What Is Gastrointestinal Bleeding?

Gastrointestinal bleeding is a common clinical syndrome and can be caused by a variety of diseases. The digestive tract is the tube from the esophagus to the anus, including the esophagus, stomach, duodenum, jejunum, ileum, cecum, colon, and rectum. Upper gastrointestinal bleeding refers to bleeding from the esophagus, stomach, duodenum, upper jejunum, and pancreas and bile ducts above the duodenal suspension ligament (Treitz ligament). Intestinal bleeding below the duodenal suspension ligament is collectively referred to as lower gastrointestinal bleeding. With the development of endoscopic technology, the new term "middle digestive tract" has changed the understanding of the traditional segmentation concept of the digestive tract. The new definition is marked by duodenal papilla and ileocecal flap, and divides the digestive tract into "upper digestive tract" (above duodenal papilla) and "middle digestive tract" (duodenal papilla to ileocecal valve) And "lower digestive tract" (cecum, colon, rectum).

Basic Information

English name: alimentarytracthemorrhage
Visiting department: Gastroenterology
Common locations: Digestive tract
Common causes: Inflammation of the digestive tract itself, mechanical damage, vascular disease, tumors, etc., caused by diseases of adjacent organs and systemic diseases involving the digestive tract

Common symptoms: Dizziness, palpitation, cold sweats, fatigue, dry mouth, syncope, cold limbs, oliguria, restlessness, shock
Contagious: no

Causes of gastrointestinal bleeding

Gastrointestinal bleeding can be caused by inflammation of the digestive tract itself, mechanical damage, vascular lesions, tumors and other factors. It can also be caused by diseases of neighboring organs and systemic diseases involving the digestive tract.

Upper gastrointestinal bleeding

2. Middle and lower gastrointestinal bleeding

(1) Anal canal diseases: hemorrhoids, anal fissures, and anal fistula.

(2) Rectal diseases: ulcerative proctitis, tumors (polyps), carcinoids, adjacent malignant tumors or abscesses invading the rectum, infections (bacterial, tuberculous, fungal, viral, parasites), ischemia, etc.

(3) Colonic infections (bacterial, tuberculous, fungal, viral, parasites), ulcerative colitis, diverticulum, tumors (polyps), ischemia and vascular malformations, intussusception, etc.

(4) Small bowel diseases: acute hemorrhagic necrotic enteritis, intestinal tuberculosis, Crohn's disease, diverticulitis or ulcers, intussusception, tumors (polyps), hemangiomas, vascular malformations, ischemia, etc.

Clinical manifestations of gastrointestinal bleeding

Clinical manifestations vary according to the bleeding site, the amount of bleeding, and the rate of bleeding.

General condition

Small amount (less than 400ml), chronic bleeding and no obvious symptoms. Symptoms such as dizziness, palpitation, cold sweat, fatigue, dry mouth, and even syncope, cold limbs, oliguria, irritability, and shock may occur during acute and massive bleeding.

Vital signs

Changes in pulse and blood pressure are important indicators of the degree of blood loss. In acute gastrointestinal bleeding, the blood volume decreases sharply. The initial compensatory function of the body is to increase the heart rate. If the blood is not stopped or replenished in time, the pulse is weak or even unclear. Early blood pressure in shock can be compensated, and as the amount of bleeding increases, blood pressure gradually decreases and enters a state of hemorrhagic shock.

3 Other accompanying symptoms and signs

According to the different primary diseases, it can be accompanied by other corresponding clinical manifestations, such as abdominal pain, fever, intestinal obstruction, vomiting, blood in the stool, tarmac, abdominal mass, spider mole, abdominal varicose veins, jaundice, etc.

Gastrointestinal bleeding examination

Routine laboratory inspection

Including hematuria and stool routine, fecal occult blood (occult blood), liver and kidney function, coagulation function, etc.

2. Endoscopy

Gastroscopy (esophagoscopy), duodenoscopy, enteroscopy, capsule endoscopy, and colonoscopy are used to determine the etiology and bleeding site according to the original disease and bleeding site.

3. X-ray barium inspection

It is only applicable to the diagnosis of the etiology of patients with chronic bleeding and the bleeding site is unclear; or patients with acute massive bleeding have stopped and the disease is stable.

4. Angiography

Through digital silhouette technology, the contrast medium is injected into the blood vessel to observe the area where the contrast medium overflows.

5. Radionuclide imaging

In recent years, radionuclide imaging has been used to find the site of active bleeding. The method is to perform an abdominal scan after intravenous injection of ^{99m 99} colloid to detect markers, and evidence of bleeding from blood vessels can be used to determine the bleeding site.

6. Other

According to the needs of the primary disease, CT, MRI, CT simulated small intestine, colonography, etc. can be selected to assist diagnosis.

Gastrointestinal bleeding treatment

The principles of treatment vary according to the primary disease, the amount and rate of bleeding.

Upper gastrointestinal bleeding

2. Middle and lower gastrointestinal bleeding

(1) Symptomatic treatment of chronic and small amount of bleeding is mainly for the treatment of the primary disease (cause). Acute massive bleeding should be bed rest, fasting; closely observe the changes in the condition, maintain venous access and measure central venous pressure. Keep the patient's airway open and avoid suffocation when vomiting blood. And take appropriate treatment for the primary disease.

(2) In the case of acute massive hemorrhage supplementation , rapid intravenous infusion should be performed to maintain blood volume and prevent blood pressure from falling; when hemoglobin is less than 6g / dl and systolic blood pressure is less than 12kPa (90mmHg), blood transfusion should be considered. To avoid blood transfusion, excessive infusion volume caused acute pulmonary edema or induced re-bleeding.

(3) Endoscopic therapy has limited hemostatic effect under colonoscopy and enteroscopy, and is not suitable for acute major bleeding, especially for diffuse intestinal lesions. Specific methods are: argon ion coagulation hemostasis (APC), electrocoagulation hemostasis (including unipolar or multipolar electrocoagulation), frozen hemostasis, thermal probe hemostasis, and spraying of epinephrine, thrombin, and hemostatic drugs on bleeding lesions to stop bleeding. For bleeding caused by diverticulum, hemostatic methods such as APC and electrocoagulation should not be used to avoid intestinal perforation.

(4) Minimally invasive interventional therapy After selective angiography shows the bleeding site, hemostasis can be performed through the catheter. Most cases can achieve the purpose of hemostasis. Although some of these cases will re-bleed during hospitalization, it improves the overall condition of the patient and creates good conditions for elective surgery. It is worth pointing out that gastrointestinal bleeding caused by intestinal ischemic diseases is contraindicated. Generally, in the case of lower gastrointestinal bleeding, embolization and hemostasis are not recommended after arterial catheterization, because the embolization of the proximal blood vessels can easily cause ischemic necrosis of the intestine, especially the colon.

(5) Surgical treatment is not recommended for blind laparotomy if the cause of bleeding and the bleeding site are unclear. Laparotomy may be considered in the following cases: active hemorrhage and hemodynamic instability are not allowed Do arterial angiography or other examinations; no bleeding site was found in the above examination, but the bleeding continued; repeated similar severe bleeding. Thorough exploration should be carried out during the operation, and endoscopic examination through transanal and / or enterostomy is necessary if necessary. It is performed by an endoscopy specialist. The surgeon assists in the introduction of the scope and can rotate the intestine to flatten the mucosal folds. This allows the endoscope doctor to obtain a clear field of vision and is conducive to the discovery of small and hidden bleeding lesions. At the same time, the surgeon can also find lesions from the serosal surface through endoscopic transillumination.