Stomach bleeding in a child. Diagnosis and treatment of internal bleeding. Maternal swallowed blood syndrome

Intestinal bleeding in children is incredibly dangerous. Regardless of their scale, the condition for restoring health is the most prompt access to specialists and qualified treatment, which involves a number of mandatory manipulations. Otherwise, there is a high risk of developing serious complications leading even to death.

What causes bleeding?

Depending on the age of the child and other circumstances, a phenomenon such as bleeding from the lower sections gastrointestinal tract may be provoked by various factors. Among the most common reasons for the development of such a process in children's body need to highlight:

the presence of tumors and polyps;
infectious and radiation colitis;
injuries and foreign bodies;
anal fissures;
blood diseases;
inflammatory processes and diseases that provoke them.

This is not the whole list. That is why one of the most difficult and important stages is the setting correct diagnosis and operational definition source of bleeding, since only in this case, specialists can eliminate it as soon as possible, preventing even more bad influence throughout the child's body.

Symptoms of intestinal bleeding in children

One of the main symptoms indicating the presence of bleeding in the intestines is vomiting and stool containing blood. These manifestations are often observed in a generalized way.

In addition, to characteristics also include:

loss of strength;
dry mucous membranes;
constant thirst;
decline blood pressure;
nausea;
pallor of the skin.

There may also be periodic fainting, a drop in body temperature, which is especially noticeable when evaluating the limb th.

It is very important to consider that the symptoms largely depend on the underlying cause, which caused intestinal bleeding. If the child has a significant increase in pain in the affected area can be noted. And if the process was provoked by caustic substances, discomfort will manifest itself throughout the entire course of the esophagus.

Treatment of intestinal bleeding

For effective treatment bleeding requires mandatory hospitalization, regardless of the degree of complexity in question.

After the appearance of the slightest suspicion associated with the possibility of the presence this disease, it is necessary to organize the transportation of the child to the Department of Pediatric Surgery.

It is important to provide the sick child with conditions of maximum rest, since any excessive activity can aggravate the process and provoke further complications.

To restore the strength of the body, first of all, blood transfusion is performed. This process accompanied additional application special vitamin preparations and others aids. going on complete failure from food for at least two days. If such therapeutic measures give positive effect requires further monitoring and compliance special diet until full recovery. If improvement is not achieved, surgical intervention is performed..

conclusions

It should be understood that the elimination of intestinal bleeding in children must necessarily be accompanied by competent treatment of the underlying disease that provoked this phenomenon. Only an integrated approach can avoid the recurrence of a similar situation in the future. Due attention must be paid to preventive measures improving the health of the child and conducting regular check-ups.

Has your child ever had intestinal bleeding? How did you deal with this problem?

The most common types of bleeding in children include nasal, pulmonary and gastrointestinal. In addition, there are often cases of abundant pathological outflow of blood from the cardial esophagus, small and rectum, as well as urinary tract. Intensive therapy with internal types of these pathologies, it is aimed at the use of hemostatic agents, and if tangible effect when providing first aid is not observed, surgical intervention is required.

Bleeding is the flow of blood from blood vessel in violation of the integrity or permeability of its wall. Bleeding in children is observed with trauma, violation of the coagulation and anticoagulation systems, increased permeability vascular wall etc. Bleeding can be external or internal, as well as arterial, venous, capillary, mixed and parenchymal.

In this article, you will learn how bleeding occurs in a child and how to stop it.

Nosebleeds in children: causes, clinic, first aid and treatment

Nosebleeds in children are bleeding from the nasal cavity or nasopharynx. Front nose bleed more often arises from the anterior parts of the nasal cavity, usually from the Kisselbach place (a section of the mucous membrane of the nasal septum, located 1 cm beyond the entrance to the nose, containing a large number of capillaries). The second most common localization is the anterior sections of the inferior turbinate. Posterior nosebleeds come from posterior divisions nasal cavity or nasopharynx - usually from the inferior turbinate or fornix of the nasal cavity.

Nosebleeds in children can be caused by trauma or common diseases(hemophilia, thrombocytopenia, von Willebrand-Jurgens disease, Osler disease, subatrophic rhinitis, vascular hyperplasia of the Kiesselbach plexus, hypovitaminosis C and K, circulatory failure, etc.). Also, infections, local inflammatory and productive processes(polyps, adenoids, neoplasms, etc.), increased blood pressure.

Clinic. If the mucous membrane of the anterior parts of the nose is damaged, the blood is poured out, if the posterior parts are damaged, it is swallowed, which imitates gastric and / or pulmonary bleeding. The color of blood is bright red. When blood is swallowed, hematemesis is possible, with heavy bleeding, pallor, lethargy, dizziness, and tinnitus appear.

Absolute rest is shown in a half-sitting position with a moderately thrown back head. The child is not allowed to blow his nose. Providing emergency care for nosebleeds, children put ice or gauze moistened with cold water on the bridge of the nose. Swabs with 3% hydrogen peroxide solution or 5% aminocaproic acid solution are inserted into the nasal passages, or hemostatic sponge. If the bleeding does not stop, perform an anterior nasal packing with 3% hydrogen peroxide solution. With persistent and prolonged bleeding, posterior tamponade is shown in first aid to children.

Inside, a 10% solution of calcium gluconate is prescribed (according to indications, it is administered intravenously at a dose of 1 ml / year of life, but not more than 10 ml, since the drug causes bradycardia), rutin, vitamin C. In parallel with the treatment of nasal bleeding in children, the underlying disease is treated. Shown hospitalization in the ENT department.

Gastrointestinal bleeding in children: causes and conservative therapy

Life-threatening bleeding includes bleeding from the upper gastrointestinal tract (esophagus and stomach), since due to significant and prolonged blood loss, they often lead to hemodynamic decompensation.

The most common causes of gastrointestinal bleeding, depending on the age of the child:

In the neonatal period - hemorrhagic disease of the newborn, due to a deficiency of vitamin K-dependent coagulation factors (II, VII, IX and X), DIC;
children early age- intussusception of the intestine, hernia of the esophageal opening of the diaphragm, hemocolitis in intestinal infections;
At the age of 3-7 years - Meckel's diverticulum ulcer, colon polyposis;
At school age - varicose veins of the esophagus and stomach with portal hypertension, peptic ulcer of the stomach and duodenum, erosive gastritis, hemorrhagic diathesis.

Bleeding from the esophagus occurs with the expansion of its veins (portal hypertension), erosive and ulcerative process in the cardiac region (short esophagus, hiatal hernia of the diaphragm). With portal hypertension, there is a history of liver disease, which helps to make a correct diagnosis. Gastrointestinal bleeding in children with portal hypertension can cause rapidly developing symptoms of BCC deficiency and anemia, or appear only melena at first, and then gradually lead to anemia.

Clinical picture depends on the amount of bleeding. In typical cases, children become lethargic, complain of weakness, dizziness, a feeling of heaviness in the epigastric region; observed nausea, profuse vomiting of blood, often repeated, pallor skin, tachycardia. The pulse is weak, blood pressure is reduced. Severe anemia develops, and with prolonged and heavy bleeding, a collaptoid state is possible. Tar-like stool (melena).

Treatment. In case of internal bleeding in a child, urgent hospitalization. Eating, liquids naturally and medicines are completely excluded. Adequate control of blood loss is possible only on the basis of clinical data, CVP, hemoglobin, hematocrit, blood pressure and pulse. Bed mode. Shown emergency esophagogastroduodenoscopy. Before endoscopic examination, the stomach is washed with cold water, isotonic saline sodium chloride. Local stop of bleeding is possible by endoscopic and endovascular means.

With ongoing diapedetic bleeding, the bleeding surface is irrigated medicines. A hemostatic cocktail is used, consisting of 0.1 g of thrombin dissolved in 50 ml of 5% aminocaproic acid, and 1 ml of a 0.025% solution of adroxon. Endovascular hemostasis is used for moderate bleeding from varicose veins of the esophagus. Pituitrin is injected intravenously at the rate of 1 U / (kg day), once 5 DB. It can be administered during esophagogastroduodenoscopy into the lumen of a bleeding vein below the bleeding site. With hemorrhagic diapedetic hemorrhages, in addition to pituitrin, a 12.5% solution of etamsylate is administered intravenously - 10-15 mg / (kg daily).

For the treatment of such bleeding in children, the following hemostatic drugs are indicated - 1% vikasol solution: up to 1 year - 0.2-0.5 ml, from 1 year to 3 years - 0.6 ml, 4-5 years - 0.8 ml, 6-9 years - 1 ml, 10 years and older - 1.5 ml 3 times a day intramuscularly; 10% solution of calcium gluconate intravenously - 1 ml / year of life, not more than 10 ml; 12.5% solution of etamsylate (dicynone) at a dose of 5 mg / kg 2-3 times a day intramuscularly or intravenously; 5% solution of aminocaproic acid - intravenous drip, 5-6 ml / (kg day); fibrinogen - intravenous drip, 1 g; 5% solution of ascorbic acid - 0.5-1 ml intravenously; antihistamines(tavegil, peritol, etc.).

Carry out infusion therapy. The volume of injected funds should not exceed the blood loss, physiological losses replenish 5-10% less than necessary. For infusion therapy, a 5-10% glucose solution is used and saline solutions. To correct protein metabolism, prevent hypoalbuminemia, FFP and albumin solutions are transfused. Correction posthemorrhagic anemia carry out erythrocyte mass under the control of hemoglobin and hematocrit levels. To prevent septic complications, a complex of vitamins and broad-spectrum antibiotics are used.

With inefficiency conservative therapy esophageal-gastric bleeding, it is necessary to determine the indications for radical surgery or embolization.

Feeding the child naturally begins only after full confidence in stopping the bleeding. Children are sequentially assigned medical tables 1 A, 1B with mechanical, chemical and thermal sparing of the mucous membrane of the esophagus, stomach and intestines.

Erosive and ulcerative bleeding in a child

Erosive-ulcerative bleeding from the cardiac esophagus occurs during an erosive-ulcerative process in the cardiac esophagus (esophagitis, short esophagus, hiatal hernia, etc.).

Symptoms of internal erosive and ulcerative bleeding in a child are manifested by an admixture of scarlet blood in the vomit. Bleeding is possible with constant mechanical injury, hernia of the esophageal opening of the diaphragm or as a result of throwing acidic gastric contents, with a congenital short esophagus, peptic ulcer of the stomach and duodenum. Diagnosis is established on the basis of anamnesis, manifestations of dysphagia, data clinical examination, endoscopy.

Treatment. For first aid with this type of bleeding, the child is urgently hospitalized. Hemostatic drugs are prescribed. A local stop of bleeding is carried out endoscopically, using a Blackmore probe. If therapy is ineffective, indications for surgical intervention are determined.

Bleeding in children with stomach diseases

The main immediate causes: peptic ulcer, acute ulcers, erosive hemorrhagic gastritis, etc.

clinical picture. Bleeding with peptic ulcer occurs unexpectedly, more often in the evening, at night or in the morning, manifested by bloody vomiting or profuse tar-like fetid stools, sometimes their combination almost simultaneously. Possible vomiting of scarlet or dark blood, in some cases, vomit looks like coffee grounds. General state worsens, occurs severe weakness, pallor of the skin and visible mucous membranes. There is a headache, dizziness, noise in the head, flashing flies before the eyes, cold sticky sweat, increased heart rate, lowering blood pressure up to loss of consciousness - a collapse develops, a picture hemorrhagic shock. The abdomen may be somewhat swollen, more often retracted, but soft on palpation. Endoscopy helps to confirm the diagnosis.

At laboratory research blood reveal a decrease in the number of erythrocytes, a decrease in the level of Hb, Ht, moderate leukocytosis. After bleeding, hypercoagulation develops, alternating with hypocoagulation phenomena, and BCC decreases.

Treatment. The classic triad: cold, hunger and rest. Esophagogastroduodenoscopy, infusion-transfusion therapy are carried out, hemostatic drugs are used (vikasol, fibrinogen, thrombin, aminocaproic acid, calcium gluconate, ascorbic acid, etc.), the stomach is washed with cold water. All methods of local (endoscopic) hemostasis are used (irrigation of the focus with a solution of aminocaproic acid, film-forming aerosol preparations, adhesive compositions, etc.). With the ineffectiveness of therapy, surgical treatment is indicated.

Mallory-Weiss syndrome: signs of internal bleeding in children and treatment

Mallory-Weiss syndrome- sudden onset bleeding due to longitudinal ruptures of the mucous membrane of the cardial part of the stomach or esophagus as a result of sharp increase intraventricular pressure, varicose vascular changes, subatrophy or atrophy of the mucous membrane, fibrosis of the muscle layer.

clinical picture. Gastric bleeding is preceded by repeated and indomitable vomiting, paroxysmal cough, epigastric pain. Often there is a high body temperature, weakness, pallor of the skin and mucous membranes, sticky cold sweat, dizziness, tachycardia, weak filling pulse, tension abdominal muscles on palpation. Also a sign internal bleeding in a child, the content in the vomit is up to 100 ml of blood or more. The diagnosis is established by esophagogastroduodenoscopy. Differential diagnosis is carried out with peptic ulcer stomach and duodenum, varicose veins veins of the esophagus and stomach.

Treatment.

Classic triad: cold, hunger and rest, conduct esophagogastroduodenoscopy, infusion-transfusion therapy, use all methods of local (endoscopic) hemostasis.
Hemostatic drugs are used: intramuscularly injected 1% solution of vikasol: children under 1 year - 0.2-0.5 ml; 1-3 years - 0.6 ml; 4-5 years - 0.8 ml; 6-9 years - 1 ml; 10 years and older - 1.5 ml; dicynone intramuscularly at a dose of 5 mg / kg 2-3 times a day, 10% calcium gluconate solution - intravenously at 1 ml / year of life, but not more than 10 ml. Assign ascorbic acid, rutin.

With massive bleeding, red blood cell transfusion in combination with FFP is indicated to restore the BCC.

To inhibit fibrinolysis with heavy bleeding, transfusion of a 5% solution of aminocaproic acid is effective - 1 ml / kg after 4-6 hours. In case of massive bleeding, surgery is indicated.

Stopping bleeding in a child with malformations of the small intestine

Bleeding with malformations small intestine(Meckel's diverticulum, diverticulum doubling) occurs as a result of an ulcerative process in the intestinal wall, in the area of a heterogeneous mucous membrane.

clinical picture. The disease is manifested by pain in the abdomen, moderate anemia, increased heart rate, dark stool with blood clots. The diagnosis is established by excluding other diseases accompanied by intestinal bleeding. Video capsule endoscopy is used.

Treatment. To provide emergency care for such bleeding, the child is urgently hospitalized.

Classic triad: cold, hunger and rest.
Assign hemostatic agents: 10% solution of calcium gluconate - intravenously at 1 ml / year of life, more than 10 ml, 12.5% solution of etamsylate (dicinone) at a dose of 5 mg / kg 2 3 times a day intravenously or intramuscularly, 5% solution of aminocaproic acid - intravenously drip 5-6 ml / (kg day), fibrinogen - intravenously, 1 g, 5% ascorbic acid solution intravenously, 1% vikasol solution: children under 1 year old - 0.2-0.5 ml; from 1 year to 3 years - 0.6 ml; 4-5 years - 0.8 ml; 6-9 years 1 ml; 10 years and older - 1.5 ml 3 times a day (intramuscularly).

To stop bleeding in a child, infusion therapy is performed. If therapy fails, surgical treatment is necessary. With massive blood loss that threatens life, an emergency laparotomy is performed to identify and remove the source of bleeding. Prescribe treatment for anemia.

Bleeding from the rectum in children

Bleeding from the rectum in most cases is due to the presence of a polyp or polyposis of the colon.

clinical picture. Intestinal bleeding in a child is not abundant, often occurs when a polyp is injured, a tear or tear of a leg, and lasts several days. Causes weakness, headache. A streak of blood appears on the feces, a separate blood clot can be seen at the end of a bowel movement. Diagnosis is based on rectal examination(after an enema) or sigmoidoscopy, colonoscopy.

Treatment. Bed rest, hunger. Hemostatic agents: aminocaproic acid - 0.2 g / (kg daily) orally or intravenously, 10% calcium gluconate solution - 1 ml / year of life intravenously (but not more than 10 ml), 5% ascorbic acid solution - intravenously 0 5-1 ml, 12.5% solution of etamsylate (dicynone) at a dose of 5 mg / kg 2-3 times a day intravenously or intramuscularly, etc. Removal of the polyp by electrocoagulation during sigmoidoscopy or colonoscopy.

Pulmonary bleeding in a child: how it manifests itself and how to stop

Pulmonary hemorrhage - coughing up blood-stained sputum (hemophthisis) or pure blood (hemoptoea). The most acceptable and practically justified classification of conditions associated with the release of blood from the respiratory tract in pediatric practice is the following:

Hemoptysis- up to 150 ml/day;
Pulmonary bleeding- 150-400 ml / day;
Massive pulmonary hemorrhage- more than 400 ml / day.

However, both in the case of hemoptysis and in the case of pulmonary hemorrhage, any amount of blood spilled can lead to serious respiratory disorders and hemodynamic instability, threatening life.

Pulmonary hemorrhage may develop with infectious diseases(tuberculosis, measles, whooping cough, influenza), bronchitis, bronchiectasis, destructive pneumonia, pulmonary hemosiderosis, angiomatosis, trauma chest, ingress of foreign bodies into the respiratory tract, tumors, primary pulmonary hypertension(Ayers syndrome), diseases of cardio-vascular system(mitral stenosis), ascariasis, certain medications, pulmonary infarction, etc.

Clinical picture depends on the severity of the bleeding. If there is blood in the sputum (hemoptysis), the symptoms of the underlying disease (tuberculosis, SARS, etc.) come to the fore. Heavy bleeding usually begins suddenly or after hemoptysis. Pallor of the skin is noted, blood pressure decreases until collapse. Coughing up bright red frothy blood. On auscultation, small bubbling rales are heard in the lungs.

Treatment. In the treatment of a patient with hemoptysis and pulmonary hemorrhage, there are three main stages:

Cardiopulmonary resuscitation, stabilization of hemodynamics and hemostasis, protection of the respiratory tract is the most important priority;
Localization of the source and establishment of the cause - the second stage;
In conclusion, specific measures are taken to stop and prevent re-bleeding.

Infusion therapy: the use of blood components and coagulation factors is carried out according to general rules correction of hemodynamics and hemostasis in case of blood loss. Apply 12.5% solution of etamsylate (dicinone) at a dose of 5 mg/kg 2-3 times a day intramuscularly or intravenously; 1% solution of vikasol: children under the age of 1 year - 0.2-0.5 ml, from 1 year to 3 years - 0.6 ml, 4-5 years - 0.8 ml, 6-9 years - 1 ml, 10 years and older - 1.5 ml 2-3 times a day intramuscularly-5% solution of ascorbic acid at a dose of 0.5-2 ml intravenously; rutin - inside: at the age of up to 1 year - 0.0075 g / day, up to 4 years - 0.02 g / day, over 5 years - 0.03 g / day. With heavy bleeding, intravenous administration of a 5% solution of aminocaproic acid at a dose of 1 ml / kg of body weight every 6 hours is effective.

Transfusion of plasma-substituting solutions (polyglucin, infucol HES, etc.), 10% calcium gluconate solution at a dose of 1 ml / year of life, but not more than 10 ml, blood products is shown. A 2.4% solution of aminophylline is used: for children under 1 year old - 0.4 ml, 1-5 years old - 0.5-2 ml, 6-10 years old - 2-3 ml, over 10 years old - 5 ml. If the therapy is ineffective, diagnostic and therapeutic bronchoscopy is necessary.

Treatment of hemoptysis and pulmonary hemorrhage should be carried out against the background of treatment of the underlying disease. In some cases specific treatment the underlying disease is decisive in the treatment of bleeding. For example, in Goodpasture's disease, there is no need for invasive procedures - high doses of glucocorticoids, cytostatic agents, and plasmapheresis should be used.

Bleeding from the child's urinary tract

Bleeding from urinary tract can be a symptom of various diseases ( viral diseases, injury lumbar region, vasopathy, thrombocytopathy, coagulopathy, glomerulonephritis, vulvitis, phimosis, cystitis, pyelonephritis, urethritis, nephrolithiasis, stenosis renal artery, thrombosis of the renal vein, tuberculosis of the kidneys, nodular polyarteritis, etc.), a consequence of taking certain medications, foods.

Clinical picture depends on localization pathological process. With an injury to the urethra - bleeding, urinary retention, perineal hematoma. The presence of stones in the urethra and bladder causes micro- or macrohematuria, pain that increases with movement, frequent urination, impaired urine flow during movement or changes in body position. With a bladder injury, in addition to hematuria, there is a sharp pain in the lower abdomen, impaired urination. At closed injury there may be signs of peritonitis, shock. Hematuria with cystitis is combined with frequent painful urination, pyuria.

Glomerulonephritis is manifested by gross hematuria, edema, oliguria, pain in the lumbar region, headache, and increased blood pressure. Renal colic is more common in children school age and is accompanied by paroxysmal pain in the lower abdomen and in the lumbar region simultaneously with macro- and microhematuria.

Treatment depends on the cause of hematuria. In all cases, appoint bed rest, 10% solution of calcium gluconate at a dose of 1 ml / year of life (no more than 10 ml) intravenously. At inflammatory process carry out antibiotic therapy(ampicillin, oxacillin, carbenicillin, etc.). With glomerulonephritis, hormonal therapy is indicated: prednisolone at a dose of 1-2 mg / (kg daily), heparin, chimes under the control of a coagulogram. With oliguria and an increase in blood pressure, Enap, captopril, furosemide or lasix are prescribed - 1-3 mg / (kg daily) orally or intramuscularly.

At renal colic use antispasmodics: papaverine - 2-3 mg / (kg daily), no-shpu - 0.01-0.02 g 3 times a day, 0.2% solution of platifillin (children under 1 year - 0.1 ml, from 1 year to 3 years - 0.2-0.3 ml each, 4-5 years - 0.4 ml each, 6 years - 0.5 ml each, 7-9 years - 0.75 ml each, over 10 years - 1 ml) subcutaneously up to 3 times a day.

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Useful articles

Gastrointestinal bleeding is one of the most formidable symptoms, which are only noted in the practice of a doctor. The life of the child may depend on how quickly the parents orient themselves in the event of gastrointestinal bleeding. What do you need to know about it?

Overview of gastrointestinal bleeding

As you know, gastrointestinal bleeding can manifest itself bloody vomiting (hematemesis), bloody diarrhea (melena), and can be internal (invisible to a non-specialist). Of course, parents can only discover visible signs gastrointestinal bleeding, and in order to notice them, you need to know that, depending on the place of bleeding, the duration and amount of blood entering the gastrointestinal tract, there may be a different color of vomit and feces.

To begin with, consider the features of vomiting in gastrointestinal bleeding. Under the influence of hydrochloric acid blood darkens in the stomach. Thus, if vomiting began shortly after the onset of bleeding, the vomit will be red, if it does not occur immediately, their color will be dark red, brown or black. Clots of clotted blood in the vomit give them characteristic appearance coffee grounds.

Hematemesis indicates that the place of bleeding is located not lower than the duodenum. In any other case, fecal changes indicate trouble. Since blood is a strong irritant and toxic effect on the intestines, so diarrhea develops with bleeding. Acute blood loss can cause bloody diarrhea for 3 days.

With the passage of blood below the level of the stomach, fecal masses under the influence of bacteria of the gastrointestinal tract become black, tarry. But in order for the black staining of the stool to appear, the blood must be in the intestine for at least 8 hours. Approximately 60 milliliters of blood is needed to stain black feces. Therefore, if bleeding is suspected, an occult blood test should be performed.

If bleeding occurs from the lower intestines, bright red blood is released.

How to wait for an ambulance

Any child with hematemesis, stool, or rectal bleeding should be immediately examined by a doctor and examined by laboratory to exclude infectious diseases.

First aid is aimed at creating conditions conducive to reducing the intensity of bleeding until it stops. Absolute rest and bed rest are shown.

When vomiting, the child should be in an elevated position, turning his head to one side. Locally apply cold (ice pack, cold water) to the area of suspected bleeding, small pieces of ice can be swallowed. Before the ambulance arrives, do not drink or feed the child, in any case do not wash the stomach and do not give him enemas.

We exclude the "external" causes of bloody vomiting and stools

In children 1-3 years of age, the most common causes gastrointestinal bleeding are invagination of the intestine, Meckel's diverticulum, doubling of the intestine, hernia of the esophageal opening of the diaphragm. In children from 3 to 7 - polyposis of the large intestine, older than 7 years - bleeding from varicose veins of the esophagus and stomach, peptic ulcer of the stomach and duodenum, erosive and allergic gastritis.

In general, there can be a great many reasons for the appearance of blood in the gastrointestinal tract. There are among them and those that are in no way connected with gastrointestinal bleeding! For example, probable cause the appearance of frightening signs of gastrointestinal bleeding in infants who are breastfed, there may be ... cracked nipples in a nursing woman!

Therefore, when breastfeeding first of all, you need to carefully examine the mother's breasts. Often, if there are deep cracks in the nipples, there is no visible bleeding, however, when sucking, the child swallows large enough "portions" of blood, which leads to bloody vomiting and sometimes to the appearance of blood impurities in the stool. In this case, the mother needs to get advice on correct technique feeding, for some time to feed with expressed milk with a spoon, from a cup or a syringe.

In addition, when bloody vomiting and bloody stools appear in children, it is necessary to carefully examine their oral cavity and nasal cavity: it is possible that it “bleeds” there, and signs of gastrointestinal bleeding are caused by swallowing blood.

Possible Causes of Gastrointestinal Bleeding

As already mentioned, the appearance of blood in vomit and stool can be a sign of the most different pathologies. Since among them it is almost impossible to single out more or less dangerous, brief information We have listed them in alphabetical order.

Crohn's disease

Crohn's disease (chronic granulomatous inflammation of the gastrointestinal tract) is accompanied by abdominal pain, diarrhea, the presence of blood, mucus, pus in the stool, fever, weight loss, and undulating course. The stool is foul-smelling and floats in the water. Often there are cracks in the anus.

Hemorrhagic disease of the newborn

In the neonatal period, bleeding from the stomach may occur against the background of hemorrhagic disease newborns due to vitamin K deficiency, imperfection of the blood coagulation system.

Hemorrhagic disease of the newborn up to 7 days is more often manifested by hematemesis, tarry stools, and abundant "menstruation" in girls. Bleeding can increase and lead to significant blood loss, so it is necessary to call ambulance at the first sign of it. Because the breast milk contains factors of the blood coagulation system - breastfeeding don't stop. Prevention - the introduction of vitamin K intramuscularly in the maternity hospital.

Hemorrhagic vasculitis

With hemorrhagic vasculitis, bloody vomiting and tarry stools with an admixture of mucus may also occur. They may be the first signs of the disease. But more often they occur against the background of high temperature, after the appearance of small-pointed and various spotted hemorrhages on the skin. The rashes are most often located on the legs.

The disease can be accompanied by damage to the joints and internal organs. Periodic repetition of attacks of the disease with the appearance of pain in the legs is characteristic, skin rash development of arthritis.

hiatal hernia

A hiatal hernia is a protrusion of the stomach through a gap or hole in the diaphragm. May be congenital or acquired. Often hiatal hernias are accompanied by reflux of contents from the stomach into the esophagus, which causes chemical burns and inflammation of the mucosa of the esophagus and stomach. Clinically, this is manifested by heartburn, bouts of vomiting, often with an admixture of blood, the presence of blood in the stool. The child may have chest pain, shortness of breath, cough. With a long course, children may lag behind in development.

At severe course surgical treatment. In all cases of suspected diaphragmatic hernia, children are hospitalized in a surgical hospital.

Intussusception ("volvulus")

Invagination is the introduction of one part of the intestine into another, as a result, the vessels of the introduced area are infringed, disturbed, and subsequently the blood circulation stops. If this condition is not treated, gangrene of the strangulated area develops.

The disease appears suddenly. The child complains about sharp pain in abdomen, covered with sweat, looking pale and restless. Attacks last 5-10 minutes, body temperature rises. Vomiting can be repeated several times, occasionally the vomit contains a dark or scarlet blood with impurities of mucus, small clots resembling currant jelly. 6-8 hours after the onset of the disease, stools in the form of raspberry jelly may appear. In the early stages, treatment by inflating the intestinal loops is possible. If not successful surgical treatment episodes of invagination may be repeated. If the intussusception cannot be straightened, an operation is indicated.

Foreign bodies

Injuries of the oropharynx and nasopharynx, esophagus, stomach when swallowed foreign objects can cause significant injury and bleeding. It is urgent to seek medical help.

infectious colitis

Infectious colitis (dysentery, salmonellosis, etc.) are characterized by an acute onset, severe intoxication, general weakness, high temperature, a rapid increase in signs of dehydration, not abundant blood impurities in the feces that appear at the height of the disease. Depending on the severity of bleeding, the child's condition can be from satisfactory to extremely severe, but in any case, hospitalization in the infectious diseases department is required.

With heavy bleeding, there is a loss of consciousness, a drop in blood pressure, a sharp pallor, and an increase in heart rate. In a satisfactory condition, a tarry stool, or a stool with slight blood impurities, may be noted for a long time. However, bleeding can increase and lead to a state of shock.

Meckel's diverticulum

Intermittent protrusion of the wall ileum. Meckel's diverticulum occurs when a duct, which is only needed during the first month of fetal development, persists throughout pregnancy until the birth of the baby. Sometimes the diverticulum remains attached to the umbilicus, then the intestinal loops can twist around it, causing intestinal obstruction. If the diverticulum is covered from the inside by a mucous membrane that secretes gastric juice bleeding ulcers may develop. Bowel obstruction can also develop if a Meckel's diverticulum turns inside out and causes intussusception (the insertion of one loop of bowel into another).

Most frequent symptoms Meckel's diverticulum is bleeding from the rectum or bloody stools. They may recur from time to time or occur suddenly. The first bowel movements are usually black, tarry, in the subsequent dark (scarlet) blood appears. Bleeding may be accompanied by nausea and vomiting.

Unlike other gastrointestinal bleeding, with Meckel's diverticulum there is no bloody vomiting, moderate abdominal pain, blood in the stool without mucus impurities. Initially, the symptoms correspond to those of acute appendicitis.

There is no cure for bleeding in Meckel's diverticulum.

At duplication of the intestine bleeding from the intestine occurs in almost 1/3 of cases. An x-ray examination of the intestine with a radiopaque substance is necessary. With repeated and persistent bleeding, treatment is surgical.

Bleeding from the veins of the esophagus

Bleeding from varicose veins of the esophagus and stomach occurs with a significant increase in pressure in portal vein(portal hypertension). Portal hypertension occurs with abnormal development of the portal vein, vascular thrombosis, cirrhosis and congenital liver fibrosis, Chiari disease. In newborns, it can develop against the background of umbilical sepsis. In addition, with liver diseases, the production of blood coagulation factors is disrupted.

For the diagnosis of this condition, it is important: the child has signs of liver disease, an enlarged spleen, and yellowness of the skin. Bleeding profusely life threatening child, scarlet vomit.

non-specific ulcerative colitis

It occurs in children of any age, more often in boys. More often it has a primary chronic course.

During periods of exacerbation, blood impurities appear in the stool in the form of separate clots or bloody-mucous diarrhea. In addition, there is pain, fever, loss of appetite, frequent stools from 3 to 10 per day. The act of defecation is accompanied by a sharp cramping pain. The use of antibiotics does not improve the condition.

Intestinal polyposis

Intestinal polyposis, according to the literature, is more common in children aged 3-6 years and has a hereditary nature. Polyps are most often located in the lower parts of the large intestine. Bleeding may be minor, appear periodically. When the polyp is torn off, profuse bleeding from the rectum can be observed.

Mallory-Weiss syndrome

Mallory-Weiss syndrome develops due to rupture of the gastric mucosa after bouts of repeated vomiting or coughing. It is manifested by the appearance of vomit stained with blood. Not accompanied by pain.

Telangiectasia of the stomach and intestines

Bloody vomiting and tarry stools are periodically observed in congenital telangiectasias (vascular tumors) of the stomach and intestines. The disease is inherited.

Repeated bleeding is also observed in the parents or close relatives of the patient. On the mucous membranes of the mouth, lips, nose, there are often a large number of vascular "asterisks".

Anal fissures

Their appearance is associated with constipation, with the formation of thick fecal masses of a dense consistency that can break the delicate tissue of the anus. Accompanied by pain in the rectum during the act of defecation, the release of unchanged blood, not mixed with feces.

Thrombocytopenic purpura

It is characterized by a decrease in the number of platelets, increased bleeding.

The symptoms of the disease are skin rashes, bleeding from the mucous membrane of the nose, mouth, intestines, uterus, vagina, blood in the urine. Hematemesis develops either due to the ingestion of blood released from the upper respiratory tract, or due to the overflow of the stomach with blood from the vessels of its mucous membrane. In cases of bleeding from the vessels of the small intestine, tarry stools occur.

Erosive and allergic gastritis

Occur against the background of poisoning with alkalis, acids, medicines. As a result of damage or allergic reaction damage to the gastric mucosa occurs. Accompanied pain syndrome, vomiting with blood. With perforation of ulcers of the stomach and duodenum, damage to the intestines, internal bleeding may occur.

Expressed pain syndrome, abdominal muscle tension, hematemesis, tarry stools. General symptoms blood loss: weakness, dizziness, palpitations, loss of consciousness.

Peptic ulcer of the stomach and duodenum

Manifested by pain in the upper abdomen, "hunger pains." May be complicated by bleeding that starts suddenly. Once the bleeding starts, the pain subsides. Occurs more often in children after 7 years.

After serious illnesses, operations, burns, stress ulcers can develop. Also, ulcers can occur during treatment with steroids.

Clinical manifestations: vomiting "coffee grounds", tarry stools, general weakness, pallor, dizziness, loss of consciousness.

Gastrointestinal bleeding requires urgent medical measures, because, even if small, they can quickly lead the patient to death. Causes: peptic ulcer of the stomach and duodenum, rupture of varicose veins of the esophagus and cardia of the stomach with portal hypertension (liver cirrhosis, thrombophlebitis spleen), erosive gastritis, burns of the gastric mucosa with accidental ingestion of caustic alkalis and concentrated acids, ulcerative lesions small and large intestines, typhoid fever, dysentery, ulcerative colitis, terminal ileitis, intestinal intussusception, bleeding Meckel's diverticulum, anal fissures. Gastrointestinal bleeding may occur with various diseases blood (hemophilia, hemorrhagic vasculitis, Werlhof's disease, leukemia, aplastic anemia, etc.).

Symptoms. Main feature given state- hematemesis or bloody stool. Often they are combined. When making a diagnosis of gastrointestinal bleeding, it is necessary to exclude diseases in which blood can enter the gastrointestinal tract from other organs (upper respiratory tract, lungs, etc.). With bloody vomiting, the blood is thick, dark in color, or looks like coffee grounds with clots. Sometimes it contains the remains of undigested food. After 8-10 hours, a "black" stool appears. In all cases of gastrointestinal bleeding, monitoring of blood pressure and hemoglobin content in the blood is necessary.

Profuse bleeding is accompanied by thirst, dryness of the mucous membranes of the oral cavity, rapidly progressive weakness with dizziness, and sometimes loss of consciousness. The skin at the same time becomes pale, covered with cold sweat, limbs become cold. The patient is either agitated or in prostration. Facial features are sharpened. Sometimes there are yawning, nausea and repeated vomiting. The pulse quickens, weak filling, then becomes thready. Blood pressure drops, breathing quickens.

In addition to those common features, depending on the causes of bleeding, one or another specific symptoms So, with peptic ulcer of the stomach and duodenum, there is a pain syndrome with a certain localization and a typical daily seasonal rhythm with an appropriate history. Bleeding can be both during an exacerbation of the disease, and during remission. Abundant bleeding occurs in 5-12% of children with peptic ulcer.

With portal hypertension due to cirrhosis of the liver, there is a long "hepatic" history, exhaustion of the patient, an increase in the liver and spleen, a pronounced pattern of collateral saphenous veins, spider veins on the skin, rarely ascites and intermittent jaundice. Functional state liver is severely impaired. At x-ray examination esophagus with a contrast mass, varicose veins are found, which can cause profuse, sometimes fountain, bloody vomiting.

With thrombophlebitic spleen, there is a rapid, sometimes painful enlargement of the spleen, with the same rapid decrease after bleeding; recurrent epistaxis and undulating enlargement of the spleen with a history of fever. Often there is a combined increase in the spleen and liver.

With erosive gastritis and burns of the gastric mucosa with caustic alkalis and concentrated acids - pain along the esophagus, epigastric region, gastric history or traces of burns with these substances on the oral mucosa. If alkalis and acids are swallowed, shock may occur.

Intestinal intussusception has the typical clinical presentation of an acute abdomen.

Bleeding from the stomach and intestines in cases of hemorrhagic diathesis is combined with other clinical symptoms of these diseases: skin hemorrhages, changes in blood clotting, bleeding duration, retraction blood clot, changes in the quantity and quality of platelets, etc. Other diseases accompanied by gastrointestinal bleeding (ulcerative colitis, typhoid fever, dysentery) have clinical symptomatology well known to doctors. With bleeding from the stomach, hematemesis is often noted; from the upper intestines, including from the duodenum - black tarry stools; from the lower intestine - stool containing little altered blood.

Treatment. In all cases of bleeding from the gastrointestinal tract, hospitalization of the patient is indicated, since even slight bleeding can turn into profuse. It is better to hospitalize children in a multidisciplinary hospital, where, along with therapeutic, infectious diseases and others, there is a children's surgical department.

The patient is provided with absolute rest. Carefully transport the patient. The child should lie on his back. An ice pack is placed on the upper half of the abdomen.

One-group blood transfusion is carried out at the rate of 10-15 ml per 1 kg of body weight (it is better to transfuse freshly citrated blood or directly from the donor to the recipient). At rapid decline hemoglobin level up to 70 g/l drip poured large quantities blood (up to 250-400 ml). 3-10 ml (depending on age) of 10% sodium chloride solution and 5-10 ml of calcium chloride are injected intravenously.

Simultaneously apply large doses ascorbic acid, vitamins PP, K, etc. Ascorbic acid administered intravenously or intramuscularly in the form of a 1% or 5% solution of sodium ascorbate up to 100-300 mg, depending on age. Vitamin PP is prescribed orally at 0.025-0.05 g 2-3 times a day. Vitamin K in the first days of bleeding is best administered intramuscularly at 0.5-1 ml (1% solution) per day for 3 days.

In case of profuse bleeding from varicose veins of the esophagus or the cardial part of the stomach, a drip transfusion of a single group or 0 (I) blood group or plasma is immediately started. To narrow the preportal arterioles and thereby reduce pressure in the portal vein, 5-10 units are dripped. pituitrin in 100 ml of 5-10% glucose solution. You can also drip inject a 6% solution of aminocaproic acid (50-100 ml). With a decrease in blood pressure, a 10% caffeine solution, a 1% mezaton solution or a 25% cordiamine solution are prescribed at an age dosage.

For burns of the esophagus and stomach burns, an energetic antishock therapy. In case of burn ammonia or caustic soda, the stomach is washed with a 0.1% solution of hydrochloric acid or warm water; vinegar essence - boiled water until the smell of vinegar disappears; acids - 2-3% solution of bicarbonate of soda through a probe, which is pre-lubricated with well-boiled vegetable oil.

On the first day after stopping the bleeding, you should refrain from feeding the child - intravenous glucose is administered mixed with saline. Starting from the 2nd day, the Meilengracht diet is prescribed, consisting of chilled milk, cream, eggs, butter, well-mashed vegetable purees with carefully chopped and pureed meat or fish. Along with the ongoing activities, vigorous therapy of the underlying disease is carried out.

If therapeutic measures are ineffective and bleeding continues, a surgeon's consultation is necessary to resolve the issue of surgical treatment.
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is a condition in which blood is poured either into the body's natural cavity (stomach, bladder, uterus, lungs, joint cavity, etc.), or into the space artificially formed by the outflow of blood (retroperitoneal, intermuscular). Symptoms of internal bleeding depend on its location and the degree of blood loss, usually include dizziness, weakness, drowsiness, loss of consciousness. Pathology is diagnosed on the basis of external examination data, the results of radiography, CT, MRI and endoscopic studies. Treatment - infusion therapy, prompt elimination source of bleeding.

Treatment of internal bleeding

It is necessary to ensure the delivery of the patient to the department as soon as possible specialized care. The patient needs to be kept calm. If a hemothorax or pulmonary bleeding is suspected, the patient is given a semi-sitting position, with blood loss in other areas, they are laid on a flat surface. Cold (eg, ice pack) should be applied to the area of the suspected source of bleeding. It is strictly forbidden to heat the affected area, give enemas, give laxatives, or inject drugs into the body that stimulate cardiac activity.

Patients are admitted to the hospital. The choice of department is carried out taking into account the source of internal bleeding. Treatment of traumatic hemothorax is carried out by traumatologists, non-traumatic hemothorax and pulmonary bleeding- thoracic surgeons, intracranial hematomas - neurosurgeons, uterine bleeding - gynecologists. In case of blunt trauma of the abdomen and gastrointestinal bleeding, hospitalization is carried out in the department of general surgery.

The main tasks in this case are an urgent stop of internal bleeding, compensation for blood loss and improvement of microcirculation. From the very beginning of treatment, to prevent empty heart syndrome (reflex cardiac arrest due to a decrease in the volume of BCC), restore the volume of circulating fluid and prevent hypovolemic shock, a jet transfusion of 5% glucose solution, saline, blood, plasma and blood substitutes is performed.

Sometimes internal bleeding is stopped by tamponade or cauterization of the bleeding area. However, in most cases, urgent surgical intervention under anesthesia is required. With signs of hemorrhagic shock or the threat of its occurrence at all stages (preparation for surgery, surgery, the period after surgery), transfusion measures are performed.

Internal bleeding due to ectopic pregnancy is an indication for emergency surgery. With dysfunctional uterine bleeding, tamponade of the uterine cavity is performed, with massive bleeding due to abortion, birth trauma, and after childbirth, surgery is performed.

If blood pressure cannot be normalized despite ongoing fluid therapy, dopamine, norepinephrine, or epinephrine are administered after bleeding has stopped. For the treatment of hemorrhagic shock, pentoxifylline, dipyridamole, heparin and steroid drugs are used. After the threat to life is eliminated, the acid-base balance is corrected.