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Preamble
preamble preambleGastrointestinal bleeding is mainly manifested as hematemesis and blood in the stool.
Gastrointestinal bleeding is mainly manifested as hematemesis and blood in the stool.
The digestive tract is divided into upper and lower digestive tracts according to the ligament of Trevor .
The digestive tract is divided into upper and lower digestive tracts according to the ligament of Trevor .
etiology _
The most common causes of the upper gastrointestinal tract are peptic ulcers, esophagogastric varices, acute gastric mucosal lesions, andgastric cancer
The most common causes of the upper gastrointestinal tract are peptic ulcers, esophagogastric varices, acute gastric mucosal lesions, andgastric cancer
clinical manifestations
clinical manifestations clinical manifestations1.
1.
2.
3.
4.
5.
Auxiliary inspection Auxiliary inspection
1.
1.
(1) Occult blood test: A strong positive stool or vomit occult blood test is an important basis for diagnosing gastrointestinal bleeding
(2) Routine blood examination: acute patients have different degrees of hemoglobin reduction, showing normocytic hypochromic anemia; portal hypertension combined with hypersplenism, the anemia is aggravated, and white blood cells and platelets are further reduced; chronic blood loss is mostly caused by low microcytic cells Pigmented anemia, iron deficiency anemia
(3) Blood urea nitrogen test: Massive bleeding in the upper gastrointestinal tract begins to increase within a few hours, reaches a peak within 24 to 48 hours, and returns to normal within 3 to 4 days, which can cause intestinal azotemia
.
2.
Emergency endoscopy
Emergency endoscopy 2.
Emergency endoscopy
Emergency endoscopy has been listed as the preferred method for acute upper gastrointestinal bleeding
.
Emergency endoscopy is safe and reliable, and its complications are no different from routine microscopy; if the condition permits, the earlier the endoscopy time, the better, which can improve the accuracy of diagnosis
.
.
Emergency endoscopy is safe and reliable, and its complications are no different from routine microscopy; if the condition permits, the earlier the endoscopy time, the better, which can improve the accuracy of diagnosis
.
Bleeding signs judgment
Judgment of bleeding signs Judgment of bleeding signs(1) Assessment of blood loss
(1) Evaluation of blood loss (1) Evaluation of blood lossThe fecal occult blood test is positive for 5-10ml of gastrointestinal bleeding per day in adults;
The fecal occult blood test is positive for 5-10ml of gastrointestinal bleeding per day in adults;Black stools can appear when the bleeding is 50~100ml;
Black stools can appear when the bleeding is 50~100ml;Hematemesis caused by accumulation of blood in the stomach in 250~300ml;
Hematemesis caused by accumulation of blood in the stomach in 250~300ml;Bleeding amount reached 1000ml dark red bloody stool
.
.
(2) Judgment of active bleeding
(2) Judgment of active bleeding (2) Judgment of active bleeding1.
Repeated hematemesis or thin melena and increased frequency; hematemesis turned bright red, melena was dark red, with hyperactive bowel sounds
.
Repeated hematemesis or thin melena and increased frequency; hematemesis turned bright red, melena was dark red, with hyperactive bowel sounds
.
2.
Peripheral circulatory failure, no significant improvement after replenishing blood volume or worsening after improvement; after rapid replenishment of blood volume, central venous pressure still fluctuates or slightly stabilizes and then decreases
.
Peripheral circulatory failure, no significant improvement after replenishing blood volume or worsening after improvement; after rapid replenishment of blood volume, central venous pressure still fluctuates or slightly stabilizes and then decreases
.
3.
Hemoglobin, red blood cells, and hematocrit continue to decline, and reticulocytes continue to rise
.
Hemoglobin, red blood cells, and hematocrit continue to decline, and reticulocytes continue to rise
.
4.
Sufficient fluid rehydration and urine volume and urea nitrogen continued or increased again
.
Sufficient fluid rehydration and urine volume and urea nitrogen continued or increased again
.
5.
Those with bleeding or bleeding under endoscopy
.
Those with bleeding or bleeding under endoscopy
.
Disease severity and prognostic classification
Disease severity and prognostic gradingAccording to age, the presence or absence of complications, blood loss and other indicators, acute gastrointestinal bleeding can be divided into mild, moderate and severe
.
.
Treatment measures
treatment action treatment action(1) Handling principles
(1) Handling principles (1) Handling principles1.
Determine the signs of bleeding and monitor vital signs, assess the amount of bleeding and active bleeding, the severity and prognosis of the disease
.
Determine the signs of bleeding and monitor vital signs, assess the amount of bleeding and active bleeding, the severity and prognosis of the disease
.
2.
Actively supplement blood volume and hemostasis treatment to prevent complications
.
Actively supplement blood volume and hemostasis treatment to prevent complications
.
prevention
3.
Carry out etiological treatment, symptomatic and supportive treatment
.
Carry out etiological treatment, symptomatic and supportive treatment
.
(2) Treatment measures
(2) Treatment measures (2) Treatment measures1.
Closely observe blood pressure, pulse, respiration and consciousness at the scene and on the way of transporting patients
.
Closely observe blood pressure, pulse, respiration and consciousness at the scene and on the way of transporting patients
.
2.
It is very important to rest in bed and monitor vital signs.
Patients who vomit blood must pay attention to turning their head to one side or lying on their side to prevent suffocation when vomiting blood
.
In the acute phase of heavy bleeding, diet should be prohibited, and when there is a small amount of bleeding, you can choose to eat or a mild full liquid diet
.
It is very important to rest in bed and monitor vital signs.
Patients who vomit blood must pay attention to turning their head to one side or lying on their side to prevent suffocation when vomiting blood
.
In the acute phase of heavy bleeding, diet should be prohibited, and when there is a small amount of bleeding, you can choose to eat or a mild full liquid diet
.
3.
Oxygen inhalation, keep quiet, and sedatives can be given to those who are restless (use with caution in patients with liver disease)
.
Oxygen inhalation, keep quiet, and sedatives can be given to those who are restless (use with caution in patients with liver disease)
.
4.
Establish venous access, intravenous infusion of normal saline, glucose saline,
etc.
Volume can be quickly replenished with whole blood, plasma or normal saline
.
The rate and type of infusion is best adjusted according to central venous pressure and hourly urine output
.
It is generally believed that the indications for blood transfusion are: polydipsia, cold sweat, shock; systolic blood pressure below 12kPa (90mmHg), pulse rate above 120 beats/min; hemoglobin below 70g/L and continuous bleeding
.
Establish venous access, intravenous infusion of normal saline, glucose saline,
etc.
Volume can be quickly replenished with whole blood, plasma or normal saline
.
The rate and type of infusion is best adjusted according to central venous pressure and hourly urine output
.
It is generally believed that the indications for blood transfusion are: polydipsia, cold sweat, shock; systolic blood pressure below 12kPa (90mmHg), pulse rate above 120 beats/min; hemoglobin below 70g/L and continuous bleeding
.
Patients with liver cirrhosis with esophageal and gastric variceal bleeding should not use dextran and excessive use of bank blood, nor excessive or fast infusion (blood transfusion), so as not to induce hepatic encephalopathy and rebleeding
.
.
5.
For repeated vomiting, a nasogastric tube or three-lumen two-capsule tube should be placed to compress the bleeding
.
For repeated vomiting, a nasogastric tube or three-lumen two-capsule tube should be placed to compress the bleeding
.
6.
People with bleeding from esophageal and gastric varices should fast for two or three days
.
Others who vomit blood should fast for 4 hours.
If there is no hematemesis or simple black stool, they can eat a warm and cool liquid and gradually transition to a semi-liquid diet
.
People with bleeding from esophageal and gastric varices should fast for two or three days
.
Others who vomit blood should fast for 4 hours.
If there is no hematemesis or simple black stool, they can eat a warm and cool liquid and gradually transition to a semi-liquid diet
.
7.
Endoscopy and endoscopic hemostasis
.
Endoscopy is the key examination to identify gastrointestinal bleeding lesions.
Emergency gastroscopy should be performed within 24 to 48 hours after bleeding, provided that vital signs are stable
.
There are some methods of hemostasis under the endoscope, including spraying hemostatic drugs, thermal coagulation to stop bleeding, and vascular clamps can be placed to clamp the bleeding end of the blood vessel
.
Endoscopy and endoscopic hemostasis
.
Endoscopy is the key examination to identify gastrointestinal bleeding lesions.
Emergency gastroscopy should be performed within 24 to 48 hours after bleeding, provided that vital signs are stable
.
There are some methods of hemostasis under the endoscope, including spraying hemostatic drugs, thermal coagulation to stop bleeding, and vascular clamps can be placed to clamp the bleeding end of the blood vessel
.
Blood vessel
8.
Drugs to stop bleeding
.
Drug hemostasis includes acid-suppressing drugs and hemostatic drugs
.
Drugs to stop bleeding
.
Drug hemostasis includes acid-suppressing drugs and hemostatic drugs
.
(1) Norepinephrine: 8 mg added to 100 mL of water orally in divided doses, or injected through a nasogastric tube
.
.
(2) Yunnan Baiyao, vitamin K, Anluoxue, thrombin, 6-aminoacetic acid, antifibrinolytic aromatic acid, sulfoethylamine, etc.
were selected according to the nature of bleeding
.
were selected according to the nature of bleeding
.
(3) vasopressin: 20-40 units of 10% glucose solution 500mL, intravenous drip ( hypertension , arteriosclerosis, heart failure, pulmonary heart disease, pregnant patients are prohibited)
.
In recent years, the use of somatostatin can reduce blood flow and portal pressure, but it is not accompanied by systemic hemodynamic changes
.
.
In recent years, the use of somatostatin can reduce blood flow and portal pressure, but it is not accompanied by systemic hemodynamic changes
.
hypertension
(4) Application of antacids: H2-receptor antagonist or proton pump inhibitor omeprazole can be used, which is effective in controlling peptic ulcer bleeding
.
.
Management of acute upper gastrointestinal bleeding
Treatment flow for acute upper gastrointestinal bleeding Treatment flow for acute upper gastrointestinal bleeding(References and image source: Emergency and Disaster Medicine 3rd Edition)
(References and image source: Emergency and Disaster Medicine 3rd Edition)Leave a message here
