Gastrointestinal bleeding

Description:

Zhedochno-kishechnoye bleeding is bleeding from bodies of digestive tract. Can be acute and chronic, explicit and hidden, single and recurrent.

Symptoms of Gastrointestinal bleeding:

In a clinical picture into the forefront blood loss symptoms (weakness, dizziness, heartbeat, perspiration, confusion of consciousness, tachycardia, arterial hypotension) usually act. At easy degrees of gastrointestinal bleeding dizziness, weakness, insignificant pallor can be observed, at massive bleedings — a collapse, falling of cordial activity. Bleedings from a gullet, a stomach and a duodenum can be followed by vomiting scarlet blood (hematemesis), and also the blood changed under the influence of a gastric juice — a so-called coffee thick. Of bleeding from upper parts of digestive tract it is characteristic also tar-like kcal (melena). At bleedings from a small bowel dark red blood is usually evenly mixed with excrements. Releases of scarlet blood from an anus demonstrate that the source of gastrointestinal bleeding is located in colonic or a rectum.
Arterial pressure. Loss of 10-15% of mass of blood does not cause sharp disturbances of a hemodynamics as gives in to full compensation. At partial compensation postural hypotension is observed. At the same time pressure is supported close to norm while the patient lies, but it can catastrophically fall when the patient sits down. At more massive blood loss which is followed by heavy hypovolemic frustration, adaptable mechanisms are not able to compensate frustration of a hemodynamics. There is hypotonia in lying situation and the vascular collapse develops. The patient falls into shock (the pallor turning into flaky-gray color, sweat, exhaustion).

Heart rate. Tachycardia - the first reaction to decrease in UOS for preservation of the IOC, but tachycardia in itself is not criterion of weight of a condition of the patient as it can be caused by some other factors, including psychogenic.

Shock index. In 1976 M. Algover and Burri offered a formula for calculation of a so-called shock index (Algover's index) characterizing weight of blood loss: ratio of ChSS and systolic ABP. In the absence of deficit of OTsK the shock index is equal to 0,5. Increase it to 1,0 corresponds to deficit to OTsK equal to 30%, and to 1,5-50% to deficit of OTsK.

Reasons of Gastrointestinal bleeding:

The source of gastrointestinal bleeding can be localized in all departments of digestive tract. The peptic ulcer, erosive gastritis, Mallori's syndrome — Weiss (the gastric bleeding caused by ruptures of a mucous membrane of abdominal department of a gullet or cardial department of a stomach at persistent recurrent vomiting), a varicosity of a gullet and stomach, nonspecific ulcer colitis, diverticulums and polyps of intestines, benign and malignant tumors of bodies of digestive tract, hemorrhoids, etc. are complicated by bleeding.
Gastrointestinal bleeding causes changes in an organism which weight depends on rate of bleeding and size of blood loss. Depending on the size of blood loss distinguish easy, moderately severe and heavy. At massive blood loss bleeding call profuse.

Treatment of Gastrointestinal bleeding:

At blood loss no more than 10% of OTsK of hemotransfusion and blood substitutes are not required. This volume of the streamed blood is able to compensate an organism completely independently. However it is necessary to remember a possibility of the repeated bleeding capable to quickly destabilize a condition of the patient against the background of compensation tension.

The patients with considerable acute ZhKK who are especially in an unstable state have to be placed in intensive care unit or resuscitation. Continuous access to a vein is necessary (catheterization of one of the central veins is desirable). Infusional therapy has to be carried out against the background of constant monitor control behind cordial activity, the ABP, function of kidneys (amount of urine) and additional oxygenation.

For recovery of the central hemodynamics use a transfusion of normal saline solution, Ringer's solution, basis solution. As colloid blood substitute middlemolecular Polyglucinum can be used. Recovery of microcirculation is carried out by means of low-molecular colloidal solutions (реополиглюкин, Haemodesum, Gelatinolum). Blood is transfused for oxygenation improvement (a cell of red blood) and coagulability (plasma, thrombocytes). As at active ZhKK it is necessary both, it is reasonable to transfuse a whole blood. At the stopped ZhKK when shortage of OTsK is filled by saline solutions, for recovery of oxygen capacity of blood and stopping of high degree of hemodilution it is reasonable to pour a packed red cells.

Direct hemotransfusions matter mainly for a hemostasis. If coagulability is broken that takes place at most of patients with cirrhosis, it is reasonable to pour freshly frozen plasma and a platelet concentrate. The patient has to receive infusional therapy until his state is not stabilized; at the same time the quantity of erythrocytes providing normal oxygenation is necessary. At the proceeding or repeatedly arisen ZhKK infusional therapy is continued to a full stop of bleeding and stabilization of parameters of a hemodynamics.