Symptoms of diseases of the digestive system - bleeding from the gastrointestinal tract

Gastrointestinal bleeding is the loss of blood from damaged blood vessels in or near the walls of the digestive tract when bleeding occurs into the lumen of the gastrointestinal tract. The source of bleeding can be any part of the digestive tract, from the pharynx to the rectum.

Bleeding can have many different causes and clinical progression depending on the rate and amount of blood lost, as well as the general condition, especially concomitant diseases.

Types of gastrointestinal bleeding

The content of the article

The severity of bleeding can range from microscopic blood loss to massive bleeding with the release of large amounts of blood (usually a mixture of blood, clots, and possibly hematin) through the mouth or anus, which can lead to hypovolemic shock and death.

Microscopic blood loss can only be detected in stool using specialized laboratory tests. The condition can also be identified by the results of peripheral blood tests and decreased iron levels.

Gastrointestinal bleeding is divided into:

• Bleeding from the upper gastrointestinal tract
  . Their source is between the pharynx and the ligament of Treitz (duodenal ligament). They are involved in 80% of cases of gastrointestinal bleeding;
• Gastrointestinal bleeding from the lower gastrointestinal tract
  . Their source is between the ligament of Treitz and the rectum;
• Hidden gastrointestinal bleeding
  . This form differs from ordinary bleeding in its clinical picture and requires specific diagnostic procedures.

Treatment methods

Therapy depends on the source and cause of blood loss. Its main goal is to stop internal bleeding, compensate for the lack of blood and restore its circulation. In difficult situations, patients require surgical intervention.

First aid

Internal bleeding (signs of a pathological condition, depending on the location of occurrence, are clearly or weakly expressed) is important to stop as quickly as possible, since a person’s life depends on it

First aid includes the following actions:

Lay the victim on a flat surface. All subsequent assistance to the person is provided while he is in a horizontal position

It is important that the victim relax all the muscles of the body. It is necessary to apply a cold compress to the abdomen, chest, hypochondrium or lower back

Place a pillow or cushion or clothing under the person’s feet. If there is vomiting, turn the victim on his side. The patient must be quickly transported to the hospital for medical care.

Failure to take the first steps will lead to massive internal bleeding, which is life-threatening and even fatal.

After providing assistance, it is important to monitor blood pressure and heart rate

Medications

Drug therapy is prescribed to the patient for minor or moderate blood loss. If the diagnostic results did not show serious internal damage and accumulation of large amounts of blood in the peritoneal area.

In an emergency situation, treatment is carried out inpatiently, the patient is prescribed the following medications:

The doctor monitors the patient's condition and also prescribes infusion therapy. It involves intravenous administration of saline solutions (Ringer, Refortan). The victim is prescribed medications to restore the permeability of the vascular wall (“Ascorbic acid”, “Rutoside”).

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Traditional methods

Prescriptions from witch doctors and healers can be used if the internal bleeding is not the result of a serious injury. In an emergency, the victim needs medical attention.

Effective hemostatic recipes:

Lemon juice and aloe are also hemostatic agents. The components are mixed in proportions 1:2. Before use, the product is diluted with a small amount of water.

Other methods

In a severe situation, massive blood loss of any origin, regardless of the cause and degree of damage, is eliminated by emergency surgery.

The patient is also given fluid therapy to maintain vital signs.

Symptoms of upper gastrointestinal bleeding

Such bleeding can be identified by specific symptoms. The patient is concerned about:

• Vomiting and tarry stools;
• Fusion vomiting - vomiting of blood (hematemesis) with an admixture of hematin, formed by the action of hydrochloric acid on hemoglobin;
• Vomiting “coffee grounds.” It is black or brown in color due to the presence of hematin. With light bleeding, “coffee grounds” may not appear, and then the only sign is tarry stool.

During intense bleeding from the upper gastrointestinal tract, vomiting blood may be accompanied by loose, bloody stools. Information about the appearance of stool can be obtained from anamnesis or rectal examination. It should be borne in mind that there are medications that can cause stools to turn black, for example, iron or bismuth salts.

First aid for internal bleeding

The main task in case of internal bleeding is to show the victim to a doctor as quickly as possible. If the situation is not very critical, you can get to the hospital by your own transport; in all other cases, you will definitely need to call an ambulance for further hospitalization of the patient.

Body position when assisting a victim

The person needs to be immobilized, his legs raised to a level slightly higher than his heart, and he needs to be kept at rest. If blood comes from the mouth, the victim must be held so that he does not choke.

Apply a cold compress to the suspected bleeding site or injury site. Anything you have on hand will do: snow, ice, a bottle of water. If you're hiking, you can take the batteries out of your cooler bag.

Constantly monitor your breathing and pulse. Under no circumstances should a person be given any drugs. If he asks for a drink, it is acceptable to rinse your mouth with clean water.

Determining the cause and assessing the intensity of bleeding

Often the probable cause of bleeding can be determined by history.

Important things to consider:

• symptoms of dyspepsia (especially at night);
• symptoms of stomach ulcer;
• side effects of medications taken, especially those that inhibit blood clotting, such as non-steroidal anti-inflammatory drugs;
• likelihood of alcohol abuse;
• the presence of hepatitis B or C - these may indicate liver cirrhosis and portal hypertension as possible causes of bleeding.

Physical examination

Physical examination
The gastroenterologist begins the examination from the head - carefully examining the nose, mouth and throat, since sometimes the cause of bleeding can be localized.

Next, they are identified with

symptoms of anemia and hypovolemia. The patient's heart rate and blood pressure are determined. A bad symptom is an acceleration of heart rate and a drop in blood pressure (>10 mmHg). Orthostatic hypotension involves rapid or severe blood loss.

Other signs that may indicate significant blood loss include:

• cool skin;
• oliguria;
• disturbances of consciousness.

Patients with anemia feel weak, dizzy, see spots before their eyes, have chest pain, and may faint. The severity of these symptoms depends on the amount of blood lost and the rate of bleeding.

It is also important to carefully examine the patient's body for symptoms of chronic liver disease. A number of specific symptoms indicate a pathological condition of the liver:

• presence of spider veins on the skin of the breast
• gynecomastia;
• loss of axillary and pubic hair;
• yellowing of the skin;
• palmar erythema;
• enlarged spleen;
• ascites;
• swelling of the legs;
• hand tremors

Signs of internal bleeding of varying severity

The clinic is determined by the severity of the pathological process.

With a mild disorder, when there is little bleeding, the following manifestations are found:

• Paleness of the skin and mucous membranes. Occurs immediately after the development of an abnormal condition. The body acquires a whitish tint, as do the gums, which is clearly noticeable upon visual assessment.
• Increased sweating. Hyperhidrosis.
• Feeling cold. Reduced skin temperature. With an objective study using a thermometer, the indicators, as a rule, are at normal levels or are slightly reduced. Restoration does not give a clear result, the problem persists. When palpating the fingertips, a decrease in local temperature is noted.
• Slight drop in blood pressure. Up to 10 mmHg above or below. It is possible to change diastolic and systolic at the same time.

Usually the patient does not feel these problems with a small amount of blood loss. There are no neurological deficits or headaches. Although options are possible, depending on the individual characteristics of the body.

• Dyspnea. Violation even without physical activity. The patient is short of air. It persists throughout the entire period until specific treatment is carried out.
• Tachycardia at 95-100 beats per minute. Not always noticeable to the victim. Moreover, the intensity of the heartbeat decreases, the force of the beats, despite the number, remains the same or decreases.
• Thirst. Strong desire to drink.
• Darkening in the eyes. Due to insufficient circulating blood volume. Ischemia of brain tissue occurs. Compensatory mechanisms do not work.

The average degree of bleeding is determined by the same manifestations. But a little more intense. Plus, there are a number of additional, subjective signs:

These include:

• Dry mouth. Changes in the hydration of mucous membranes.
• Fainting conditions. Syncopal phenomena occur one or more times, depending on the nature of the insufficiency of trophism of nerve tissues. The brain always suffers, the only difference is the severity of the disorder.
• Dizziness. The patient cannot navigate even in a familiar environment and falls. Forced to take a sitting or lying position. To alleviate the severity of the disorder.
• Nausea. Without vomiting or with a single episode of it.
• Weakness and drowsiness. To the point of being unable to concentrate on anything.

The severe form is accompanied by critical signs:

• Rapid drop in blood pressure. 30-40 mm Hg or more. Up to functionally impossible indicators, which are fraught with cardiogenic shock and death of the patient.
• Tachycardia. Increased heart rate up to 120-160 beats per minute or even more. The strength of contractions and pumping ability are paradoxically reduced. The pulse is palpable weakly, despite the nature of the rhythm disorder.
• Severe shortness of breath.
• Cloudiness of consciousness. The person practically does not understand the situation.
• Apathy. The patient does not respond to words addressed to him; any influence, be it painful or mechanical, is practically useless. There is no response to light or sound stimuli.
• Loss of consciousness is almost inevitable.

The patient is in critical condition. Symptoms of severe internal bleeding are easily recognized and are included in the list of cardiac and neurological abnormalities.

There is often pain in the place where the anatomical integrity of the vessels has been violated. For example, for kidney injuries, liver injuries, hemorrhagic stroke, lung rupture, and other diseases and conditions.

Signs of internal bleeding also depend on the location of the violation of the anatomical integrity of the vessel. Generally speaking:

• Cavity types are accompanied by the described manifestations. At the same time, there are specific moments during palpation: symptoms of irritation of the abdominal wall, sounds during auscultation.
• Tissue varieties are noticeable by the main manifestations of the affected organ.
• The effusion of blood into the joints leads to severe pain, an increase in size up to a significant, unnatural one. There can be many options.

Recognizing internal bleeding when the problem is minor is not so easy. With severe disorders, everything becomes obvious almost immediately. It is necessary to evaluate the signs of the disorder so as not to miss the moment to start therapy.

Symptoms of neoplasms

Advanced neoplastic diseases are indicated by:

• underweight;
• enlarged, hard liver with a lumpy structure;
• palpable tumor in the abdominal cavity;
• enlarged and hard lymph nodes.

Other symptoms:

• Subcutaneous emphysema in a patient with persistent vomiting indicates Boerhaave syndrome (esophageal perforation). A prompt consultation with a surgeon is necessary.
• Telangiectasia on the mucous membranes may indicate Randu-Osler-Weber disease.

Etiology

The causative factors for internal bleeding are divided into 3 large groups:

1. Mechanical damage:

• cut, stab, chopped wounds;
• amputation injuries (severation of a finger, limb);
• falls from a height (rupture of the spleen, liver);
• animal bites, etc.

2. Arrosive bleeding - occurs due to necrosis of the vascular wall (for example, during the disintegration of a malignant tumor, gangrene of a limb, burns, poisoning with acids or alkalis).

3. Diapedetic bleeding (hemorrhage) - soaking of tissues with blood without damaging the vessel wall. Most often observed in the microvasculature in genetic diseases with coagulation disorders (hemophilia, thrombocytopenia), acute conditions (disseminated intravascular coagulation syndrome, sepsis).

Sigmoidoscopy (rectoscopy)

If necessary, an examination of the rectum is performed. Sigmoidoscopy (rectoscopy) is a method of endoscopic examination of the rectum and distal sigmoid colon by examining their internal surface using a sigmoidoscope inserted through the anus.

Sigmoidoscopy is the most accurate and reliable examination of the rectum and lower sigmoid colon. In the practice of a coloproctologist, sigmoidoscopy is an obligatory component of every proctological examination. The examination allows you to visually assess the internal surface of the rectum and distal third of the sigmoid colon to a level of 20-35 cm from the anus.

Bleeding from the lower digestive tract

Bleeding from the lower gastrointestinal tract accounts for approximately 20% of cases of gastrointestinal bleeding. The main symptom is chestnut or burgundy stool mixed with fresh blood (hematochezia).

The appearance of blood in the stool can indicate where the source of the bleeding is, namely:

• The presence of bright red blood in the stool indicates bleeding in the left side of the colon (up to the flexure of the spleen) or in the rectum;
• If there is bleeding in the right side of the colon, the blood is dark in color and may be mixed with the stool;
• Blood from the rectum may also be clear if it passes quickly from the right side of the colon or if there is a lot of bleeding from the upper gastrointestinal tract. In approximately 13% of patients with fresh blood in the stool, the source of bleeding is in the upper gastrointestinal tract;
• In the case of tarry stools, the most common source of bleeding is the upper gastrointestinal tract. The stool may be the same color if the source of bleeding is the cecum.

Types of internal bleeding in medical practice

In modern medical science there is no unified classification of internal bleeding.

The phenomenon under consideration, depending on certain characteristics, can be divided as follows:

1. Based on the reason that provoked the bleeding:

1. Mechanical . This type of bleeding occurs when blood vessels are injured, which can occur due to blows, or as a result of surgery.
2. Arrosive . It is the result of necrotic processes that affect blood vessels, or develops against the background of germination and decay of pathological neoplasms.
3. Diapedetic . With this bleeding, the walls of the blood vessels are not destroyed, but due to various ailments (hemorrhagic vasculitis, scurvy, phosphorus poisoning, etc.), the permeability of the capillaries increases.

2. Depending on the type of vessel that is bleeding:

1. Arterial . The doctor diagnoses damage to the integrity of the artery wall.
2. Venous . Occurs when a vein is damaged.
3. Capillary . In such situations, blood oozes evenly from the capillaries. If the outpouring of blood occurs from the capillaries of any internal organ, they speak of parenchymal bleeding .
4. Mixed . This type of bleeding occurs as a result of simultaneous damage to veins, arteries, and capillaries.

3. Taking into account the location of the bleeding:

1. Gastrointestinal . They can develop against the background of a stomach/duodenal ulcer, gastritis, with cracks in the mucous membrane, colitis, and pathological neoplasms. When making a diagnosis, the presence/absence of vomiting and the degree of change in stool are taken into account. The main “culprit” of esophageal bleeding is a malfunctioning liver. Intestinal bleeding often occurs due to hemorrhoids or rectal fissures.
2. Hemothorax. Bleeding is concentrated in the pleural cavity and is the result of rupture of intercostal vessels. A similar phenomenon occurs with a closed chest injury.

3. Hemopericardium . In these cases, blood flows into the pericardial sac, which leads to compression of the heart. If this type of bleeding is ignored, the victim quickly develops heart failure, followed by death. The cause of this type of bleeding may be mechanical damage to the anterior chest wall or heart surgery.
4. Hemarthrosis . Blood penetrates into the joints. The knee joints are most often affected.

4. Based on the area of ​​blood accumulation:

1. Cavity . In turn, they are divided into bleeding in the peritoneal cavity (with injuries to the abdomen, chest, internal organs), pleura (with rib fractures), and skull.
2. Interstitial . Blood accumulates in the thickness of the tissues, which leads to their separation and the formation of hematomas.

5. Depending on the amount of blood lost:

1. Light bleeding . Total losses amount to no more than 15% of the total circulating blood volume (CBV).
2. Average . Blood loss reaches 20% of the total blood volume.
3. Heavy . Due to bleeding, the victim lost about 1500 ml. blood (24-30% of bcc).
4. Massive . The total volume of circulating blood decreased by more than 30%.
5. Lethal . Blood loss exceeds 60% of the total blood volume.

6. Considering the nature of bleeding:

1. Explicit . Over time, blood leaks out through various natural openings of the victim.
2. Hidden . There are no clinical manifestations or they are mild.

7. Depending on the moment of bleeding:

1. Primary . They make themselves felt immediately after the wall of a blood vessel ruptures.
2. Secondary . It appears after a certain period of time after injury. This type of bleeding is divided into two subtypes:
3. Secondary early. They appear after 1-3 days due to the release of a blood clot from the affected vessel or when a ligature suture is applied incorrectly.
4. Secondary late. Fixed at least 3 days after damage to the vessel as a result of infection of the wound surface.

Determining the cause and assessing the intensity of bleeding from the lower gastrointestinal tract

Determining the cause and assessing the intensity of bleeding from the lower gastrointestinal tract
Sometimes bleeding from the upper gastrointestinal tract occurs without vomiting with bloody or soil-like contents, but with the removal of bloody contents through the anus.

It is important to consider the patient's age. For example, symptoms of bleeding from the lower gastrointestinal tract in a young person, with abdominal pain and diarrhea, may indicate inflammatory bowel disease. Similar symptoms in an elderly person indicate intestinal ischemia.

Streaks or spots of blood on the surface of the stool, pain in the anal area, and drops of blood on toilet paper or in the toilet indicate an anal fissure or bleeding from the rectum, such as hemorrhoids.

During the physical examination, the doctor pays special attention to symptoms indicating bleeding from the upper gastrointestinal tract and carefully examines the perineum and anal canal (rectally).

Methods for determining the location of internal damage

If a person feels bad, how to find an objective sign of internal bleeding and recognize its source?

If hemorrhage occurs in the abdominal cavity, followed by a rupture of the spleen or liver, then general symptoms include dizziness, weakness, low blood pressure and tachycardia. The patient experiences heaviness in the abdomen, pain in the left and right shoulder, and upon palpation of the peritoneum there is pain in the upper part.

It is difficult, but possible, to independently determine bleeding and its nature.

If there is a rupture of the tubes or ovaries, then there is pain in the lower abdomen, in the anus, deterioration in health, and there is red discharge from the genitals.

When bleeding occurs in the retroperitoneal space (ruptures of the kidneys, aorta), the patient experiences general symptoms, which are not very pronounced.

There is pain in the lumbar region; if you lightly tap on the spine, it will intensify.

If the lesion is in the stomach or intestines, then bloody vomiting or diarrhea and no abdominal pain are observed.

Hidden and unexplained gastrointestinal bleeding - classification, causes

In 2007, the American Gastroenterological Association proposed the following nomenclature for conditions associated with chronic gastrointestinal blood loss:

• Hidden bleeding
  . This is the most common cause of iron deficiency. In men, it most often occurs in the gastrointestinal tract. In women, menstruation should be taken into account;
• Vague bleeding
  . It is recurrent or constant bleeding in the gastrointestinal tract, the cause of which cannot be determined despite endoscopic and radiological studies involving the entire gastrointestinal tract. This type of bleeding is divided into obvious and hidden.

The causes of hidden gastrointestinal bleeding are varied. The most common:

• colon cancer;
• esophagitis;
• inflammation or ulceration of the mucous membrane of the stomach or duodenum;
• intestinal inflammation;
• angiectasia;
• hypertensive portal gastropathy;
• diverticula;
• celiac disease.

Less common reasons include:

• esophageal carcinoma;
• stomach cancer;
• bleeding from the bile ducts or pancreatic ducts;
• aorto-intestinal fistulas;
• endometriosis;
• gastrointestinal infections.

Tests for latent blood in the stool may test positive for hemoptysis or nosebleeds.

It is not recommended to collect samples during digital rectal examination, as it may cause microtrauma and give a false-positive result.

Causes of pathology

Most often, patients seek help in this condition, after receiving injuries to the chest, abdominal cavity, when there is a fracture of the limbs, ribs and pelvic bones. This also leads to damage to some organs, for example, the spleen and liver. So, after a fall from a hill or an accident, damage to the intestines and mesentery is diagnosed, and the result of a traumatic brain injury can be bleeding in the cranial cavity. In the latter case, even a small amount of blood fluid puts pressure on the brain and poses a threat. It is necessary to clarify that this condition may not occur immediately, but after a couple of hours or even days, sometimes this happens even when the patient is feeling well. This problem can be caused by the following diseases that occur in acute or chronic form:

• Tuberculosis. Leads to pulmonary hemorrhages.
• Ulcers. They can damage blood vessels, resulting in blood in the intestines, peritoneum, and duodenum.
• Cirrhosis. Promotes hemorrhage from varicose veins located in the esophagus.
• Malignant tumors formed in the intestines and stomach. Their breakdown sometimes causes blood loss.
• Aortic aneurysm dissection. This is not a rare cause of such ailment in elderly patients.
• Gynecological pathologies.
• Mallory-Weiss syndrome. There are cracks in the esophagus, which have caused frequent drinking or overeating.

The list continues with physical activity and poor diet.

Peroxidase test to confirm the presence of guaiacol

This is the most commonly used stool blood test. The test available is called Hemoccult. In this study, a stool sample is distributed into a guaiacol-impregnated cardboard box, which, if the stool contains heme, turns blue (heme causes a reaction similar to peroxidase). The more blood in the stool, the higher the likelihood of a positive result.

The Hemoccult test gives a positive result in 50% of cases when 10 ml of blood enters the gastrointestinal tract during the day. Under physiological conditions, 0.5-1.5 ml of blood is normally extravasated into the lumen of the gastrointestinal tract during the day.

The sensitivity of the first test is estimated to be approximately 30%. Performing 3 tests (which is the standard) increases the confidence to 92%. False negative results are especially common in people taking medications or foods high in vitamin C.

Relatively often, the test gives false positive results when consuming large amounts of red meat and foods high in peroxidase (radish, radish, horseradish). Taking iron supplements does not give false positive results in the study.

Diagnostics

Laboratory diagnostics

1. Complete blood count - depending on the duration of the bleeding, the blood picture may vary. In the acute phase, a decrease in the level of red blood cells, hemoglobin and the liquid part of the blood (plasma) is observed; the hematocrit “Ht” during acute bleeding remains unchanged, since plasma and formed elements are lost equally. With chronic minor bleeding, a decrease in the level of red blood cells and hemoglobin is also found, “Ht” in this case is reduced, there is an increase in the level of reticulocytes (immature red blood cells) - this is a compensation reaction, replenishing the number of red blood cells. An advanced analysis with determination of platelet levels is necessary for diagnosing thrombocytopenia (possible with various diseases of internal organs, poor nutrition, genetic pathologies).

2. General urine test - necessary to assess the functional ability of the kidneys to secrete urine. With significant blood loss, diuresis may be reduced and even absent altogether (anuria in hemorrhagic shock).

3. Biochemical blood test - determination of the concentration of bilirubin, urea, creatinine, total protein, LDH (lactate dehydrogenase), cholesterol, blood glucose, etc. All these studies are necessary for a thorough differential diagnosis.

4. Determination of blood group and Rh factor - necessary for possible blood transfusion.

5. Coagulogram - analysis of the function of the cascade protein blood coagulation system (prothrombin index, prothrombin time, level of fibrinogen, antithrombin III, D-dimer, etc.).

Instrumental diagnostics

1. X-ray of the abdominal organs and chest cavity - allows you to determine the presence of fluid accumulation in the cavities, displacement of organs, defects of large vessels. Additionally, special contrast agents (for example, barium sulfate) can be used.

2. Ultrasound examination (ultrasound) - used for primary and differential diagnosis of bleeding with other pathologies (cysts, tumors).

3. Computed tomography (CT) - used when the primary diagnosis is questionable. The essence of the method is to obtain a layer-by-layer image of tissues and organs using x-rays.

4. Magnetic resonance imaging is a safe and informative diagnostic method. Used when other graphical research methods are ineffective. Allows you to identify the smallest and “hidden” hematomas.

5. Diagnostic laparoscopy is a method of visualizing the contents of the abdominal cavity by puncturing the abdominal wall with the introduction of a tube with a video camera.

6. Diagnostic laparatomy - an incision is made in the anterior abdominal wall from the xiphoid process to the symphysis pubis (to the extent necessary for diagnosis). The doctor examines the organs and makes a final diagnosis.

Immunochemical tests

Immunochemical tests
Immunochemical tests (HemeSelect, FECA, I-FOBT and Hemoccult ICT), used within European standards, detect undenatured human hemoglobin and give a positive result when it enters the gastrointestinal tract in an amount of 0.3 ml/24 hours.

These tests are not positive if the source of the bleeding is found in the upper gastrointestinal tract—hemoglobin from this source is denatured and degraded before it reaches the stool.

Determining the cause of bleeding - endoscopic and radiological methods

A history and physical examination are performed by a gastroenterologist in accordance with the principles of treatment when analyzing bleeding from the upper or lower gastrointestinal tract.

Further tests for a patient who tests positive for blood in the stool include:

• Peripheral blood test - looking for signs of anemia;
• Endoscopic examinations of the gastrointestinal tract - esophagogastroduodenoscopy and colonoscopy. These tests help identify the possible source of bleeding. Colonoscopy may be considered sufficient in the absence of anemia or gastrointestinal symptoms.

Enteroscopy offers great diagnostic and therapeutic options in case of suspicious changes in the small intestine.

When endoscopic examinations do not help determine the source of bleeding, X-ray examination

small intestine with evaluation of the fragment and possibly enteroclysis.

In difficult cases, CT or MRI enterography and endoscopic examination are performed using a special capsule with a built-in video camera, which the patient swallows like a regular pill.

Stopping capillary bleeding

Typically, capillary bleeding is characterized by minor blood loss. This type of bleeding can be stopped very quickly. To do this, apply clean gauze to the injured area, and place a layer of cotton wool on top, which is wrapped with a bandage.

If there is no cotton wool, gauze, or bandage, you can use any clean material at hand (handkerchief, scarf, headscarf). Do not place shaggy fabric over the wound. Fuzzy fabric contains more germs than smooth fabric. The fleecy tissue provokes infection of the wound. Due to the large number of microbes, cotton wool should not be applied directly to the wound.

Pathologies that rarely cause bleeding

A positive stool blood test should not be associated with pathologies of the gastrointestinal tract, which rarely cause hidden bleeding, namely:

• varicose veins of the esophagus;
• diverticulosis of the large intestine.

In the vast majority of these cases, bleeding is obvious. An exception is the disease of varicose veins of the esophagus, after endoscopic therapy or sclerotherapy procedures. The discovery of such changes in a patient with a positive test result does not exempt him from performing gastrointestinal studies.

Diverticula in the colon produce symptoms in people of the same age similar to organ cancer, which often causes hidden bleeding.

Reasons for false test results

• Anticoagulant treatment. A positive test result for the presence of latent exudate in the stool cannot be taken into account in patients taking medications that suppress blood clotting (acetylsalicylic acid, clopidogrel, acenocoumarol, warfarin, heparins). Also, taking such drugs does not eliminate the need to look for the cause of blood in the stool. Taking acetylsalicylic acid at a dose of 300 mg/24 hours. slightly increases the amount of blood passing into the stool. Neither aspirin nor warfarin interferes with fecal tests;

• Alcohol abuse. Hidden blood in the stool has nothing to do with alcohol consumption. But alcohol abuse increases the risk of developing peptic ulcers and gastrointestinal cancer;

• Menstruation. The most common cause of iron deficiency and anemia in premenopausal women is menstruation. However, when abdominal symptoms coexist, women over 40 years of age may be diagnosed with gastrointestinal cancer. A positive stool blood test requires diagnosis of sources of bleeding.

Pulmonary hemorrhage in a child: how it manifests itself and how to stop it

Pulmonary hemorrhage is the production of blood-stained sputum (hemophthisis) or pure blood (hemoptoea) when coughing. The most acceptable and practically justified classification of conditions associated with the release of blood from the respiratory tract in pediatric practice is the following:

• Hemoptysis - up to 150 ml/day;
• Pulmonary bleeding - 150-400 ml/day;
• Massive pulmonary bleeding - more than 400 ml/day.

However, in both hemoptysis and pulmonary hemorrhage, any amount of blood released can lead to serious respiratory compromise and life-threatening hemodynamic instability.

Pulmonary hemorrhage can develop with infectious diseases (tuberculosis, measles, whooping cough, influenza), bronchitis, bronchiectasis, destructive pneumonia, pulmonary hemosiderosis, angiomatosis, chest trauma, foreign bodies entering the respiratory tract, tumors, primary pulmonary hypertension (Ayers syndrome), diseases of the cardiovascular system (mitral stenosis), ascariasis, taking certain medications, pulmonary infarction, etc.

The clinical picture depends on the severity of the bleeding. If there is blood in the sputum (hemoptysis), the symptoms of the underlying disease (tuberculosis, ARVI, etc.) come to the fore. Heavy bleeding usually begins suddenly or after hemoptysis. Pallor of the skin is noted, blood pressure decreases until collapse. When you cough, bright red frothy blood is released. On auscultation, fine bubbling rales are heard in the lungs.

Treatment. There are three main stages in the treatment of a patient with hemoptysis and pulmonary hemorrhage:

• Cardiopulmonary resuscitation, stabilization of hemodynamics and hemostasis, protection of the respiratory tract are the highest priority;
• Localizing the source and identifying the cause is the second stage;
• In conclusion, specific measures are taken to stop and prevent re-bleeding.

Infusion therapy: the use of blood components and coagulation factors is carried out according to the general rules for the correction of hemodynamics and hemostasis during blood loss. Apply a 12.5% ​​solution of ethamsylate (dicinone) at a dose of 5 mg/kg 2-3 times a day intramuscularly or intravenously; 1% solution of Vikasol: children under 1 year of age - 0.2-0.5 ml, from 1 to 3 years - 0.6 ml, 4-5 years - 0.8 ml, 6-9 years - 1 ml, 10 years and older - 1.5 ml 2-3 times a day intramuscularly - 5% ascorbic acid solution at a dose of 0.5-2 ml intravenously; rutin - orally: up to 1 year of age - 0.0075 g/day, up to 4 years - 0.02 g/day, over 5 years - 0.03 g/day. For heavy bleeding, intravenous administration of a 5% solution of aminocaproic acid at a dose of 1 ml/kg body weight every 6 hours is effective.

Transfusion of plasma replacement solutions (polyglucin, infucol HES, etc.), 10% calcium gluconate solution at a dose of 1 ml/year of life, but not more than 10 ml, and blood products is indicated. A 2.4% aminophylline solution is used: for children under 1 year old - 0.4 ml, 1-5 years old - 0.5-2 ml, 6-10 years old - 2-3 ml, over 10 years old - 5 ml. If the therapy is ineffective, diagnostic and therapeutic bronchoscopy is necessary.

If the cause of bleeding is established, surgical treatment is sometimes indicated, which remains one of the main methods of choice for pulmonary hemorrhage, if the source of bleeding is established, especially in the case of localized bronchiectasis, trauma, parasitic cyst, aspergiloma, arteriovenous malformation, aneurysm.

Treatment of hemoptysis and pulmonary hemorrhage should be carried out against the background of treatment of the underlying disease. In some cases, specific treatment of the underlying disease is decisive in the treatment of bleeding. For example, in Goodpasture's disease there is no need to perform invasive procedures - high doses of glucocorticoids, cytostatic agents and plasmapheresis should be used.

Diagnosis of gastrointestinal bleeding - tests

Diagnosis of gastrointestinal bleeding - tests
First of all, the gastroenterologist needs to detect the source of bleeding. It must be looked for using: endoscopic, x-ray and scintigraphic studies.

• Morphology of peripheral blood.
  The analysis is necessary to assess blood loss. Comparing the current result with previous ones helps with this. On the first day of bleeding, analysis should be done every 4-6 hours. In the first few hours of acute bleeding, hemoglobin levels and hematocrit may not change significantly (due to compensatory mechanisms). In addition to the loss of red blood cells, elevated white blood cell and platelet counts are common in this diagnosis, and from days 3 to 7, the reticulocyte count begins to increase (however, this does not occur in people with significant iron deficiency);
• Urea concentration and assessment of renal function.
  Blood urea levels may rise slightly if there is heavy bleeding from the upper gastrointestinal tract because the protein-containing blood becomes a source of ammonia and urea. In this regard, the patient may have concurrent chronic kidney disease, which increases the risk of death. Acute prerenal kidney injury may be a symptom of hemorrhagic shock;
• Liver markers
  . Serum transaminase and bilirubin activities help assess the coexistence of liver disease;
• Markers of thyroid diseases
  . Measuring serum calcium levels can identify hyperparathyroidism, which contributes to the development of gastric and duodenal ulcers;
• Assessment of blood clotting.
  Tests that evaluate the efficiency of the blood coagulation system—prothrombin time (PT) and activated partial thromboplastin time (aPTT)—are important.

The problem occurs in patients taking warfarin or acenocoumarol. It should be assessed whether continuation of treatment, which makes it difficult to control bleeding, or discontinuation of treatment due to the risk of thromboembolic complications, would be more life-threatening. In such a situation, oral drugs are replaced with short-acting low-molecular-weight heparin drugs.

If generalized intravascular coagulation syndrome is suspected, the concentration of D-dimer, fibrinogen and platelet count should be determined.

When a blood transfusion is necessary, the blood type should be determined and cross-matched.

Can the body cope with bleeding?

Nature has provided for the possibility that fragile and delicate living tissues of the body will be injured over a long life. This means that a mechanism is needed to resist the flow of blood from damaged vessels. And people have it. Blood plasma, that is, the liquid part that does not contain cells, contains biologically active substances - special proteins. Together they make up the blood coagulation system. It is assisted by special blood cells called platelets. The result of complex multi-stage blood clotting processes is the formation of a thrombus - a small clot that clogs the affected vessel.

In laboratory practice, there are special indicators that show the state of the blood coagulation system:

• Duration of bleeding. An indicator of the duration of blood effusion from a small standard injury caused by a special stylet on a finger or earlobe.
• Blood clotting time - shows how long it takes the blood to clot and form a clot. Conducted in test tubes.

Often, trauma or damage to a vessel by a pathological process is too extensive and natural mechanisms to stop bleeding cannot cope, or a person simply does not have time to wait due to the threat to life. Without being a specialist, it is difficult to assess the condition of the victim, and treatment tactics will vary depending on the cause.

Therefore, a patient who has severe bleeding from a vein or artery must be urgently transported to a medical facility. Before this, he must be provided with emergency assistance. To do this, you need to stop the bleeding. Usually this is a temporary cessation of blood flow from the vessel.