First aid for gastrointestinal bleeding

Gastrointestinal bleeding is a complex of symptoms that unite the course of various diseases of the gastrointestinal tract complicated by bleeding.

Most often, pathology is a consequence of a violation of the integrity of the mucous membrane, leading to the exposure of deep vessels, their erosion; penetration of blood through the wall of blood vessels due to increased permeability; blood coagulation disorders.

The main danger of gastrointestinal bleeding is that in the early stages or with small amounts of blood loss, the patient may not experience any symptoms at all. This is due to the absence of pain receptors on the mucous membrane of the digestive tract. Since the main purpose of these organs is to process incoming food, blood passes through the digestive tract in the same way as liquid food. Bleeding can also lead to a decrease or disappearance of signs of the underlying disease that led to this complication, or provoke its exacerbation. Massive (profuse) gastrointestinal bleeding is often (10-15%) the cause of life-threatening hemorrhagic shock.

General characteristics of the pathology, the reasons for its formation

Gastrointestinal bleeding is a condition that is considered one of the most common in gastroenterology, as there are more than 200 causes in which blood flows into the lumen of the esophagus, stomach or intestines.

The source of bleeding can be localized in any part of the gastrointestinal tract, depending on the topography, it is customary to isolate bleeding from the upper gastrointestinal tract (80% of cases), when the source of bleeding is located in the esophagus, stomach, duodenum and lower gastrointestinal tract – the source is in the jejunum and ileum (5%), colon (15%) In turn, bleeding from the upper gastrointestinal tract are divided into unrelated to varicose veins of the esophagus and bleeding from varicose veins of the esophagus. According to the clinical course, bleeding can be chronic and acute, single, ongoing, profuse (usually with hemorrhagic shock), stopped (held) and recurrent (repeated).

It has been established that pathology occurs much more often in men over 40 years of age, and the likelihood of bleeding in elderly patients is much higher, reaching 70–90% of cases. In women and young people, such a lesion is less common. Approximately 9% of the population go to hospitals.

All etiological prerequisites for the appearance of pathology are divided into several groups: diseases of the gastrointestinal tract, vascular damage, portal hypertension and blood diseases.

The division of bleeding into ulcerative and non-ulcerative just refers to the first group. Of these, the most common are:

• stomach ulcer and duodenal ulcer;
• esophagitis in a chronic form;
• reflux esophagitis;
• nonspecific ulcerative colitis.

The development of peptic ulcers, and, consequently, bleeding, is affected by stress, long-term use of certain groups of medications, and disruption of the functioning of the endocrine system.

Non-ulcer bleeding from the intestinal mucosa and stomach can be triggered by erosions, diverticulosis, anal fissures and hemorrhoids, diaphragmatic hernia, benign and malignant tumors in the gastrointestinal tract, parasitic lesions, inflammatory processes, and some infectious diseases.

Bleeding can also cause such vascular disorders:

• atherosclerosis;
• systemic lupus erythematosus;
• hemorrhagic vasculitis;
• nodular periarteritis;
• phlebeurysm.

As for portal hypertension, it is one of the most dangerous complications of liver cirrhosis, hepatitis, thrombosis of the hepatic and portal veins.

Blood diseases that may be the causes of gastrointestinal bleeding:

• acute and chronic leukemia;
• aplastic anemia;
• hemophilia;
• von Willebrand disease.

Symptoms: how to recognize the presence of pathology

Any first aid – first aid or medical – cannot be provided to the patient until he has established the presence of specific symptoms of the pathology, the degree of damage and the level of threat to life have not been determined.

General symptoms of gastrointestinal bleeding are represented by such manifestations:

• weakness, severe dizziness;
• increased sweating;
• darkening in the eyes;
• cooling of the extremities;
• blanching of the skin and mucous membranes.

However, a characteristic feature that allows you to identify exactly a specific type of bleeding is the admixture of blood in the feces (black stools, or melena), as well as vomiting of fresh blood and “coffee grounds”

Classification of gastrointestinal bleeding according to severity

According to the severity (that is, the volume of blood loss), there are four degrees or stages of bleeding in the gastrointestinal tract:

• mild severity, when the patient feels satisfactory and is conscious, he has a drop in blood pressure of at least 100 mm. rt. column, and the level of erythrocytes and hemoglobin is still normal;
• a moderate condition is characterized by pallor of the skin, increased heart rate, sweating, tinnitus, a decrease in blood pressure to the value of “80” and hemoglobin twice;
• a serious condition in which the patient develops swelling of the face, lethargy, fainting, hemoglobin fluctuates at the level of 25% of the norm;
• hemorrhagic shock and coma, which can be fatal.

Gastrointestinal bleeding can lead to the following consequences:

• posthemorrhagic anemia;
• hemorrhagic shock;
• acute renal failure.

First aid rules

A patient with suspected gastrointestinal bleeding should be urgently admitted to the surgical department. There he will be provided with qualified assistance: they will assess the severity of bleeding, the state of blood circulation, respiratory and other systems, the likelihood of relapse and the risk of developing hemorrhagic shock; conduct a diagnostic search, establish the place of bleeding and, according to indications and with technical capabilities, neutralize it; they will prescribe medication aimed at stopping bleeding, combating complications and replenishing the qualitative composition and volume of blood by intravenous administration of drugs and blood components.

Before the arrival of specialized assistance, the patient must be given first aid according to the following algorithm: the patient is laid on his back, his legs slightly raised, ensuring complete rest, sudden movements, walking and vertical body position are prohibited.

First aid at the prehospital stage for acute gastrointestinal bleeding should include: cold on the epigastric region, rest (strict bed rest), with a sharp decrease in blood pressure – the Trendelenburg position, when the upper body is lowered and the feet are raised. It should be remembered that the introduction in such patients, cardiac and vascular drugs are contraindicated due to the risk of increased bleeding. Diagnosis of bleeding at home, and especially its localization, is quite difficult. However, if there is a suspicion of a specific location, the patient is forbidden to drink and eat, give an enema, rinse the stomach, take laxatives, leave the patient alone, refuse medical assistance, hoping that the bleeding will stop spontaneously. In case of loss of consciousness, the patient can be revived using ammonia. While a person is unconscious, it is necessary to carefully control the pulse and breathing.

First aid consists in the appointment of general hemostatic conservative therapy. The patient is shown strict bed rest, food and water intake is prohibited, an ice pack is placed on the stomach to cause vasoconstriction.

Oxygen therapy through a mask or nasal probes is prescribed as primary therapy. Intravenous or intramuscular administration of dicynone (2–4 ml of a 12,5% ​​solution). Intravenous administration of 10 ml of a 10% solution of calcium gluconate or calcium chloride. The introduction of a 0,025% solution of adroxan 1-2 ml intramuscularly.

Every 4 hours, epsilon-aminocaproic acid is injected intravenously in a 5% solution of 100 mg, 5% or 10% ascorbic acid solution in an amount of 1-2 ml, 1% vikasol solution of 1-2 ml.

The emergency treatment protocol also includes the introduction of the H2-blocker ranitidine intravenously, not more than 50 mg 3-4 times a day, famotidine 2 times a day in an amount of 20 mg. Also, the patient is prescribed omeprazole (a proton pump inhibitor) – 40 mg once or twice a day.

This completes the drug treatment, and the rest of the activities remain in the competence of the surgeon.

Bleeding from the stomach and intestines is a dangerous condition that can develop against the background of a wide variety of diseases and pathologies. The presence of bleeding in a patient can be chronic, and undermine his health for a long time, or acute, when a person can lose large volumes of blood in a short period of time and die. First aid for gastrointestinal bleeding is aimed primarily at stabilizing a person’s condition.

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