Hemorrhagic shock with ulcerative bleeding. Ulcer bleeding

In some patients with erosive lesion stomach, possibly ulcerative bleeding, the severity of which depends on how large the vessel is damaged. It can open unexpectedly, regardless of the size and location of the defect.

Sometimes vessel damage is detected for the first time, and in some cases the cause is an ineffectively treated bleeding ulcer.

Hemorrhage with an ulcer is always life-threatening, so medical assistance is needed to eliminate it. Even if the bleeding spontaneously stops, after a certain period of time it can resume.

Symptoms of open bleeding

With hidden hemorrhage, signs are almost completely absent. The patient's state of health practically does not suffer, there may be a slight decrease in working capacity and weakness.

With prolonged bleeding, symptoms of oxygen starvation of tissues may occur: dizziness, pallor, headache, shortness of breath, palpitations. It is possible to lower blood pressure in a sitting and standing position.

So that the disease is detected in a timely manner and does not pass into more severe stage, it is necessary from time to time to take emetic and stool, as well as gastric juice to carry out the Gregersen reaction, which allows to detect traces of blood in the samples.

Average blood loss

With blood loss medium size(from 16 to 20%), the patient's extremities become cold, the face becomes pale, diuresis decreases, the heartbeat becomes more frequent even at rest.

In addition, the following symptoms are noted:

tremor and dizziness;
blood in saliva after reflux or vomiting;
increased sweating;
hypothermia;
photophobia;
signs of dehydration.

For obvious bleeding from a stomach ulcer, pronounced signs are characteristic. Such hemorrhage can be recognized by hematomesis (vomiting blood) and melena (black feces).

massive bleeding

With a large blood loss (from 21 to 30%), the symptoms of a bleeding stomach ulcer can be determined by strong heartbeat, shortness of breath and sharp drop pressure. In this case, the body is not able to replenish the blood loss on its own, but the consequences of severe hemorrhagic shock are still reversible. Patients with these signs of bleeding ulcers usually become unhealthy agitated, irritable and restless.

A bleeding ulcer is very high percent mortality, up to half of the cases. Symptoms of massive bleeding (more than 30%) are characterized by a sharp pallor of the skin, unconsciousness, thready pulse and increased sweating. The pressure is often impossible to determine. If the patient is not provided with emergency medical care, then the patient's condition worsens and becomes irreversible.

Causes of ulcer bleeding

There are many reasons for bleeding from stomach ulcers.

The following negative factors are of greatest importance:

Associated infection.
Mechanical damage to the surface of the ulcer, for example, during FGDS.
Excessive physical activity during an acute process.
Inadequate healing effect therapy, incorrectly chosen tactics.
Taking illegal foods, alcohol, or drugs, such as NSAIDs.
Not provided first aid for exacerbation.

It is important to adhere to a properly selected diet, because due to its absence or nutritional errors, hemorrhage can also open.

Danger of ulcers with hemorrhage

Any hemorrhage, massive or light, is extremely life-threatening for the patient. Profuse bleeding can cause the death of the patient in a few hours, and an ulcer that bleeds slightly for a long time imperceptibly leads to the extinction of the patient.

Hemorrhage is a typical complication of stomach ulcers. In this case, the erased form of the disease passes into the active stage. The patient suffers severe pain after eating, therefore, begins to avoid eating any food, which leads to exhaustion of the body. In addition, blood loss further weakens the patient, causing weight loss, bad feeling and weakness.

In an ulcer with profuse bleeding, damage occurs large vessels so the patient may lose most blood in the first half hour.

This condition can cause multiple organ failure syndrome:

swelling of the meninges;
hypovolemic shock;
pressure drop;
heart and liver failure;
intoxication with decomposed blood.

A bleeding stomach ulcer can cause a condition that is practically incompatible with life. In this case, the probability of death is high, therefore, if signs of hemorrhage appear, you should immediately seek medical help.

Health food

The most important component of effective therapy is a diet for bleeding stomach ulcers. It provides for abstinence from eating and drinking for the first 2-3 days. You can periodically slightly quench your thirst with a piece of ice or a spoonful of water. After this period of time, the patient is allowed to give some food of a liquid consistency.

Nutrition for a stomach ulcer with bleeding should include:

raw and soft-boiled eggs;
milk and cream;
oatmeal or milk jelly;
not too thick jelly;
sweet diluted juices.

Proper nutrition does not welcome fasting for more than 3 days. Even if the ulcer is acute with bleeding, it is necessary to ensure that the patient receives enough calories, as well as proteins, fats, carbohydrates, minerals and vitamins. In addition, mechanical, chemical and thermal protection of the mucosa is necessary, so the consistency of the food should be semi-liquid, the taste is neutral, and the temperature is warm.

Gradually, the diet expands and includes:

mashed potatoes and carrots;
meat and curd souffles;
mucous pureed soups;
steam meat and fish meatballs;
boiled pureed porridge;
butter;
cocoa and tea with milk;
decoction of rose hips and compote.

With this form of the disease, alcohol, coffee, spicy and sour foods are categorically excluded. The dietary diet should be discussed and agreed with a specialist who is aware of all the intricacies of therapy. He will advise the optimal set of products that will contribute to effective treatment.

If a drug treatment and diet do not help or are inappropriate, surgery is necessary. Resection or suturing of the stomach, the treatment of which in this case occurs only under general anesthesia performed using endoscopic equipment.

Sometimes there is a need for open operation with a longitudinal section abdominal wall. After surgical intervention the patient is shown strict bed rest, massive maintenance therapy and parenteral nutrition.

Therapy of ulcers with hemorrhage

The assumption that a patient develops a bleeding stomach ulcer excludes examination in a polyclinic, since it is a reason for urgent hospitalization to the surgical hospital. In this case, there is a huge risk of increased blood loss, so the patient should be in bed and refrain from eating in the first days (hereinafter referred to as the diet).

Compensation for blood loss and the appointment of drugs that help stop hemorrhage are shown:

blood and plasma preparations;
aminocaproic acid;
vicasola;
calcium chloride;
atropine.

Conservative treatment is indicated for older people with common diseases. It is also carried out with hemorrhages of mild and moderate severity.

There are methods of endoscopic hemorrhage arrest:

Mechanical - the imposition of a clip, alloying, as well as the use of gluing.
Injection - the introduction of sclerosants, adrenaline, novocaine, saline.
Thermal - laser coagulation, thermocoagulation, radiofrequency coagulation and thermoprobe.

Indication for surgical treatment is an open defect with massive blood loss, regardless of the type of ulcer, recurrent and incessant with conventional treatment bleeding, the addition of other complications of the disease. The choice of operation is determined by the localization of the defect and the severity of the pathology. The doctor may recommend excision or suturing of the vessels of the bottom of the ulcer.

with hemorrhage consists of careful attention to your health and contact a specialist if you experience slightest symptoms stomach lesions. And also in the medical examination on the recommendation of a doctor and examination with the appointment of adequate treatment.

- complication peptic ulcer, which consists in the outflow of blood into the cavity of the stomach from damaged vessels (arrosed arteries, veins or capillaries). Symptoms are determined by the severity of bleeding; the main manifestations are vomiting of "coffee grounds", "tarry" stools, signs of hypovolemia and systemic hemodynamic disorders. The most important method diagnosis is esophagogastroduodenoscopy, during which hemostasis can be performed. Treatment in most cases is surgical; with a small amount of blood loss, as well as in patients of the group high risk conservative hemostasis is performed.

Cause serious condition patients is bleeding. With a loss of less than 15% of the blood volume, there are no significant violations of systemic hemodynamics, since defense mechanisms: spasm of blood vessels of the skin and abdominal organs, opening of arteriovenous shunts, increased heart rate. Blood flow in vital important organs is preserved, and in the conditions of cessation of blood loss, the volume of circulating blood is restored due to natural depots. With a loss of more than 15% of the BCC, generalized spasm blood vessels, a significant increase in the frequency of heart contractions and the transition of interstitial fluid into the vascular bed are initially compensatory in nature, and then pathological. Systemic blood flow is disturbed, microcirculation suffers, including in the heart, brain, kidneys, arterial hypotension develops, compensation mechanisms are depleted. Perhaps the development of hepatic, renal failure, cerebral edema, myocardial infarction and hypovolemic shock.

Symptoms of a bleeding stomach ulcer

Symptoms of this pathological condition determined by the degree of blood loss and the duration of bleeding. Hidden bleeding ulcers appear general weakness, dizziness, pale skin. hemoglobin in acidic environment the stomach is metabolized, acquiring a dark color, and in the case of vomiting, staining of the vomit in the color of "coffee with milk" is characteristic.

In the case of profuse bleeding, the main symptom is hematemesis, which can be single or repeated. The vomit has a characteristic "coffee grounds" color. AT rare cases massive bleeding from the artery, vomiting of scarlet blood with clots is possible.

A mandatory sign of a bleeding stomach ulcer with a loss of more than 50 ml of blood is a "tarry" stool that occurs after a few hours or the next day. With bleeding, the volume of which does not exceed 50 ml, stool normal consistency painted in dark color.

Many patients note an increase in the intensity of symptoms of peptic ulcer (stomach pain, dyspepsia) for several days, as well as their disappearance with the onset of bleeding (Bergman's symptom). There may also be signs such as thirst, dry skin, decreased diuresis, pain on palpation of the abdomen.

The general symptoms of a bleeding ulcer are due to the degree of blood loss. With a shortage of circulating blood volume of less than 5 percent (1 degree of severity), minor violations of systemic hemodynamics occur; the patient's condition remains satisfactory, arterial pressure within the noma, the pulse is somewhat quickened. With a deficit of 5-15 percent of the volume of circulating blood (2nd degree of blood loss), patients report lethargy, dizziness, fainting is possible, systolic blood pressure is below 90 mm Hg. Art., the pulse is significantly quickened. With a loss of more than 15-30 percent of the BCC (grade 3), the condition of the patients is severe, there is a pronounced pallor of the skin and mucous membranes, the pulse is thready, frequent, systolic blood pressure is below 60. A deficiency of more than 30 percent of the blood volume (grade 4) is accompanied by impaired consciousness, the condition is extremely severe, blood pressure is reduced to a critical level, the pulse is not determined.

Diagnosis of a bleeding stomach ulcer

A consultation with a gastroenterologist with a detailed study of the history of the disease, patient complaints and objective data suggests the presence of this pathology even with a small amount of blood loss. At objective examination the patient's attention is drawn to the pallor of the skin, a decrease in skin turgor, pain is possible on palpation of the abdomen in epigastric region. AT general analysis blood is determined by a decrease in hemoglobin and erythrocytes.

An obligatory diagnostic method for gastric bleeding is esophagogastroduodenoscopy. Diagnostic endoscopy is performed in all cases where there is a reasonable suspicion of ulcer bleeding. The only contraindication is the agonal state of the patient, when the results of the study cannot affect the outcome of the disease. Endoscopy allows visualizing the source of bleeding, differentiating a bleeding ulcer from other causes of gastrointestinal bleeding. In most cases diagnostic procedure goes to the treatment room. It has been proven that early endoscopic hemostasis significantly reduces the recurrence rate, the need for surgical interventions, and mortality.

Differential diagnosis is carried out with gastric bleeding of a different etiology: with malignant tumors, gastric polyps, Mallory-Weiss syndrome, pathology of the blood coagulation system, cardiovascular system.

Treatment of a bleeding stomach ulcer

Suspicion of a bleeding stomach ulcer is a direct indication for emergency hospitalization of patients in surgery department. Examination on an outpatient basis is strictly unacceptable. All patients are prescribed strict bed rest, complete hunger (after stopping bleeding - the Meilengracht diet). Conservative hemostasis includes transfusion of blood products, plasma, the introduction of fibrinogen, aminocaproic acid, calcium chloride, vikasol, atropine, as well as oral administration of aminocaproic acid. Conservative treatment may be given to high-risk patients ( elderly age, heavy concomitant pathology), as well as with mild and medium degree severity of bleeding.

Currently, effective methods of endoscopic hemostasis have been developed: thermal (electrocoagulation, thermoprobe, laser, radiofrequency and argon plasma coagulation), injection (local administration of adrenaline, novocaine, physiological saline and sclerosants), mechanical (stopping gastroduodenal bleeding by clipping or ligating bleeding vessels during gastroduodenoscopy) and the use of hemostatic materials (biological glue, hemostatic powder).

Indications for surgical treatment are severe bleeding, regardless of the type of ulcer, combination with other complications of peptic ulcer (penetration, pyloroduodenal stenosis), repeated and not stopped under the influence of conservative methods bleeding hemostasis. The specific choice of operation is determined by the localization of the ulcer and individual features. Resection of the stomach according to Billroth I or II, excision, suturing of a stomach ulcer, suturing of the bottom vessels can be performed ulcer defect possibly combined with vagotomy.

Forecast and prevention

The prognosis is determined by the volume of blood loss and the timeliness of the provision specialized care. At present, the active surgical tactics treatment (in the absence of contraindications). In addition to the rate of bleeding arrest, the prognosis depends on the safety compensatory mechanisms patient, adequate replacement of the volume of circulating blood. With profuse bleeding, a high percentage of mortality is recorded.

Prevention of bleeding stomach ulcers is timely handling to the gastroenterologist in the presence of complaints from the stomach, adequate treatment peptic ulcer according to current standards, medical examination of patients and regular examination.

One of serious complications peptic ulcer is considered to be a bleeding ulcer of the stomach. It occurs when there is an increase in defects on the mucous membrane, which can lead to damage to blood vessels and the opening of bleeding. Against this background, there is always sharp deterioration the patient's condition.

The reasons

Bleeding stomach ulcer and duodenum always occurs against the background of the presence of deep ulceration. Internal bleeding begins when the lesion reaches the vessels and arteries.

There are a number of predisposing factors to open bleeding with a stomach ulcer. First of all, the occurrence of such a complication is associated with a violation by the patient of the prescribed diet. In particular, the risk increases when the patient's diet includes:

Rough products that can injure a peptic ulcer.
hot and cold food, which has an irritating effect on the wounds present on the mucosa.
Alcoholic drinks that are especially dangerous are on an empty stomach.

In addition, a perforated stomach ulcer often occurs:

After an abdominal injury.
Long-term use medicines.
With cardiovascular pathologies.
With diabetes.

Increases the risk of bleeding from stomach ulcers poor clotting blood. Also, defects in the mucous membranes increase with stress, nervous strain and emotional breakdowns. Sometimes dangerous pathology may occur with large physical activity or sudden lifting of weight. Provoke in the patient the onset of bleeding can:

Long mental stress.
Avitaminosis.
Failure to comply with the regime of work and rest.

Sometimes development dangerous complication in a patient with a stomach ulcer, doctors explain it with a genetic predisposition. That is, if a bleeding ulcer was diagnosed in one of the parents, then the likelihood of its occurrence in children is high.

Symptoms

If hemorrhage has a latent form, then there may be no signs of bleeding. The patient's well-being changes slightly. As a rule, only weakness is observed. But even mild prolonged bleeding with a stomach ulcer leads to oxygen starvation tissues, which manifests itself in the patient:

Vertigo.
Headache.
Decreased blood pressure.
photophobia.

In addition, if the ulcer has opened, then black feces appear, and traces of blood may be observed in the eructation. Symptoms of bleeding in peptic ulcer are more pronounced with massive blood loss.

In particular, the patient always has a strong vomiting with an admixture of blood. It can be disposable or reusable, but relief never comes after it. At the same time, against the background of the opened bleeding, the patient develops such a strong pain syndrome that the person may lose consciousness.

When the first serious signs, indicating severe internal bleeding, even if the body is not able to replenish blood loss on its own, with urgent medical care the effects of severe hemorrhagic shock are still reversible.

Otherwise, if help is not provided, symptoms of multiple organ failure may join. This means that the patient the pressure will drop to a critical level, swelling of the brain tissue will occur, the functions of the heart and other internal organs will be weakened. In this case, a stomach ulcer with bleeding can be fatal.

First aid

When did they appear obvious symptoms the fact that ulcer bleeding has opened, it is necessary in urgently call ambulance. It is very important to accurately describe the symptoms that caused the emergency call.

In anticipation of the arrival of specialists, it is necessary to provide a person with complete immobility. To do this, lay it on a hard horizontal surface and place a pillow under your feet. This position will increase blood flow to the brain, which will reduce the risk of developing hypoxia.

First aid for gastrointestinal bleeding also lies in the fact that it is necessary to cool the stomach area in order to promote vasoconstriction. At home, you can use ice or frozen foods from the freezer.

It is necessary to apply cold for a quarter of an hour, and then remove it. This will help, if not stop the bleeding, then slow it down to a certain extent. And this is very important for stabilizing the condition with a bleeding stomach ulcer.

It is strictly forbidden to give water and food to a person when he has a stomach ulcer. This will increase the motility of the stomach and increase blood circulation, which means that blood loss will increase.

Do not give any pain medication when acute pain. You should also not attempt to seat the person or lift them up if vomiting occurs. All you need to do is turn the person on their side to prevent the vomit from entering the airways.

It is very important to be close to a person and constantly talk to him. We must strive not to let him lose consciousness. To do this, before the arrival of the ambulance, it is recommended to use ammonia.

Diagnostics

An experienced ambulance specialist, even during the initial examination with little blood loss in characteristic symptoms can determine that blood is flowing from the ulcer. But in order to determine the degree of a bleeding ulcer and the danger of a complication that has arisen, it is necessary to pass tests and perform a series of studies:

General blood analysis. In it, the main indicators for confirming bleeding will be a decrease in the number of red blood cells and hemoglobin.
Coagulogram, which determines blood clotting.
Bilirubin test. The level of this substance always increases with perforation and perforation of the ulcer.
Abdominal ultrasound.

If the patient's condition allows, then after admission to the hospital, the diagnosis of a bleeding gastric ulcer is carried out using endoscopic examination. During the procedure, an examination of the mucous membrane of the digestive organ is performed using a special probe. This allows you to set exact location bleeding.

An open stomach ulcer often causes heavy bleeding. As a result, there are obvious symptoms that do not require additional diagnosis. In this case, measures are taken to stop the bleeding. Sometimes urgent surgery is required.

Treatment of bleeding from a stomach ulcer

At the slightest suspicion of a bleeding ulcer, an emergency hospitalization of a person is carried out. Treatment for bleeding stomach ulcers begins with the appointment of strict bed rest and complete abstinence from food.

The goal of all procedures is to stop bleeding in the stomach. Therapeutic measures carried out under the obligatory supervision of a doctor. The improvement in the patient's condition indicates the effectiveness of the treatment of a bleeding stomach ulcer.

Treatment of gastric ulcers involves emergency hemostatic therapy. After the patient's condition stabilizes, a strict special diet will be prescribed.

If in the process stomach bleeding If you have lost a lot of blood, you will need a blood transfusion. This procedure is also a necessity if the bleeding cannot be stopped in a short time.

Advice! It is unacceptable to conduct an examination and prescribe treatment to stop ulcer bleeding on an outpatient basis.

Medical therapy

To stop gastric bleeding, medical therapy of the stomach is necessary. For this, drugs are used that can stop bleeding. It:

Aminocaproic acid. It promotes vasoconstriction and increased blood clotting. The agent is also able to suppress specific allergic reactions. In addition, the drug helps to eliminate toxins from the body.
Vikasol. This is a chemical analogue of vitamin K, which normalizes blood clotting.
Calcium chloride. The drug reduces internal bleeding and can be used as an antiallergic agent.

Recovery water-salt balance with internal bleeding, special solutions are prescribed. The most famous are reopoliglyukin and trental.

Advice! In the process of treating a bleeding stomach ulcer, painkillers can be used, but they must be prescribed by a doctor, taking into account the patient's condition.

Operation

Today developed a large number of effective methods endoscopic hemostasis to eliminate bleeding in the stomach. The most commonly used thermal effects, which involve cauterization of a bleeding ulcer. For this, apply:

Electrocoagulation.
Laser coagulation.
Argon plasma coagulation.
Radiofrequency coagulation.
Thermal probes.

Injection methods of treatment using endoscopy involve the introduction of various drugs in order to deliver them directly to the lesion. Clipping or ligation of bleeding vessels during gastroduodenoscopy is also widespread.

Hemostatic materials such as biological glue and hemostatic powder can be used. If conservative and endoscopic methods treatments have proven ineffective, surgical treatment is always considered.

Surgery is indicated for elderly patients who have gastric bleeding. This is due to the fact that most drugs, the action of which is aimed at eliminating bleeding, have age contraindications and their use can lead to unpredictable consequences. Other indications for surgery are:

Massive bleeding.
Regular relapses.
Location of the defect near large arteries.

The operation involves a resection of the stomach under general anesthesia. In this case, the affected area is completely excised, and the walls of the stomach are sutured. After such an operation, a long rehabilitation is required.

Diet

In the first 2-3 days with a bleeding stomach ulcer, you must completely refuse to eat. Strong thirst can be removed with ice cubes or a spoonful of water. As a rule, after this period it is possible to stabilize the condition.

Therefore, after bleeding, you can start eating a small amount of food of a liquid consistency. The diet for a stomach ulcer in this case provides for the gradual inclusion of the following foods in the diet:

Raw from boiled soft-boiled.
Milk.
Milk and oatmeal.
Not strong jelly.
Sweet diluted juice.

It is very important that all food is taken in small portions, but quite often. With stabilization, the state of nutrition with a stomach ulcer should become more diverse. Others should appear on the menu diet meals. It can be:

Carrot and mashed potatoes.
Slimy soups.
Mashed porridge.
Steamed meatballs from lean meats and fish.
Curd mousse and soufflé.
Cream.

Allowed to fill dishes a small amount creamy and vegetable oil. It is very important to use fresh and quality products. Sometimes you are allowed to drink strong tea with milk, as well as a decoction of rose hips and sweet compotes.

This diet should be long time to avoid relapses. It is strictly forbidden to consume alcoholic and carbonated drinks, any sour food, dishes with spices, strong tea and coffee.

Advice! Any changes in diet should be discussed with the doctor.

Complications

If a bleeding ulcer is not completely healed, then this means that the bleeding will not be permanently eliminated. Against this background, there is a high risk of relapse. Even minimum loss blood can significantly worsen the patient's condition and cause very dangerous complications.

Against the background of a bleeding ulcer, the treatment of which is not carried out properly, anemia may develop. This is very dangerous state, which leads to an increase in weakness, provokes dizziness and, in the future, a complete loss of working capacity.

Symptoms of developing anemia is, in addition to worsening general well-being, the appearance of a grayish tint on skin and blanching of mucous membranes. Very often, the patient has numbness of the lower extremities.

An increase in temperature may occur from time to time. Usually due to increased weakness, the pulse during movement increases significantly. A complication of a bleeding ulcer can be a disorder of all body systems, in particular liver dysfunction.

This is very dangerous, because as a result of this, toxic poisoning of the body and metabolic disorders occur. by the most terrible complication untreated bleeding peptic ulcer, due to constant blood loss, is cerebral edema.

That's not all dangerous consequences which can be caused by incorrect diagnosis and incorrect treatment. Statistics show that mortality from hemorrhage is 10-15%, and in cases where massive bleeding opens, 50-55% of patients cannot be helped.

Prevention

To prevent the occurrence of a bleeding stomach ulcer, you should take care of your health. It is very important to prevent the occurrence of pathology. For this, it is necessary to treat any diseases of the digestive system in a timely manner.

It is also important to eat right, avoid stress, minimize nervous tension, as well as eliminate increased mental and physical overwork. It is important to learn how to properly organize the mode of work and rest. It is recommended to undergo regular medical examinations and, if any pathological changes are detected, follow all the doctor's instructions.

But even in the case when a stomach ulcer is diagnosed, it is important not to get upset prematurely. Today there are many ways and methods successful treatment the most severe forms of the disease. It's important to keep going active image life and keep strict diet on the background complete failure from alcoholic beverages and smoking.

A positive prognosis for the treatment of a bleeding stomach ulcer largely depends on right attitude patient. The main thing is to believe that it will be possible to defeat the disease and do everything for this.

Ulcer bleeding is the most common complication of ulcers. It occurs in 10% of patients. Most often, such a violation of the stomach occurs against the background of an exacerbated peptic ulcer. Both a new small ulcer and an old erosion that has not made itself felt for a long time can bleed. it dangerous disease, the treatment of which requires a lot of effort on the part of doctors, and on the part of the patient.

Types of bleeding with stomach ulcers

Complications of stomach ulcers occur in many patients. Among them, bleeding is the most common. Bleeding is:

open;
hidden.

With hidden blood loss, the symptoms are almost imperceptible. Classification according to the origin of bleeding also comes from such ulcers;

sharp;
chronic;
symptomatic.

By location they are divided into:

bleeding from a stomach ulcer:
- body;
- cardia;
- gatekeeper channel;
- antrum;
duodenum:
- descending region;
- postbulbar;
- bulbous.

By the nature of bleeding with a stomach ulcer is:

ongoing (jet, laminar, capillary, in the form of unstable hemostasis, recurrent);
held (in the form of stable hemostasis or posthemorrhagic anemia).

The degrees are as follows:

bleeding;
blood loss.

Causes

Often it is not possible to determine the cause of ulcer bleeding. It does not fit such provoking factors as physical or mental stress, mental trauma, violation of the integrity of the abdominal cavity, or others.

Gastric bleeding is often associated with the occurrence of a necrotic process in an exacerbation of the disease, as a result of which the integrity of the vessel is violated.

Sometimes atherosclerosis is the main cause of the complication. Vitamin deficiencies, thrombosis, or other diseases contribute to gastric bleeding vascular network. The process can be triggered by a transferred infectious disease or a diet disorder. Alcohol and smoking can affect the likelihood of blood loss.

Clinical picture and symptoms of the disease

The brightest and first symptom of bleeding of the stomach is vomiting with blood impurities. Because of this, vomit has a scarlet or dark brown color(how coffee grounds). This reaction appears almost immediately. Scarlet blood in the vomit is a sign that.

Another sign of such a complication in ulcers is melena. With melena, the stool looks like thick tar. This is a symptom of a duodenal bleeding ulcer. As a rule, such stool means that the bleeding is large in terms of blood loss. At the same time, the stool is liquid, black, shiny and sticky. Melena can be like early symptom, and will appear after a couple of days.

A similar stool can be observed after eating blueberries, blackberries, medicines to raise the level of hemoglobin in the blood, but its consistency is different. Such a chair is called pseudomelena. At heavy bleeding the stool may contain impurities of scarlet blood.

A sign of complication is oppression pain. In general, the symptoms depend on how severe the blood loss is. If the complication is light form, the patient almost does not feel discomfort. Symptoms:

the skin becomes pale;
pressure decreases;
extremities become cold;
the volume of excreted bile decreases;
the pulse speeds up.

For medium blood loss:

skin becomes more pale;
cyanosis of the nasolabial triangle appears;
tachycardia;
oliguria;
pulse accelerates;
the pressure drops.

O severe blood loss The following symptoms may indicate:

black liquid stool;
chills;
nausea and vomiting;
loss of consciousness;
shortness of breath;
dizziness;
the pulse becomes thready;
vascular spasm;
sweat cold and clammy on forehead;
systolic pressure impossible to feel;
oligoanuria.

With single bleeding associated with ulcers, cases of death are rare. Dangerous resumption of complications for 1.5 weeks.

How to stop and cure stomach ulcer bleeding?

Stop gastric bleeding, especially if it opened quickly, you need to short time. This is the main condition for saving the life and health of the patient. A patient who is bleeding from an open ulcer needs to call an ambulance, lie on his back and not move. If possible, in the conditions in which the person lives, it is recommended to apply ice or other cold to the stomach.

If a bleeding ulcer has opened, it is forbidden to take anything inside, even drink water. You just need to lie still. Ambulance doctors will provide transportation on a stretcher.

First aid is that you need to do everything to stop the ulcer that has opened.

Endoscopic homostasis is performed. It is carried out by individuals or medical methods. An ulcer can be cauterized by thermal, laser, or electrical methods. Bleeding is stopped with coagulants, hemostatics, vasoconstrictor drugs, oil, saline or sclerosing solution.

Stopping bleeding with the help of surgical intervention is carried out only if other methods have failed to do this. If you do not immediately seek treatment, or if doctors do not see the seriousness of the ongoing violation, complications associated with bleeding may be irreversible.

Sometimes bleeding associated with the stomach stops on its own. But in such a situation, medical consultation is no less important, since without treatment, the next exacerbation will come soon. Hospitalization is needed to stop the bleeding. The patient is shown bed rest and the use of food and liquids is prohibited. First, for hemostatics, injections of a chloride solution, Vikasol, are given, the patient is given a dropper with epsilon-aminocaproic acid.

If the blood loss is very strong, the patient is given a blood transfusion. When the number of red blood cells stabilizes, the patient is carefully monitored. In this case, you need additional diagnostics etymology. How stomach bleeding is treated depends on where it occurs.

In addition to traditional and surgical methods, for the treatment of the disease, one must adhere to special food. Absolutely everything is prohibited for about 3 days. When intense thirst allowed to drink 2 teaspoons of water or dissolve a small piece of ice.

After that, the patient is given liquid food. The diet consists in the use of eggs, jelly, milk, juices, jelly, cream, etc. Today, it is becoming more and more common to believe that hunger with ulcers is dangerous, since the body is limited in useful substances that can help with illness. The patient is allowed any puree food. Allowed meals:

liquid mashed porridge;
soufflé from cottage cheese or meat;
vegetable puree;
meatballs;
compotes and broth rose hips and others.

It is the absolute norm for this disease. A patient exudes several milliliters of blood daily from a wound.

However, there are situations when blood loss is more significant, and often such internal bleeding cannot be stopped at home. Moreover, in some situations, even in a hospital setting, it is not possible to stop blood loss in a timely and effective manner.

In this article, we will talk in detail about what a bleeding ulcer is, how to prevent this disease and what should be the emergency first aid for its development. We will also talk about how bleeding ulcers of the stomach and duodenum are treated.

How and why does bleeding occur with a stomach or duodenal ulcer?

Ulcerative bleeding occurs in approximately 18-30% of all ulcer patients. gastrointestinal tract. At the same time, for all types of bleeding of the gastrointestinal tract, 60-75% of cases fall precisely on the ulcerative type of bleeding.

An open bleeding ulcer usually occurs in the gastric region, with blood loss coming from arteries that have become arrosic. Much less often, blood loss comes from veins or capillaries (according to PubMed).

There are many reasons for ulcerative bleeding. We list the most common causes in practice:

Incorrectly formulated diet for the patient or its absence.
Insufficiently effective treatment, attempts by the attending physician to conduct therapy empirically, that is, at random.
An ulcer complicated by infection.
Damage to the ulcer surface by gastric acid or implantation foreign body(performing EGD analysis, for example).
Overstrain of the abdominal cavity due to exhausting physical activity against the background of an acute ulcerative process.
Taking products or drugs that are aggressive for the gastric mucosa and duodenal ulcer (alcohol and non-steroidal anti-inflammatory drugs are especially dangerous).
Not carried out first urgent care during exacerbation or acute form ulcers of the stomach or duodenum.

Why is ulcer bleeding dangerous?

Any bleeding, whether it is profuse (profuse) or light, is life-threatening for the patient. And if profuse bleeding can lead to the death of the patient within a few hours, then light and prolonged bleeding imperceptibly kills a person.

So it is not uncommon for patients with mild but prolonged bleeding to go to the doctor for years. The disease manifests itself only in terminal stage, while on early stages there are no symptoms (including pain).

As a result, the patient first appears chronic fatigue, impaired attention, sometimes even enough serious problems with sleep. After a few months, the level of circulating blood drops even more, there is photophobia, dizziness and, in rare cases, syncope (loss of consciousness).

As a result, the patient turns to the doctor already at the manifestation of the disease, when the saturation of the organs with blood drops to a critical level. Such cases are not uncommon and usually occur in people with dismissive attitude to your health.

Acute blood loss is not so insidious, but has a high mortality even with timely treatment. So acute blood loss at perforated ulcer stomach and duodenum even in intensive care in 30-50% of cases leads to death.

It should be understood that acute blood loss is terrible because it can occur against the background of complete well-being, without previous signs. And first aid in this case is meaningless, since directly without medical equipment no effect on internal bleeding.

Symptoms of ulcer bleeding

In the vast majority of cases, when little blood is released, the symptoms of ulcerative bleeding are so poor that it is almost impossible to determine the disease in the early stages.

In other cases, when the problem progresses, the following symptoms are observed:

the presence of blood in saliva (when the contents of the stomach are thrown into oral cavity with heartburn), including the presence of blood in saliva after vomiting;
pallor of the body, disappearance of superficial veins into the thickness of the body;
lowering body temperature to 36.3-36.4 degrees;
photophobia (with a concomitant increase in temperature this symptom requires testing to rule out meningitis);
dizziness;
nausea and vomiting of bloody masses;
black stools in stomach ulcers and blood-streaked stools in duodenal ulcers;
increased sweating even against the background of calmness and normal temperature;
tremor;
symptoms of dehydration, including dry mouth and lips.

Classification of ulcerative bleeding

There is a medical classification of ulcerative bleeding, based on the characteristics of its course. medical classification subdivides bleeding ulcers according to the following parameters:

due to (etiology): from chronic form, from acute or from symptomatic;
by location (localization): from the stomach, from the duodenum;
by the nature of the course: ongoing bleeding and held;
by severity: moderate blood loss and massive blood loss.

Also, the classification of bleeding from wounds of the gastrointestinal tract is divided by severity. Total exists three degrees of disease severity:

Mild: single vomiting, black stools (melena), blood pressure and pulse normal, general state the patient is generally satisfactory.
Medium: the presence of fainting, recurrent bloody vomiting, weakness, a decrease in systolic pressure to 90-80 mm Hg. Art., tachycardia with an increase in heart rate up to 100 beats.
Severe: massive recurrent vomiting of blood, tarry stools, systolic pressure reduced to 60-50 mm Hg. Art., tachycardia with an increase in heart rate to 120 or more beats, critical situation patient.

Forrest classification

Apart from general classification ulcer bleeding, there is also a special classification Forrest (Forrest). It was created by the doctor J. Forrest in 1987. Forrest classification is needed to assess the likelihood of recurrent bleeding and, accordingly, the probability of death of the patient.

Forrest classification looks like this:

Jet gastroduodenal bleeding from an ulcer (F1A).
Drip gastroduodenal bleeding from an ulcer (F1B).
Thrombosed arteries at the bottom of the ulcer (FIIA).
Blood clot tightly covering an ulcer (FIIB).
Ulcer without any signs of bleeding (FIIC).
No sources of bleeding were found at all (FIII).

Based on this classification, risk of relapse and patient death are calculated as follows:

F1A: complicated disease, 55-100% recurrence risk, 11% mortality, severe symptoms;
F1B: same as F1A, symptoms are severe;
FIIA: complicated disease, recurrence risk 40-50%, mortality 11%;
FIIB: complicated disease, recurrence risk 20-30%, mortality 7%;
FIIC: the risk of recurrence in this type of disease is 10-20%, mortality is 6%;
FIII: the risk of recurrence in this type of disease is 5%, mortality is 2%.

Gastrointestinal bleeding (video)

Treatment of ulcer bleeding

For light and minor bleeding, the treatment is that the doctor prescribes a special sparing diet. Therapeutic diet aimed at minimizing the burden on gastrointestinal system and to enhance the regenerative abilities of the body.

Nutrition (you can read the details) is selected with an emphasis on not provoking progression (development) in any case. The menu is very modest, since most of the products are simply forbidden to the patient. Spicy, salty, fried, smoked and other similar products are strictly prohibited. From drinks, the patient is forbidden to drink alcohol, caffeine and stimulant drinks.

When medical nutrition does not help or it makes no sense to use it, they resort to surgical intervention. Surgery in this case carried out exclusively under general anesthesia, since the local analgesic effect is not enough, pain can provoke shock in the patient.

The operation is performed using medical endoscopic equipment, in more rare cases, open surgery with an incision along the abdominal wall is resorted to. After the operation, the patient is prescribed the strictest bed rest, feeding through a tube and powerful drug therapy.

Upon awakening, patients often experience a strong fear of death, therefore, in order to avoid stress shock after awakening the patient, the doctor should be next to him for reassurance. The patient is not allowed to actively move on the couch for the first days after the operation, because due to active movements sutures or clips placed on the ulcer may break.