Prayer for intestinal bleeding in a child. Signs of internal bleeding in a child

Bleeding can be arterial, venous and capillary. Capillary bleeding is usually weak and does not pose a danger, as it occurs when small, superficial vessels are damaged. Venous bleeding can be quite severe and requires quick help to the victim. With arterial bleeding, blood loss occurs very quickly, as blood gushes out of the wound. It is the most dangerous, since the victim can die from loss of blood. Here it is important not to get confused and quickly stop the bleeding by pressing the damaged artery.

It is very important to be able to distinguish one bleeding from another. Sometimes bleeding heavily superficial wound the head is not as dangerous as a small but deep wound at the site where the artery passes. In any case, you need to be able to quickly come to the child’s aid and try to stop the bleeding.

Signs of arterial bleeding:

Blood spurts out from the wound with every heartbeat.

The blood is bright red.

Signs venous bleeding:

Blood slowly flows out of the wound.

The blood is dark in color.

When to see a doctor:

If your child has a deep wound and the bleeding cannot be stopped, call emergency services.

If the child is in shock, call an ambulance while providing anti-shock care.

First aid for arterial bleeding:

1. Calm your child.

2. Find the source of bleeding.

3. With clean hands remove all visible foreign objects from the wound.

4. Taking advantage sterile bandage or a clean cloth, press directly on the wound to stop bleeding.

5. Elevate the bleeding limb above the level of the child's heart unless you suspect a bone fracture and unless doing so increases the child's pain.

6. If the bleeding does not stop or if you need to free your hands, apply pressure bandage. To do this, roll the bandage into a long strip and tie it tightly on the wound.

7. If bleeding does not stop after fifteen minutes of direct pressure, or if the wound is too large to cover effectively, apply pressure to a major artery.

8. If bleeding stops with direct pressure but then starts again, return to direct pressure on the wound.

9. If the bleeding is very heavy, take steps to prevent shock while you wait for medical help to arrive:

Lay the child down and raise his legs to a height of 30-40 cm;

Cover it with a blanket.

Pay attention!

Do not use direct pressure: in case of eye injury; in case of a wound in which any object is stuck; with a head injury, if there is a risk of a skull fracture.

Pay attention!

Do not move the child if there is suspicion of damage to the skull, neck or spine or if this increases pain.

First aid for venous bleeding:

1. If the wound is shallow, wash it warm water with soap and dry.

2. There is no need to wash deep and heavily bleeding wounds.

3. Apply pressure to the wound with a clean, dry cloth.

4. If a limb is injured, elevate it.

5. Press the cloth firmly but gently against the wound for 5 to 10 minutes until the bleeding stops. If blood has leaked through the tissue, do not remove it from the wound to avoid preventing a blood clot from forming. Place another on top of the first piece of fabric.

6. Signs of shock:

The child feels dizzy;

He loses consciousness;

The skin becomes pale, cold and damp;

Breathing is shallow and rapid, and the pulse is weak and rapid.

In this case, proceed with resuscitation measures:

Calm the child, monitor breathing and pulse;

If the child is conscious and not injured chest with breathing problems or head injuries, place him on his back and raise his legs 20-30 cm;

If the child has not lost consciousness, but has

chest injury with breathing problems or head injury, elevate his head, not his legs;

If the child has no heartbeat and is not breathing, begin CPR.

7. If the bleeding has stopped, even if it has not stopped completely, be sure to bandage the wound with a clean cloth. Please note: the bandage applied to the limb should be tight, but not cause paleness and coldness of the limb: a bandage that is too tight interferes with normal blood circulation.

8. If the bleeding does not stop, apply a tourniquet. To do this, take a piece of clean cloth. Bandage your arm or leg tightly above the wound, tie a knot, under which place a stick or pencil in the form of a twist. Together with a pencil, turn the knot several times until the bleeding stops. Keep the tourniquet for no more than an hour, periodically loosening the knot for 1-2 minutes.

9. If it is impossible to apply a tourniquet (when the wound is located on the face, head, neck), to stop the bleeding, press the area located above the wound with your palm or fist.

Bleeding in a child occurs due to dysfunction of blood clotting processes. There are whole groups and subgroups this state. There is bleeding that appears instantly or lasts a long time without visible signs. There are also bleedings that occur as a result various diseases internal organs, occurs internal hemorrhage.

With blood diseases, some children have impaired clotting function. Spontaneous hemorrhages are observed, and also with ordinary injuries the bleeding does not stop for a long time. It is necessary to quickly stop the bleeding and find out the cause of the appearance, otherwise there may be irreversible consequences, which will lead to an unfavorable outcome.

In children, gastric or gastric symptoms are the least common, but the most common is discharge. There are several factors that cause nosebleeds:

Increased level of inhaled air temperature;
Specific location of the child's head;
Minor injuries to the nose during games;
Presence of infectious agents.
Body of foreign origin;
Violation of the mucous membrane of the nasal septum (telangiectasia);

IN lately Cases have become more frequent in children, as a result of which nasal hemorrhages also occur. The child must be examined by a pediatrician to exclude such a pathology.

Internal

The most important causes of internal bleeding in children:

Various injuries;
Infectious diseases;
Diathesis of hemorrhagic origin;
Heart pathologies;
Respiratory failure and other diseases lung tissue.

The most common cases of internal bleeding in children involve the respiratory and digestive systems.

Hemophilia

Bleeding is often inherited. Such a disease is hemophilia. But it should be taken into account that this pathology occurs exclusively in males, in boys. The female sex is a carrier, so girls do not suffer from this pathology.

There are many factors that can cause bleeding in hemophilia. These factors include:

Minor cuts or abrasions of the skin;
Trauma to the mucous membrane of the nasal and oral cavity;
Idiopathic blood from other parts of the body.

It should also be noted that there is another disease in which there is high risk bleeding - thrombopenic purpura. Blood can be released from the lungs from the child's lung tissue.

Symptoms

Clinical manifestations of hemorrhage in children depend on the nature of blood loss, the cause of the disease, and the type. If this is a factor of injury, then the release of blood is temporary. In this case, it is enough to stop the bleeding (hemostasis).

Depending on the severity of the injury, bleeding can be arterial, venous or capillary in nature.

If your child is experiencing blood loss long time, the following symptoms may be observed:

Apathy;
Weakness;
Loss of consciousness;
Hemorrhagic shock.

Of all the blood losses, the most dangerous is recurrent bleeding. In this condition, the child experiences anemia, with further development. With frequent blood loss, the following is observed:

Deterioration of the child’s general condition;
Anemic state of the body;
Fatigue, weakness.

So, based on this, the most dangerous bleeding is something that is repeated again and again. In this case, you need to urgently seek medical help to identify the etiology of the pathological process.

Diagnostics

In order to make a diagnosis, it is necessary to examine the child completely. When a doctor examines a baby, he pays attention to certain clinical signs. If there is an injury, there is bleeding.

If the cause of bleeding was the penetration of infection into the child’s body, then this process should be stopped. In order to identify infections in a child, it is enough to conduct some diagnostic tests:

General blood test;
Stool analysis;
General urine analysis.

If you need to check hereditary predisposition, then you need to carefully study the history of the child and parents. After all, in this way it is possible to clearly determine the history of the pathology that is observed in the baby.

For various heart diseases, you need to do a cardiogram. This method will make it possible to determine what is bothering the patient and what is the cause of the symptoms. An echogram is also needed for heart disease. In order to study a child’s blood pressure, it is necessary to use a tonometer, a simple and painless diagnostic method.

If a child is suspected of having thrombopenic purpura, a clinical study should be conducted. As a result of the disease you can observe:

A sharp decrease in platelets in the blood;
Enlargement of the spleen (splenomegaly).

There is a duration of bleeding according to Duque. If there is a violation in time, that is, more than 4 minutes, then this is already a violation of clotting.

If a child has a strong suspicion that blood in the cavity is due to tuberculosis, then the sputum needs to be examined. This is a 100% method that gives a positive or negative answer. If the doctor does not understand enough about baby's lungs, then you need to carry out X-ray examination lung tissue. This is necessary if pulmonary tuberculosis is suspected.

Treatment and first aid

How to stop bleeding? If your child is bleeding, here are some things you can do: It is necessary to calm the baby and create optimal condition for his general condition. At the same time, it is necessary to speed up the search for the origin of this bleeding. It is also necessary to quickly stop bleeding in children.

If a child is diagnosed with bleeding from the nose, then urgent measures need to be taken. These actions include:

Place the baby in an elevated position;
Throw your head back;
Do not let the child blow his nose;
Avoid picking in the nasal cavity.

It is urgently necessary to plug the nasal passage with cotton. But under no circumstances should the cotton wool be dry. You need to wet the tampon with liquids such as: table vinegar, hydrogen peroxide, as well as raw meat. If a child has a minor injury, the bleeding will normally stop quickly.

If there is strong discharge from the nose, you need to carefully press the nose towards the septum (press on the nasal wings).

Ingestion;
Cacl 10% taken orally;
Give your baby a drink containing salt and water.

If you give a solution table salt, a certain proportion should be adhered to. For one mug of water there is about one teaspoon of regular salt. You need to drink in doses, drink one tablespoon of this liquid every hour. As for a solution such as calcium gluconate, you need to drink 2 dessert spoons per day.

Ministry of Education of the Russian Federation

Penza State University

Medical Institute

Department of Therapy

"Bleeding in Children"

Penza

Plan

Introduction

Nosebleed
Bleeding from digestive tract
Pulmonary hemorrhage
Bleeding from the kidneys and urinary tract

Literature

Introduction

Bleeding and increased bleeding in children are quite common. The causes of bleeding in children are different: traumatic and non-traumatic (increased fragility vascular wall, dysfunction of platelets, coagulation and anticoagulation systems, etc.). By clinical manifestations bleeding can be divided into external and internal; depending on the nature of the vessels, it can be arterial, venous, mixed, capillary (parenchymal).

1. Nosebleed

Often occurs in children and can be a consequence of trauma (blow, damage to the mucous membrane with a finger, etc.) or a sign general disease(hemophilia, thrombocytopenia, Osler's disease, von Willebrand-Jurgens disease, hemorrhagic vasculitis, hypovitaminosis C and K, circulatory failure, etc.). Nosebleeds can occur due to infectious diseases (measles, whooping cough, ARVI, influenza, sepsis, etc.), local inflammatory and productive processes (polyps, adenoids, neoplasms, etc.), and increased blood pressure.

If you are predisposed to nosebleeds, the resolving factor may be: overheating, sudden head tilts, straining, etc.

Symptoms depend on the nature of the nosebleed (profuse or only an admixture of blood), the location of the bleeding area (anterior, posterior). If the mucous membrane of the anterior parts of the nose is damaged, the blood pours out; if the back parts of the nose are damaged, it is swallowed, simulating gastric and (or) pulmonary hemorrhage. The color of the blood is bright red. If blood is swallowed, bloody vomiting may occur. In cases of heavy bleeding, pallor, lethargy, dizziness, and tinnitus appear.

Urgent Care. Absolute rest, in a half-sitting position with the head moderately thrown back. It is forbidden to blow your nose. Ice or gauze soaked in water is placed on the bridge of the nose. cold water. Tampons moistened with a solution of 3% hydrogen peroxide, thrombin, or hemostatic sponge and press them to the nasal septum. If the bleeding does not stop, anterior nasal tamponade is performed with a swab moistened with the same solutions. For persistent and prolonged bleeding, posterior tamponade is indicated. At the same time, a 10% solution of calcium chloride or calcium gluconate is prescribed orally (1-5 ml intravenously according to indications), rutin (up to 1 year - 0.0075 g, 1-2 years - 0.015 g, 3-4 years - 0.02 g ., 5-14 years - 0.03 g per day), vitamin C, Vicasol for 3 days, 3-15 mg per day. In case of heavy and persistent bleeding, blood transfusion (including direct) is indicated.

Hospitalization. If the above measures are ineffective, the child must be hospitalized in the otolaryngology department.

2. Bleeding from the digestive tract

The main unifying symptom of bleeding from the digestive tract is bloody vomiting or bloody stools, which are often combined. At slight bleeding and the relatively long stay of blood in the stomach, the vomit looks like coffee grounds; in cases of heavy bleeding, they contain scarlet blood. After 8-10 and when blood is swallowed, tar-like stools are detected. When bleeding from the lower intestines, the stool contains little changed blood. The nature and causes of bleeding from the digestive tract in children largely depend on the age of the child. Thus, neonatal melena is a manifestation of hemorrhagic syndrome. In children 1-3 years of age, the most common cause of bleeding is intussusception, Meckel's diverticulum and duplication of the intestine, hernia hiatus diaphragm, from 3 to 7 years - colon polyposis, over 7 years - varicose veins veins, esophagus and stomach, peptic ulcer stomach and duodenum, erosive and allergic gastritis.

MELENA OF NEWBORNS is caused by diapedetic bleeding from the capillaries of the stomach or intestines; it is more common in children in the first week of life. It begins suddenly with vomiting of blood and blood in the crimson-colored stool. The general condition may not change, but in some cases melena is severe against the background of severe anemia, continuous bleeding from anus. Differentiate from false melena (swallowing of blood from cracks in the mother’s nipples or from the child’s mouth).

Urgent Care. 0.2 ml of a 1% solution of Vikasol is administered intramuscularly (no more than 4 mg per day), fresh blood is transfused or directly transfused in an amount of 10-15 ml/kg, depending on blood loss.

Hospitalization in all cases of melena is emergency in the neonatal department.

MECKEL'S DIVERTICULUM AND DUPLICATION OF THE INTESTINE. When the mucous membrane of Meckel's diverticulum is ulcerated, intestinal bleeding is observed, often profuse, occurring among full health, repeated at intervals of 3-4 months, which leads to anemia, pallor, tachycardia, collapse. The first stools are usually dark in color, followed by dark (scarlet) blood without clots or mucus. Unlike gastrointestinal bleeding of other origins, Meckel's diverticulum does not cause bloody vomiting. The diagnosis is made by exclusion. When the intestine is doubled, bleeding from the intestine occurs in almost 1/3 of all cases. An X-ray contrast examination of the gastrointestinal tract with barium is necessary.

Urgent Care. The patient should not be fed. Vikasol is prescribed to children up to 1 year - 0.002-0.005 g, up to 2 years - 0.006 g, 3-4 years - 0.008 g, 5-9 years - 0.01 g, 10-14 years - 0.015 g, 2 possible -3 times orally (1 tablet - 0.015 g) or intramuscularly 1% solution (1 ml - 10 mg); intravenously 1-5 ml of a 10% solution of calcium gluconate or calcium chloride with ascorbic acid (1-3 ml of a 5% solution).

Hospitalization in a surgical hospital (for trial laparotomy) in case of repeated and persistent bleeding.

HEAT HERNIA. This disease in children often manifests itself as persistent vomiting mixed with blood, iron deficiency anemia, the presence of blood in the stool (usually hidden) as a result of erosive-ulcerative esophagitis and gastritis. Constant dysphagic phenomena, pain behind the sternum, attacks of cyanosis, shortness of breath, cough, children are behind in physical development, pale. The diagnosis is helped by percussion detection of areas of tympanitis in the chest, displacement of the borders of the heart in the direction opposite to the hernia, upon auscultation in chest cavity manages to listen intestinal peristalsis, rumbling.

Urgent Care. Compliance with the diet, Vikasol (see doses above), ascorbic acid, calcium supplements (gluconag or calcium chloride orally or intravenously 1-5-10 ml of 10% solution), in case of severe anemia - blood transfusion.

Hospitalization in all cases of suspected diaphragmatic hernia to the surgical hospital. The diagnosis is confirmed by x-ray examination.

INTESTINAL POLYPOSIS. Occurs more often in children and age 36 years, localized in lower sections large intestine. Bleeding can be from barely noticeable to profuse, life-threatening for the patient (with spontaneous tearing off of the toe), and occurs during or after the act of defecation. Even with insignificant but constant allocation blood appears pallor of the skin, weakness, tachycardia, indicating anemia. The diagnosis is made when digital examination rectum, sigmoidoscopy and irrigography. With hereditary polyposis (Peutz-Jeghers syndrome), pigmentation is detected around the mouth and on the mucous membrane of the oral cavity.

Urgent Care. Maintaining a gentle diet, prescribing calcium chloride and ascorbic acid.

Hospitalization in a surgical hospital for any bleeding from the rectum.

VARICOSE VEINS OF THE ESOPHAGUS AND STOMACH. Occurs with portal hypertension. In children, the predominant extrahepatic form of portal hypertension is caused by developmental anomalies portal vein or thrombosis of the portal system vessels due to pylephlebitis; The causes of the intrahepatic form of portal hypertension in children can be cirrhosis and congenital fibrosis of the liver. Bleeding more often occurs in older children from the veins of the cardial part of the stomach, in these cases it is always threatening, since at the same time, due to liver damage, there are disorders of the blood coagulation system. There is a lot in vomit and feces dark blood. Diagnosis is helped by anamnesis (presence of liver diseases), enlargement of the spleen (possible only in the anamnesis, since against the background of bleeding the spleen can decrease in size and then increase again), examination (dilation of the veins of the anterior abdominal wall, liver enlargement, erythema of the palmar surface of the hands, spider veins on the skin of the face, chest, icterus); in blood tests - the phenomenon of hypersplenism (decrease in the number of platelets, leukocytes, erythrocytes). Differentiate with portal hypertension due to intranasal sepsis, suppurative processes in abdominal cavity, Chiari disease (suprahepatic portal hypertension), lymphogranulomatosis.

Urgent Care. Place the child in a position with the head elevated and turned to one side to prevent aspiration of vomit. It is necessary to adequately and quickly compensate for blood loss: with blood loss up to 15 ml/kg, you can transfuse donor blood (7-10 ml/kg), rheopolyglucin (10-15 ml/kg) in combination with saline solutions(10 ml/kg); for blood loss of 16-25 ml/kg - transfusion of plasma-substituting solutions and donated blood in a ratio of 2:1, with blood loss of 26-35 ml/kg and above, their ratio is 1:1 or 1:2. The total volume of transfusions should exceed blood loss by an average of 20-30%. In the hospital, the veins of the esophagus are compressed using a Blakemore zone, sclerosing drugs (varicocid) can be administered through an esophagocop, and oxygen is started early into the stomach and intestines through a tube until slight swelling epigastric region and tympanic percussion sound. If conservative treatment is unsuccessful within 2 days, surgical intervention is indicated.

Hospitalization in all cases of bleeding from the veins of the esophagus is emergency in a surgical hospital. The diagnosis is clarified using radiography of the stomach, which is performed during bleeding simultaneously with hemostatic measures.

ULCER DISEASE OF THE STOMACH AND DUODENUM. It may be complicated by bleeding, which begins suddenly, without warning or complaints, more often in children after 7 years of age. Bleeding stomach ulcers can occur against the background of conditions such as sepsis, uremia, collagenosis, thermal burns, long-term corticosteroid therapy. Differentiate from erosive gastritis, portal hypertension syndrome.

Urgent Care. Abstinence from eating for 1-2 days, an ice pack on the epigastric area, crushed hemostatic sponge inside 1 tablespoon every 1-2 hours, blood transfusion, calcium chloride or calcium gluconate - 10% solution 1-5 ml intravenously with ascorbic acid (1-3 ml of 5% solution, vikasol.

Hospitalization for minor bleeding to a therapeutic hospital, where an X-ray examination is carried out and conservative treatment; If there is heavy and persistent bleeding, the child is hospitalized in a surgical hospital.

EROSIVE AND ALLERGIC GASTRITIS. Causes: poisoning with alkalis, acids, drug side reactions, intoxication. Simultaneously with pain along the esophagus and (or) stomach, vomiting with blood occurs, possibly a collapsed state.

Urgent Care. Gastric lavage a large number warm water, rest, abstinence from eating, an ice pack on the epigastric area, intravenous 10% solution of calcium chloride or gluconate - 1-5 ml; antihistamines: diphenhydramine for children under 6 months - 0.002 g (0.02 ml of 1% solution), 7-12 months - 0.005 g (0.5 ml), 1-2 years - 0.01 g (0.7 ml ), 3-9 years - 0.015-0.03 ml), 10-14 years - 0.04 g (1.5 ml) up to 3 times a day; suprastin for children under 1 year - 0.005 g (0.25 ml of 2% solution), 1-2 years - 0.00 g (0.3 ml), 3-4 years - 0.008 g (0.4 ml) , 5-6 years - 0.01 g (0.5 ml), 7-9 years - 0.015 g (0.75 ml), 10-14 years - 0.02 g (1 ml).

Hospitalization in a therapeutic hospital; indications for gastrofibroscopy.

3. Pulmonary hemorrhage

Bleeding can be pulmonary, pulmonary-pleural and intrapleural. More often occurs in children after 5-7 years of life. Reasons: infectious diseases(ARVI, influenza, measles, whooping cough), foreign bodies of the respiratory tract, chest trauma, bronchitis, bronchiectasis, abscess pneumonia, tuberculosis, Hamman-Rich syndrome, Ayersa syndrome (primary pulmonary hypertension), pulmonary hemosiderosis, angiomatosis, tumor, diseases cardiovascular system (mitral stenosis), pulmonary infarction, ascariasis, taking certain medications ( acetylsalicylic acid, iodine preparations), hemorrhagic diathesis, etc.

Symptoms depend on the severity of pulmonary hemorrhage. In cases of blood in the sputum (hemoptysis), the symptoms of the underlying disease (influenza, tuberculosis, etc.) predominate. Heavy bleeding may begin with hemoptysis or suddenly. The child is frightened, pale, blood pressure is reduced, there may be loss of consciousness, fine rales are heard in the lungs, and upon aspiration of blood there are signs of pulmonary parenchyma being excluded from breathing. Characteristic of bright red color is foamy (admixed with air) blood that does not clot, has alkaline reaction. Hemoptysis and pulmonary hemorrhage should be differentiated from hematemesis (which is characterized by dark red blood and an acidic reaction, with an admixture of gastric contents, the presence of tarry stools, a history of diseases of the gastrointestinal tract or liver), from bleeding from the gums, nasopharynx ( inspection helps, the blood is pinkish-brown in color and contains mucus).

Urgent Care. Place the child in a semi-sitting position with legs down. Blood transfusion: with blood loss up to 15 ml/kg, blood can be transfused in the amount of 10 ml/kg, rheopolyglucin - 10-15 ml/kg in combination with saline solutions - 10 ml/kg; for blood loss of 16-25 ml/kg - transfusion of plasma replacement solutions and fresh donor blood or direct transfusion in a ratio of 2:1, for blood loss of 26-35 ml/kg and above - ratio of 1:1 or 1:2 (total volume of transfusion therapy exceeds blood loss by an average of 20-30%); calcium chloride or calcium gluconate - intravenously 1-5 ml of 10% solution; vikasol - intramuscular 1% solution (10 mg in 1 ml), children under 1 year - 0.002-0.005 g, up to 2 years - 0.006 g, 3-4 years - 0.008 g, 5-9 years - 0.01 g., 10-14 years - 0.015 g. 2-3 times; 10% heated gelatin solution at the rate of 0.1-1 g/kg intravenously: ascorbic acid - 0.5-2 ml of 5% solution intravenously, rutin in daily doses up to 1 year - 0.0075 g, 1 - 4 years - 0.02 g, 5-14 years - 0.03 g. To suppress fibrinolysis in case of heavy bleeding, transfusion of aminocaproic acid is indicated (1 ml of 5% solution per 1 kg of body weight after 4-6 hours). To reduce pressure in the pulmonary circulation, aminophylline is administered intravenously; up to 1 year - 0.4 ml of 2.4% solution, 1-5 years - 0.5-2 ml, 6-10 years - 2-3 ml, 11-14 years - 5 ml (can be repeated every 8 hours) , atropine: 0.1-1 ml of 0.1% solution; to calm a cough - codeine 0.005-0.01 mg 3 times a day. In the absence of effect and massive bleeding, surgical treatment is indicated.

Immediate hospitalization in a surgical hospital, in unclear cases - diagnostic bronchoscopy.

4. Bleeding from the urinary tract

Excretion of blood in the urine can be observed in healthy children (neonatal hematuria, orthostatic hematuria) and can be a symptom of various diseases. Hematuria occurs with fever, viral diseases, injuries lumbar region, hypovitaminosis C, vitamin A overdose, hemorrhagic diathesis, diffuse glomerulonephritis, vulvitis, phimosis, cystitis, urethritis, pyelonephritis, nephroliasis, tumors, shock kidney, renal artery stenosis, thrombosis renal vein. Among rare causes: cystic kidney, renal tuberculosis, periargeritis nodosa, Alport syndrome. Hematuria can be true or false (red coloration of urine due to the admixture of blood pigments in hemoglobinuria, porfininuria, side effect some medicines, some nutrients), possible as microhematuria (the presence of red blood cells, detected only with microscopic examination), and gross hematuria (blood in the urine is visible to the naked eye, has the color of meat), both regenerative and persistent. Profuse hematuria is indicated by blood clots in the urine. Three groups of causes of hematuria can be distinguished: extrarenal, associated with impaired hemostasis; renal; caused by pathology of the urinary tract.

DISEASES OF THE URETHER CHANNEL AND BLADDER. Bleeding can be caused by trauma, papillomatosis, angiomatosis, stones, inflammatory process, girls may have prolapse of the urethral mucosa.

Urethral injury. A triad of symptoms is typical: bleeding (pure blood), urinary retention (immediately after injury or several hours later), perineal hematoma. Bleeding can occur with penetrating and non-penetrating ruptures, and may or may not be associated with the act of urination. Differentiate from external abdominal rupture bladder.

Urgent Care. Bed rest, cold on the perineum, drinking plenty of fluids, antibacterial therapy, in case of urinary retention - a permanent catheter for 2-3 days, according to indications - a blood transfusion.

Urethral stones occur predominantly in boys. There is pain when urinating, a weakening of the urine stream or a change in its shape, sometimes urinary retention (obstruction of the lumen), hematuria. Stones can be identified by palpation in the hanging part of the urethra or in its posterior sections (if rectal examination). In some cases, a urethrogram is performed for diagnosis. Differentiate from urethral stricture.

Urgent Care. 2-5 ml of 0.5-1% novocaine solution is injected into the urethra, after 2-3 minutes 2-4 ml heated to 3. From a sterile Vaseline oil. Stones anterior section the canal is removed with special urethral forceps; if it is not possible to remove the stone from the posterior urethra, it can be pushed into the bladder, followed by stone crushing.

Hospitalization in all cases is indicated in a urological or surgical hospital.

Bladder stones are more common than urethral stones, and predominantly in boys, which is facilitated by neurogenic bladder dysfunction, phimosis, balanoposthitis, narrowing of the external opening or valve of the urethra.

Symptoms: micro- or macrohematuria (if a stone is pinched in the neck of the bladder - terminal hematuria), pain that increases with movement and radiates to the perineum, testicle, glans penis, frequent urination in daytime, a symptom of interruption (“laying”) of the stream (disappears when changing body position) or complete violation outflow of urine, the phenomenon of cystitis.

Emergency care: calcium chloride orally or intravenously 15-10 ml of 10% solution.

Hospitalization in a urological or surgical hospital; cystoscopy and x-ray examination are indicated.

A bladder injury can be open or closed. Hematuria (terminal or total) is the most common and early sign of extraperitoneal and intraperitoneal rupture of the bladder. In addition to hematuria, there is pain in the lower abdomen, difficulty urinating (frequent, fruitless urges or the passage of a small amount of urine with blood or pure blood), signs of urine flowing into the peri-vesical and pelvic tissue or into the abdominal cavity, and there may be signs of peritonitis and shock. When establishing a diagnosis, anamnesis helps (the nature of the injury, its localization), with concomitant fracture pelvic bones the diagnosis is beyond doubt. Differential diagnosis carried out with trauma to the abdominal organs.

Urgent Care. For non-penetrating injuries of the bladder - conservative treatment (antibiotics, gluconate or calcium chloride, Vicasol), for urinary retention - a permanent catheter, for penetrating injuries - surgical treatment.

Emergency hospitalization in a urological or surgical hospital.

Cystitis. Terminal hematuria in combination with frequent and painful urination, pyuria - the most characteristic symptoms diseases. Turbidity of urine is caused by the presence of a large number of leukocytes, bacteria, epithelium, and red blood cells. Differentiate from tuberculous process, tumor, neurogenic bladder.

Urgent Care. Bed rest, diet (exclusion of spicy, irritating foods, drinking plenty of water - alkaline waters and juices), diuretics ( kidney tea, bear ears, etc.), heating pads on the bladder area or a warm bath, nitrofuran preparations (furagin 0.025-0.05 g, furadonin 0.015-0.03 g 3 times a day), antibiotics (chloramphenicol 50 mg /kg per day).

Hospitalization in a urological or therapeutic hospital for severe pain, persistent hematuria.

Literature

"Urgent medical care", ed. J.E. Tintinally, R.L. Kroma, E. Ruiz, Translated from English doctor honey. Sciences V.I. Kandrora, MD M.V. Neverova, Dr. med. Sciences A.V. Suchkova, Ph.D. A.V. Nizovoy, Yu.L. Amchenkova; edited by Doctor of Medical Sciences V.T. Ivashkina, Doctor of Medical Sciences P.G. Bryusova; Moscow "Medicine" 2001
Eliseev O.M. (compiler) Handbook of emergency and emergency care, “Leila”, St. Petersburg, 1996

Detecting internal bleeding is very difficult. On initial stage its symptoms are very vague and similar to those of other diseases. Something is wrong can be suspected if there are severe external injuries, but some chronic diseases also cause similar condition. The danger is that a person does not always experience pain. However, if you do not accept urgent measures, the life of the sufferer will be at risk. How to recognize signs of internal bleeding and how to help before doctors arrive? Read about this later in the article.

Types of internal bleeding and their manifestations

Significant internal loss bleeding occurs for two reasons:

mechanical damage to internal organs due to impact, fall from height, work injury or even after a showdown with fists;
chronic diseases that lead to thinning of the walls of blood vessels and their rupture. In this case, blood fills either a natural cavity (stomach, uterus in women, lungs) or a cavity created by it.

No matter how much blood is poured out, the body strives to push it out. It comes out along with feces, stomach contents, from the internal genital organs in women, and is expectorated with sputum from the bronchi and lungs. However, you should not think that the bleeding will stop on its own; the wound will heal on its own. At the first manifestations of internal blood loss, you should consult a doctor as soon as possible.

Gastrointestinal

According to doctors, cirrhosis of the liver, ulcers, varicose veins of the stomach or duodenum provoke every third internal bleeding. In this case, you can recognize the problem by vomiting mixed with bloody clots of a dark, almost black color. Another characteristic feature internal bleeding into the digestive organs - stool that resembles tar in color and consistency. It can appear 1–2 or even 9–10 hours after the onset of blood loss.

Cranial

Otherwise, this type of internal bleeding is called a stroke. In this situation, the fluid does not find a way out and accumulates in the skull. Delete blood clots you can only surgically. The danger of blood clots in the brain cannot be underestimated: they can cause complete or partial paralysis, disruption of the functioning of those organs for which the affected area is responsible, and even fatal outcome. In addition to severe head injury, stroke often results from:

high blood pressure;
diabetes mellitus;
brain tumors;
vascular aneurysm;
encephalitis.

Small pelvis

It's about about uterine bleeding. It can occur in women various reasons. Changes hormonal levels, tumors, ectopic pregnancy, miscarriage, placental abruption during pregnancy, rupture of the uterus or ovaries - all these factors hidden from human eyes provoke internal bleeding. They may open after or during your period. One of the signs of internal bleeding is blood coming out profusely in the form of large clots dark color. The process is accompanied by aching pain in the lower abdomen.

In the abdominal cavity

Severe internal bleeding in this area is possible for various reasons:

ectopic pregnancy;
tumors;
low blood clotting.

What makes bleeding of this type special is the fact that a person, experiencing sharp pain in the peritoneum, in order to calm it down a little, I have to sit with my knees pulled up to my chest. Most often, doctors encounter external mechanical damage:

abdominal injuries;
chest injuries;
ruptures of internal organs: liver, ovaries, spleen.

In the respiratory system

The accumulation of blood in the lungs and its release is associated with complications after certain diseases (tumors in the chest, tuberculosis), with injuries to the ribs, heart and respiratory organs themselves. At the same time, along with typical characteristics, there are also some specific signs:

The pulse rate decreases noticeably with heart injuries and increases if the lungs are damaged;
difficulty breathing, lack of oxygen if the blood has filled pleural cavity;
there are chest pains of varying strength;
characterized by restless behavior, distortion of facial features;
cough is accompanied by the release of scarlet blood mixed with foam.

Main signs and symptoms

Along with specific ones, experts note numerous general symptoms of internal bleeding, regardless of which specific organ or part of the body is affected. These signs include:

severe dizziness;
inability to do daily activities, weakness;
unnatural pallor of the skin and whites of the eyes;
apathy, drowsiness, inability to concentrate;
nausea, vomiting;
fainting;
especially severe cases are marked by confusion, inability to adequately perceive and respond to what is happening;
with injuries incompatible with life, the person falls into a coma.

By some signs you can judge which vessels are damaged. Capillary bleeding is very weak and does not pose any particular danger to life. Parenchymal, in which all channels are involved, is very long-lasting and abundant. Arterial is characterized by the release of bright red blood, and it flows jerkily. The main signs of venous bleeding are the slow, uniform flow of dark-colored blood.

First aid for internal bleeding

It is difficult to determine the source of internal bleeding without examining a doctor. However, if the sufferer is left without help at all, the situation can significantly worsen. A few simple steps will alleviate the victim’s condition and give him a chance for a successful outcome:

try to provide the victim with peace and maximum possible comfort;
if, based on some signs, you can assume that internal hemorrhage occurred in top part body, arrange the person reclining. Otherwise, lay on your back;
make sure that the victim moves as little as possible;
put something cold (a bag of frozen food, cold water, ice cubes) to the area where you think internal bleeding is occurring;
You should not give the sufferer any medications, drinks other than water, or carry out any procedures. What is necessary in each specific case can only be determined by a specialist;
do everything so that the doctor arrives as soon as possible.

By watching the video below, you will learn how to properly assist a person suffering from internal bleeding on the street. A professional doctor tells how to competently, armed with the familiar items at hand, relieve a patient’s suffering before the emergency doctor appears. You will learn about the first symptoms of internal bleeding, which will give you a signal to act, because such a problem should never be left to chance.

Gastrointestinal bleeding is one of the most ominous symptoms, which are only noted in the doctor’s practice. The child’s life may depend on how quickly parents react in the event of gastrointestinal bleeding. What do you need to know about him?

Understanding Gastrointestinal Bleeding

As is known, gastrointestinal bleeding can manifest itself bloody vomiting (hematemesis), bloody diarrhea (melena), or can be internal (invisible to a non-specialist). Of course, parents can only discover visible signs gastrointestinal bleeding, and in order to notice them, you need to know that, depending on the location of the bleeding, the duration and amount of blood entering the gastrointestinal tract, there may be different colors of vomit and feces.

First, let's look at the features of vomiting during gastrointestinal bleeding. Under the influence of hydrochloric acid in the stomach, the blood darkens. Thus, if vomiting began soon after the bleeding began, the vomit will be red, but if it does not occur immediately, its color will be dark red, brown or black. Clots of coagulated blood in the vomit give them characteristic appearance coffee grounds.

Bloody vomiting indicates that the site of bleeding is located not lower than the duodenum. In any other case, changes in stool indicate trouble. Since blood is a strong irritant and toxic effect on the intestines, so when bleeding occurs, diarrhea develops. Acute blood loss can cause bloody diarrhea for 3 days.

When blood passes below the level of the stomach, stool under the influence of bacteria of the gastrointestinal tract becomes black and tarry. But in order for black stool to appear, blood must remain in the intestines for at least 8 hours. Approximately 60 milliliters of blood is required to turn stool black. Therefore, if bleeding is suspected, an occult blood test should be performed.

If bleeding occurs from the lower intestines, bright red blood is released.

How to wait for an ambulance correctly

Any child with bloody vomiting, stool, or rectal bleeding should be immediately examined by a doctor and examined laboratory to exclude infectious diseases.

First aid is aimed at creating conditions that help reduce the intensity of bleeding until it stops. Absolute rest and bed rest are indicated.

When vomiting, the child should be in an elevated position with his head turned to the side. Locally apply cold (ice pack, cold water) to the area of suspected bleeding, you can swallow small pieces of ice. Before the ambulance arrives, do not give the child anything to drink or feed, do not rinse the stomach under any circumstances, or give him an enema.

We exclude “external” causes of bloody vomiting and stool

In children 1-3 years of age, the most common reasons Gastrointestinal bleeding includes intussusception, Meckel's diverticulum, duplication of the intestine, and hiatal hernia. In children from 3 to 7 - colon polyposis, over 7 years - bleeding from varicose veins of the esophagus and stomach, peptic ulcer of the stomach and duodenum, erosive and allergic gastritis.

In general, the reasons for the appearance of blood in gastrointestinal tract there may be a great variety. Among them there are also those that have nothing to do with gastrointestinal bleeding! For example, probable cause appearance of frightening signs of gastrointestinal bleeding in breastfed babies may be... Cracked nipples in a breastfeeding woman!

Therefore, when breastfeeding First of all, you need to carefully examine the mother’s breasts. Often, in the presence of deep cracks in the nipples, there is no visible bleeding, but when sucking, the child swallows quite large “portions” of blood, which leads to bloody vomiting and sometimes the appearance of blood in the stool. In this case, the mother needs to get advice on the correct feeding technique and feed the expressed milk with a spoon, cup or syringe for a while.

In addition, when children experience bloody vomiting and bloody stool need to inspect them carefully oral cavity and the nasal cavity: it is possible that there is “bleeding” there, and the signs of gastrointestinal bleeding are caused by ingestion of blood.

Possible causes of gastrointestinal bleeding

As already mentioned, the appearance of blood in vomit and stool can be a sign of the most various pathologies. Since it is almost impossible to identify more or less dangerous ones among them, we have placed brief information about them in alphabetical order.

Crohn's disease

Crohn's disease (chronic granulomatous inflammation of the gastrointestinal tract) is accompanied by abdominal pain, diarrhea, the presence of blood, mucus, pus in the stool, fever, weight loss, and an undulating course. Stool with an unpleasant odor, floating in the water. Anal fissures often occur.

Hemorrhagic disease of the newborn

During the newborn period, bleeding from the stomach may occur due to hemorrhagic disease newborns due to vitamin K deficiency, imperfect blood coagulation system.

Hemorrhagic disease of a newborn up to 7 days is more often manifested by bloody vomiting, tarry stools, and heavy periods in girls. Bleeding may increase and lead to significant blood loss, so it is necessary to call ambulance at the first sign of it. Since breast milk contains factors of the blood coagulation system - breastfeeding is not stopped. Prevention - administration of vitamin K intramuscularly in the maternity hospital.

Hemorrhagic vasculitis

At hemorrhagic vasculitis Bloody vomiting and tarry stools mixed with mucus may also occur. They may be the first signs of the disease. But more often they occur against a background of high temperature, after the appearance of pinpoint and various spotty hemorrhages on the skin. The rashes are most often located on the legs.

The disease may be accompanied by damage to joints and internal organs. Characterized by periodic repetition of attacks of the disease with the appearance of pain in the legs, skin rash, development of arthritis.

Hiatal hernia

A hiatal hernia is a protrusion of the stomach through a gap or hole in the diaphragm. May be congenital or acquired. Often, hiatal hernias are accompanied by the reflux of contents from the stomach into the esophagus, which causes a chemical burn and inflammation of the esophageal and stomach mucosa. Clinically, this is manifested by heartburn, bouts of vomiting, often mixed with blood, and the presence of blood in the stool. The child may have chest pain, shortness of breath, and cough. If it lasts for a long time, children may lag behind in development.

At severe course surgical treatment. In all cases of suspected diaphragmatic hernia, children are hospitalized in a surgical hospital.

Intussusception (“volvulus”)

Intussusception is the penetration of one part of the intestine into another, as a result the vessels of the implanted area are infringed, disrupted, and subsequently blood circulation stops. If this condition is not treated, gangrene of the strangulated area develops.

The disease appears suddenly. The child complains of acute pain in the abdomen, breaks out in sweat, looks pale and restless. The attacks last 5-10 minutes, the body temperature rises. Vomiting can be repeated several times; occasionally the vomit contains dark or scarlet blood mixed with mucus, small clots resembling currant jelly. 6-8 hours after the onset of the disease, stool in the form of raspberry jelly may appear. On early stages treatment is possible by inflating the intestinal loops. If successful surgical treatment episodes of intussusception may recur. If the intussusception cannot be straightened, surgery is indicated.

Foreign bodies

Injuries to the oropharynx and nasopharynx, esophagus, stomach when swallowed foreign objects may cause significant damage and bleeding. It is necessary to urgently seek medical help.

Infectious colitis

Infectious colitis (dysentery, salmonellosis, etc.) is characterized by an acute onset, severe intoxication, general weakness, high fever, rapid increase in signs of dehydration, and light amounts of blood in the stool, which appear at the height of the disease. Depending on the severity of the bleeding, the child’s condition can range from satisfactory to extremely severe, but in any case, hospitalization in the infectious diseases department is required.

With heavy bleeding, loss of consciousness, a drop in blood pressure, severe pallor, and increased heart rate are observed. If the condition is satisfactory, tarry stools or stools with minor traces of blood may be observed for a long time. However, bleeding may increase and lead to shock.

Meckel's diverticulum

An intermittently occurring protrusion of the ileal wall. Meckel's diverticulum occurs when the duct, which is necessary only during the first month of fetal development, persists throughout pregnancy until the birth of the child. Sometimes the diverticulum remains attached to the navel, then loops of intestine can twist around it, causing intestinal obstruction. If the diverticulum is covered from the inside with mucous secretion gastric juice, bleeding ulcers may develop. Bowel obstruction can also develop if a Meckel's diverticulum turns inside out and causes intussusception (the insertion of one loop of intestine into another).

Most frequent symptoms Meckel's diverticulum causes bleeding from the rectum or bloody stool. They may recur from time to time or occur suddenly. The first stools are usually black and tarry, followed by dark (scarlet) blood. Bleeding may be accompanied by nausea and vomiting.

Unlike others gastro- intestinal bleeding, with Meckel's diverticulum there is no bloody vomiting, moderate abdominal pain, blood in the stool without mucus. Initially, the symptoms correspond to those of acute appendicitis.

There is no way to prevent bleeding from Meckel's diverticulum.

At duplication of the intestine bleeding from the intestines occurs in almost 1/3 of cases. An X-ray examination of the intestine with a radiopaque substance is necessary. For repeated and persistent bleeding, treatment is surgical.

Bleeding from the veins of the esophagus

Bleeding from varicose veins of the esophagus and stomach occurs with a significant increase in pressure in the portal vein (portal hypertension). Portal hypertension occurs with abnormalities in the development of the portal vein, vascular thrombosis, cirrhosis and congenital fibrosis of the liver, Chiari disease. In newborns it can develop against the background umbilical sepsis. In addition, with liver diseases, the production of blood coagulation factors is disrupted.

To diagnose this condition, it is important: the child has signs of liver disease, an enlarged spleen, and yellowness of the skin. Bleeding profusely life-threatening child, scarlet vomit.

Nonspecific ulcerative colitis

It occurs in children of any age, most often in boys. More often it has a primarily chronic course.

During periods of exacerbation, blood appears in the stool in the form of individual clots or bloody-mucous diarrhea. In addition, there is pain, increased temperature, decreased appetite, and increased bowel movements from 3 to 10 per day. The act of defecation is accompanied by sharp cramping pain. The use of antibiotics does not improve the condition.

Intestinal polyposis

Intestinal polyposis, according to the literature, is more common in children 3-6 years old and is of a hereditary nature. Polyps are most often located in the lower parts of the large intestine. Bleeding may be minor and occur periodically. When a polyp is torn off, there may be heavy bleeding from the rectum.

Mallory-Weiss syndrome

Mallory-Weiss syndrome develops due to a rupture of the gastric mucosa after bouts of repeated vomiting or coughing. Manifested by the appearance of vomit, stained with blood. Not accompanied by pain.

Telangiectasia of the stomach and intestines

Bloody vomiting and tarry stools are periodically observed with congenital telangiectasia ( vascular tumors) stomach and intestines. The disease is inherited.

Repeated bleeding is also observed in parents or close relatives of the patient. There are often a large number of spider veins on the mucous membranes of the mouth, lips, and nose.

Anal canal fissures

Their appearance is associated with constipation, with the formation of thick feces of dense consistency that can tear the delicate tissue of the anus. Accompanied by pain in the rectum during the act of defecation, the release of unchanged blood not mixed with feces.

Thrombocytopenic purpura

Characterized by a decrease in platelet count and increased bleeding.

Signs of the disease are skin rashes, bleeding from the mucous membrane of the nose, mouth, intestines, uterus, vagina, blood in the urine. Hematemesis develops either as a result of ingestion of blood released from the upper respiratory tract, or as a result of the stomach overflowing with blood from the vessels of its mucous membrane. In cases of bleeding from blood vessels small intestine tarry stools occur.

Erosive and allergic gastritis

Occurs against the background of poisoning with alkalis, acids, medicines. As a result of damage or allergic reaction damage occurs to the gastric mucosa. Accompanied by pain and vomiting blood. When ulcers of the stomach and duodenum are perforated or the intestines are damaged, internal bleeding may occur.

There is severe pain, tension in the abdominal muscles, bloody vomiting, and tarry stools. General symptoms blood loss: weakness, dizziness, palpitations, loss of consciousness.

Peptic ulcer of the stomach and duodenum

Manifested by pain in upper half stomach, “hunger pains.” May be complicated by bleeding that begins suddenly. Once bleeding begins, the pain subsides. Occurs more often in children after 7 years of age.

After serious illnesses, operations, burns, stress ulcers can develop. Ulcers can also occur during treatment with steroids.

Clinical manifestations: vomiting "coffee grounds", tarry stools, general weakness, pallor, dizziness, loss of consciousness.