the most common diseases for which bleeding is considered a serious complication.

Erosive or hemorrhagic gastritis

Multiple surface defects are formed on the mucous membrane of the stomach or duodenum. At the beginning of the disease, the vessels are spasmodic in the wall of the stomach. This causes areas of ischemia (tissue hypoxia). As a result, a large amount of pepsin and histamine is released.

These hormonal substances contribute to hemorrhage and swelling of the mucosa, the formation of ulcerations, in a few days the defects reach a size of 20 mm, merge into large ulcers. Usually the process is acute, occurs under the influence of toxic or medicinal products.

Acute ulcers can be stressful. They appear after trauma, burns, operations, freezing, sepsis, myocardial infarction, renal and hepatic failure. The mechanism does not differ from erosion. Reach in depth only to the muscle layer. In the formation of erosion, vascularization of different parts of the stomach is important.

The cardiac section is most vulnerable, since there is no submucosal vascular plexus in this zone. Vessels enter directly into the mucosa.

local_offerevent_note March 27, 2020

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