What Causes a Bleeding Ulcer?

1. Symptoms The major symptoms of major bleeding from gastroduodenal ulcer are vomiting and blood in the stool. Most only have blood in the stool and no vomiting, and those who have vomiting usually indicate a large or rapid bleeding. After vomiting or blood in the stool can be manifested as collapse, weakness, sweating and even syncope.

Gastric ulcer bleeding

Gastroduodenal bleeding is also a common complication of ulcer disease. Small amounts of bleeding often have no clinical symptoms. Found only during fecal occult blood tests. When the amount of bleeding is greater than 500ml, it is a major bleeding, which is mainly manifested by vomiting, blood in the stool, and anemia of varying degrees. About 10% of hospitalized patients with ulcers are hospitalized for major bleeding. Although bleeding accounts for the largest proportion of all complications, bleeding has recently increased in the proportion of peptic ulcer complications.

Gastric ulcer bleeding symptoms and signs

2. Signs Depend on the rate and amount of bleeding, such as about 400ml of bleeding, often manifested as a circulatory system compensatory response, such as pale skin, pulse, normal blood pressure or slightly increased; if blood loss is more than 800ml, there are signs of shock. These include decreased blood pressure, rapid pulse, shortness of breath, sweating, and cold limbs. Abdominal signs are often only active with bowel sounds. Temperature rose in half of the patients.

Gastric ulcer bleeding medication

Most patients with major gastric ulcer bleeding can be controlled by non-surgical treatment. Only those who have bleeding more than once or have stopped bleeding repeatedly after being temporarily stopped will be considered for surgical treatment.

1. Non-surgical treatment includes the following aspects:

(1) General treatment: including bed rest, sedation, such as barbiturates or morphine preparations, to calm the mind and reduce fear. Closely observe the changes in each vital sign and check the hemoglobin and red blood cell counts as the basis for further treatment. If the general condition of the patient is stable, oral ulcer disease diet can be given, and oral hemostatic drugs, such as celestin, Yunnan Baiyao, Hansanqi or other hemostatic drugs can be given orally.

(2) Blood transfusion and fluid replacement: For patients with severe illness, blood transfusion or fluid replacement should be given. Common liquids are:

Balanced salt solution: Not only can supplement dehydration, but also can replace part of blood transfusion, it can be preferentially used when transfusion of hemorrhagic shock is temporarily unavailable. For every 1ml of blood loss, 3ml of balanced salt solution can be given to supplement, and it can be input as 10ml per kilogram of body weight in the first hour, and then reduced to 5ml per kilogram of body weight per hour.

Dextran: Including low-molecular-weight dextran and high-medium-molecular dextran, high-molecular-weight individuals (molecular weights above 10 × 103) have an effect on coagulation, can cause microcirculation obstruction, and are not easy to be excreted from the body, so they are not used clinically. Those with low molecular weight (molecular weight around 4 × 103) are good for improving peripheral circulation, those with medium molecular weight (molecular weight around 7 × 103) can increase blood volume, and each gram of dextran can increase the amount of plasma by 15ml, such as 6% dextran 500ml with dextran 30g, can increase the amount of plasma by 450ml, can be maintained for 6-12 hours. Such solutions are likely to cause bleeding and renal dysfunction when used in large quantities, so the daily dosage should not exceed 1000ml.

blood transfusion: the most effective method to replenish blood volume. Therefore, transfusion should be given to major bleeding, especially when there are symptoms of hemorrhagic shock. The amount of blood transfusion is preferably equivalent to the amount of bleeding, but it is difficult to accurately estimate the amount of blood loss in the clinic, and the body is very complicated with a series of pathophysiological changes that occur after blood loss. A large amount of blood transfusion can cause many complications, so it is not necessarily Enter all blood. One or most of them can be replaced with a balanced salt solution or a plasma substitute. Generally, the blood pressure rises to 13.3kPa (100mmHg) or more after blood transfusion, and the hematocrit increases to about 40%, which can be considered as the ideal level. If the hematocrit decreases by 10%, about 1000ml of blood transfusion is required; if it decreases by 5%, about 300-500ml of blood transfusion is required. When the blood pressure after transfusion exceeds 13.3kPa (100mmHg), the blood transfusion should be stopped. If the blood pressure drops after the blood transfusion is stopped, it means that there is continuous bleeding and surgery should be considered.

(3) Hemostasis:

Stomach hypothermia therapy: Use a special gastric tube with a rubber pouch to insert into the stomach (clean the residual blood and blood clots in the stomach with cold saline before placing the tube), then use a special circulation pump to continuously inject ice water alcohol from the tube And withdraw, keep the stomach at low temperature for 24 to 72 hours, and keep the temperature in the return tube at 5 to 10 ° C. This method can not only reduce bleeding, but also reduce gastric juice secretion. The effective rate of hemostasis is more than 80%, but the method is more complicated and the bleeding recurrence rate is higher. It is more suitable for patients who have more bleeding and complicated complications and are not suitable for surgery.

Cold physiological saline gastric lavage method: Inject cold cold saline at 4 ° C through the gastric tube to shrink the local blood vessels in the stomach and reduce the ability to locally dissolve cellulose, thus achieving the purpose of hemostasis. This method is simple and easy to implement and can be adopted by general hospitals. In recent years, some people have also used noradrenaline solution to inject from gastric tube to obtain good hemostatic effect. The method is to wash the residual blood in the stomach after inserting the gastric tube, and then inject 100 ml of a physiological saline solution containing 8 mg of norepinephrine through the gastric tube, and clamp the tube for 30 minutes. During the clamping period, the patient can change the position, and then use saline Rinse and observe whether there is continuous bleeding. This method can be repeated once every minute, and the bleeding can be appropriately extended. Since norepinephrine is absorbed through the portal vein and is inactivated in the liver, it has little effect on cardiovascular.

Hemostasis via endoscope:

A. Local injection of hypertonic sodium-adrenaline solution (HS-E): After identifying the bleeding site through an endoscope, insert a plastic tube through the biopsy hole, wash the surface blood clot, and directly inject HS-E around the bleeding vessel The solution is 3 to 4 places, each 3ml, as long as the injection is sure to stop bleeding. The mechanism is: hypertonic sodium can prolong the local action time of adrenaline, and can make the surrounding tissue edema, fibrin degeneration of blood vessel wall, and thrombosis. Hirao et al. (1980) reported 21 cases of upper gastrointestinal hemorrhagic lesions in 23 patients. After local injection of hypertonic sodium-adrenaline solution, 82% achieved permanent hemostasis, 9% temporarily stopped bleeding, and 9% were ineffective.

B. Laser photocoagulation therapy: After the bleeding site is determined through an endoscope, the laser is used to perform coagulation to stop bleeding. Laser is a kind of very dense and powerful light energy. When its light beam hits an appropriate absorption surface, the light energy is converted into heat energy, so as to achieve the purpose of coagulation and hemostasis. Currently used lasers include a ruby laser, a carbon dioxide laser, an argon ion laser, and a neodymium yttrium aluminum garnet (Nd: YAG) laser. The argon ion laser is widely used for irradiation. Animal tests and clinical applications have shown that the simple laser irradiation often damages the stomach or duodenal wall, and even perforates, so some people advocate using CO2 coaxial spray method for laser irradiation. This can reduce the deep damage of the stomach wall by laser. Before the laser irradiation, the local injection of CO2 will cause a certain pressure in the rupture of the blood vessel to stop the bleeding, and then the laser irradiation will quickly solidify and stop the bleeding. Laurence (1980) reported 60 patients with gastric or duodenal hemorrhage. After the endoscopic determination of the bleeding site, argon ion laser was used to perform coagulation treatment through a variable-curvature quartz fiber. Among 36 cases with arterial ejection bleeding, bleeding was controlled in 25 (69%), but bleeding recurred in 3 (8.3%); in 24 chronic bleeding, 23 (95.8%) bleeding was controlled, Two patients (8.3%) had recurrent bleeding.

C. High-frequency electrocoagulation to stop bleeding: In addition, there is still high-frequency electrocoagulation to stop ulcer bleeding through endoscope or use a strong magnetic field to press the ferromagnetic mixture containing thrombin to the bleeding lesion to achieve the purpose of hemostasis. These methods have some effects in clinical application, but there are few cases, and further research is needed in the future.

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Gastric ulcer bleeding diet health care

I. Food therapy for gastric ulcer bleeding

(The following information is for reference only, please consult your doctor for details)

1. Two spoons of maltose, boiled in water to treat gastric ulcers and duodenal ulcers, and have the effect of alleviating stomach pain.

2. Milk and goat milk are each 125 ml, mixed and boiled, and taken once every morning on an empty stomach.

3. Treatment of gastric ulcer: 150 ml of tomato juice and 150 ml of potato juice, mixed once, morning and evening.

4. Steamed eggs with panax notoginseng juice: Beat the eggs one by one, add 30ml of fresh pancake juice and 3g of panax notoginseng, season with a little white sugar and steam for consumption. Has hemostatic, analgesic, and blood stasis effects. Applicable to gastric ulcer bleeding, duodenal bulb ulcer bleeding, tuberculosis hemoptysis and other symptoms.

5. Wash 600g of fresh potatoes, peel and peel the juice and boil the juice. When the juice is boiled until it is thick, add 1200 milliliters of honey, and then boil until it is more viscous and then cool. Store in a wide-mouth bottle in the refrigerator. Take one tablespoon each on an empty stomach, the effect is very reliable.

6. Dry lotus leaves, roasted and ground finely, 1 g per serving, once a day for several consecutive days.

7. Treatment of gastric ulcer bleeding: 100 grams of jellyfish, 100 grams of white peony, total research fines, 5 grams each time, served or washed with warm water, 3 to 4 times a day.

8. 150 ml of tomato juice and 150 ml of potato juice, mixed with each morning and evening.

9. Two spoons of maltose, boiled in water, can relieve stomach pain.

10. Treat all kinds of chronic stomach diseases: 1 pig belly, rub with salt and clean. 30--60 grams of Shixiantao, add water in the same bowl and steam it in the pot, season with salt and season. Applicable to gastric ulcer, duodenal ulcer, malnutrition, etc.

11, 500 grams of jellyfish skin, 500 grams of jujube, 250 grams of brown sugar, thick fried into a paste, 1 tablespoon each time, 2 times a day.

Second, what are the health benefits of eating gastric ulcer bleeding?

1. To enhance nutrition, you should choose foods that are easy to digest, contain enough calories, and are rich in protein and vitamins. Such as porridge, vermicelli, milk, soft rice, soy milk, eggs, lean meat, tofu and soy products.

2. Eat more foods rich in vitamins A, B, and C, such as fresh vegetables and fruits. These foods can strengthen the body's resistance, help repair damaged tissue and promote ulcer healing.

This article introduces several foods that can help stomach ulcers.

1. Honey, it tastes really good. It contains glucose, fructose, organic acids, yeast multivitamins and trace elements, and can protect the ulcerative surface of the gastric mucosa.

2, lotus root, rich in starch, can promote gastrointestinal motility, accelerate the healing of gastric ulcers, as well as the function of hangover!

3. Eggs and yolks contain a large amount of lecithin and brain phospholipids, which have a strong protective effect on gastric mucosa. So remember to eat more eggs!

4, jujube, jujube has the function of nourishing the spleen and stomach, often eating jujube or porridge made of jujube, glutinous rice, has a certain prevention and cure effect on gastric ulcer.

What foods are best not to eat for gastric ulcer bleeding?

1. Restrict foods with excessive residues. Avoid eating fried and fried foods, as well as celery, chives, bean sprouts, ham, bacon, dried fish and various coarse grains containing more crude fiber. These foods are not only rough and difficult to digest, but also cause a large amount of gastric juice secretion and increase the burden on the stomach. But digestible foods such as puree can be processed.

2. Do not eat foods that are irritating. Forbid foods that stimulate gastric acid secretion, such as broth, raw onions, raw garlic, concentrated fruit juice, coffee, wine, strong tea, etc., as well as too sweet, too sour, too salty, too hot, Raw, cold, hard food. Sweet food can increase gastric acid secretion and stimulate the ulcer surface to aggravate the condition; overheated food stimulates the ulcer surface and cause pain, which causes the blood vessels in the ulcer surface to expand and cause bleeding; spicy food stimulates the ulcer surface and increases gastric acid secretion; cold and hard food is not easy Digestion can aggravate the condition.

3. In addition, patients with ulcers should also quit smoking. Nicotine in tobacco can change the pH of gastric juice, disrupt the normal activities of gastric pylorus, and induce or exacerbate ulcers.

Gastric ulcer bleeding prevention care

Actively treat the primary disease and take good care of the stomach.

Pathological causes of gastric ulcer bleeding

Gastric ulcer bleeding is caused by erosion and destruction of ulcer base blood vessels, mostly arterial bleeding. Major bleeding ulcers are usually located in the small curvature of the stomach or the back wall of the duodenum. Therefore, the source of gastric ulcer bleeding is usually the branches of the left and right arteries of the stomach or blood vessels in the hepatogastric ligament. Most of the bleeding comes from the blood vessels near the superior pancreaticoduodenal or gastroduodenal arteries.

Gastric ulcer bleeding disease diagnosis

Often need to distinguish with esophageal gastric varices rupture bleeding, gastritis bleeding, gastric cancer and gastric leiomyoma, gastric hemangioma bleeding, biliary tract bleeding and so on. Mallory-Weiss syndrome, that is, esophageal and cardia mucosa tear syndrome, can also be manifested as severe bleeding after severe vomiting.

Gastric ulcer bleeding test method

Laboratory inspection:

1. Blood tests Blood tests related to GU bleeding, including hemoglobin, hematocrit, reticulocyte count, bleeding, and clotting time.

2. Fecal occult blood test.

Other auxiliary checks:

For patients who have difficulty in diagnosing the etiology and site of bleeding, the following methods can be used to assist the diagnosis:

1. Fiber gastroscopy Fiber gastroscopy is listed as the first choice for upper gastrointestinal bleeding. Practice has proved that this test has a 90% accuracy rate in the diagnosis of gastric ulcer bleeding.

The examination should be performed within 6-12 hours after the bleeding. If the patient's general circumstances permit, the earlier the examination, the better. If the examination time exceeds 12 hours, it may stop due to bleeding, and mucosal healing is not easy to be found. At the same time, because of blood clot in the stomach, it is not easy to remove although it is washed with iced saline, which affects the examination results.

For some patients with severe gastric ulcer and bleeding that are difficult to diagnose before surgery and difficult to find lesions during surgery, fiber gastroscopy can be applied during surgery. That is, through a gastrostomy, the blood in the stomach is first sucked out, and then the fiber gastroscope soaked and sterilized is placed, the stoma is tightened, and the examination is performed step by step. Often, it is possible to find the lesions that are not easy to find during preoperative examination.

2. Selective arteriography has a high accuracy for the diagnosis of gastric ulcer bleeding sites, and the bleeding rate can be displayed at 0.5 ~ 2ml / min. When fiber gastroscopy does not clearly indicate the bleeding site, angiography can often show the location and extent of the bleeding. If angiography shows most of the small bleeding points in the distribution area of the left gastric artery, hemostasis can be performed by injecting a vasoconstrictor through the left gastric artery; when a large vascular bleeding is confirmed, early surgical treatment should be performed.

3. Barium meal examination Barium meal examination for acute bleeding often causes artifacts or affects diagnosis due to the presence of blood clots. At the same time, the presence of barium shadows affects other examinations.

Gastric ulcer bleeding complications

May be issued with bloody shock.

Gastric ulcer bleeding prognosis

10% to 50% of patients with ulcer bleeding have recurred bleeding within 5 years after medical treatment, and the surgical mortality rate is 2% to 10%. DU major bleeding has a higher mortality rate than GU major bleeding. Mortality is closely related to age. The mortality rate of patients aged 60 years is 10% to 15%, and the mortality rate of patients aged 80 years is 25% to 30%, while the total mortality of patients with peptic ulcer bleeding is only 5%. ~ 8%.

Gastric ulcer bleeding pathogenesis

The pathophysiological changes caused by ulcer bleeding are related to the amount and rate of bleeding. Bleeding of 50 to 80ml can often cause tar-like stools without causing other significant symptoms. Massive rapid blood loss causes hypovolemic shock, anemia, hypoxia, circulatory failure, and death. A large amount of blood often causes blood biochemical changes in the gastrointestinal tract, which is manifested by increased non-protein nitrogen.