Internal bleeding of the stomach in a newborn. Intestinal bleeding in children

Gastrointestinal bleeding requires emergency medical treatment, since, even if small, it can quickly lead to death. Causes: peptic ulcer of the stomach and duodenum, rupture of varicose veins of the esophagus and cardia of the stomach with portal hypertension(liver cirrhosis, thrombophlebitic spleen), erosive gastritis, burn of the gastric mucosa due to accidental ingestion of caustic alkalis and concentrated acids, ulcerative lesions of the small and large intestines, typhoid fever, dysentery, ulcerative colitis, terminal ileitis, intussusception, bleeding Meckel's diverticulum, anal fissures. Gastrointestinal bleeding can occur with various blood diseases (hemophilia, hemorrhagic vasculitis, Werlhof's disease, leukemia, aplastic anemia, etc.).

Symptoms. Main feature this state- bloody vomiting or bloody stool. Often they are combined. When diagnosing gastrointestinal bleeding, it is necessary to exclude diseases in which blood may enter the gastrointestinal tract from other organs (upper respiratory tract, lungs, etc.). With hematemesis, the blood is thick, dark in color, or looks like coffee grounds with clots. Sometimes it contains remnants of undigested food. After 8-10 hours, “black” stool appears. In all cases of gastrointestinal bleeding, monitoring of blood pressure and hemoglobin content in the blood is necessary.

Heavy bleeding is accompanied by thirst, dryness of the mucous membranes of the oral cavity, rapidly progressing weakness with dizziness, and sometimes loss of consciousness. The skin becomes pale, covered in cold sweat, and the extremities become cold. The patient is either excited or in prostration. Facial features become sharper. Sometimes yawning, nausea and repeated vomiting appear. The pulse quickens, has weak filling, and then becomes thread-like. Blood pressure decreases, breathing quickens.

In addition to these general signs, depending on the causes of bleeding, certain specific symptoms are observed. Thus, with peptic ulcer of the stomach and duodenum, pain syndrome with a specific localization and a typical daily seasonal rhythm with an appropriate medical history. Bleeding can occur both during exacerbation of the disease and during remission. Heavy bleeding is observed in 5-12% of children with peptic ulcer disease.

With portal hypertension due to cirrhosis of the liver, a long “hepatic” history, exhaustion of the patient, enlargement of the liver and spleen, a pronounced pattern of collateral saphenous veins, spider veins on the skin, and, less commonly, ascites and intermittent jaundice are noted. The functional state of the liver is severely impaired. An X-ray examination of the esophagus with a contrast mass reveals varicose veins, which can cause profuse, sometimes fountain, bloody vomiting.

With thrombophlebitic spleen, there is a rapid, sometimes with pain, enlargement of the spleen, with an equally rapid decrease in it after bleeding; recurrent nosebleeds and undulating enlargement of the spleen with a history of fever. A combined enlargement of the spleen and liver is often observed.

In case of erosive gastritis and burns of the gastric mucosa with caustic alkalis and concentrated acids - pain along the esophagus, in the epigastric region, gastric history or traces of burns with these substances on the oral mucosa. If alkalis or acids are ingested, shock may occur.

Intussusception has a typical clinical picture acute abdomen.

Bleeding from the stomach and intestines in cases of hemorrhagic diathesis is combined with other clinical symptoms these diseases: skin hemorrhages, changes in blood clotting, duration of bleeding, retraction of a blood clot, changes in the quantity and quality of platelets, etc. Other diseases accompanied by gastrointestinal bleeding (ulcerative colitis, typhoid fever, dysentery), have a clinical symptomatology well known to doctors. When bleeding from the stomach, bloody vomiting is often observed; from the upper intestines, including the duodenum, black tarry stools; from lower sections intestines - stool containing little changed blood.

Treatment. In all cases of bleeding from the gastrointestinal tract, hospitalization of the patient is indicated, since even slight bleeding may become profuse. It is better to hospitalize children in a multidisciplinary hospital, where, along with therapeutic, infectious diseases and others, there is a children's surgical department.

The patient is provided with absolute rest. The patient is transported carefully. The child should lie on his back. An ice pack is placed on the upper half of the abdomen.

A single-group blood transfusion is performed at the rate of 10-15 ml per 1 kg of body weight (it is better to transfuse freshly citrated blood or directly from the donor to the recipient). At rapid decline hemoglobin level up to 70 g/l, large amounts of blood are drip-transfused (up to 250-400 ml). 3-10 ml (depending on age) of 10% sodium chloride solution and 5-10 ml of calcium chloride are administered intravenously.

At the same time apply large doses ascorbic acid, vitamins PP, K, etc. Ascorbic acid administered intravenously or intramuscularly in the form of a 1% or 5% solution of sodium ascorbate up to 100-300 mg, depending on age. Vitamin PP is prescribed orally at 0.025-0.05 g 2-3 times a day. In the first days of bleeding, it is better to administer vitamin K intramuscularly at 0.5-1 ml (1% solution) per day for 3 days.

In case of profuse bleeding from varicose veins of the esophagus or cardia of the stomach, drip transfusions of the same group or 0 (I) blood group or plasma are immediately started. To narrow the preportal arterioles and thereby reduce the pressure in portal vein 5-10 units are injected dropwise. pituitrin in 100 ml of 5-10% glucose solution. You can also inject a 6% solution of aminocaproic acid (50-100 ml) dropwise. When blood pressure decreases, a 10% caffeine solution, a 1% mezaton solution or a 25% cordiamine solution in an age-specific dosage is prescribed.

For burns of the esophagus and burns of the stomach, vigorous antishock therapy. In case of burn ammonia or caustic soda, wash the stomach with a 0.1% solution of hydrochloric acid or warm water; vinegar essence - boiled water until the smell of vinegar disappears; acids - 2-3% solution of bicarbonate of soda through a probe, which is pre-lubricated with well-boiled vegetable oil.

On the first day after the bleeding stops, you should refrain from feeding the child - glucose mixed with saline is administered intravenously. Starting from the 2nd day, the Meulengracht diet is prescribed, consisting of chilled milk, cream, eggs, butter, well-mashed vegetable purees with carefully chopped and pureed meat or fish. Along with the measures taken, vigorous therapy of the underlying disease is carried out.

If therapeutic measures are ineffective and bleeding continues, consultation with a surgeon is necessary to decide on surgical treatment.
Women's magazine www.. Shamsiev

Internal bleeding is an acute life-threatening condition in which blood flows out of the bloodstream or into the lumen through a rupture in the vessel wall. hollow organ(uterus, stomach, lungs) or into a cavity artificially created by the volume of leaked blood (for example, intermuscular space). Such bleeding is never an isolated independent disease - but only either a sign or a consequence of the underlying pathological condition.

This pathology often develops as a result of injury or chronic illness. Severe types of such bleeding with great blood loss(more than 1.5 liters) are very dangerous and can lead to fatal outcome. Bleeding with less blood loss (less than 1.5 liters) is still very serious. Erupted blood can compress nearby vessels, disrupt the functioning of internal organs, escape through the mouth, for example, during stomach bleeding, and be accompanied by other serious manifestations.

Internal bleeding is called because the spilled blood does not flow outside the body. Therefore, uterine, gastric or intestinal bleeding is not always interpreted as internal; although, given that blood sometimes does not immediately exit through physiological openings - mouth, anus, vagina - it is advisable to classify them as internal.

The general causes, symptoms and treatment of internal bleeding are the same in men and women.

Uterine bleeding is eliminated by a gynecologist, intestinal bleeding by a proctologist, pulmonary bleeding by a thoracic surgeon, post-traumatic bleeding by a traumatologist, and intracranial bleeding by a neurosurgeon.

Untimely provision of medical care when a person contacts doctors late or difficulties with differential diagnosis increase the risk to his health, and even life.

Types of internal bleeding

Internal bleeding is classified into many types based on location, cause, time of occurrence, amount of blood loss, etc.

Gastric - into the lumen of the stomach

Gastrointestinal – blood loss into the cavity of the esophagus or other hollow organ

Hemopericardium - filling the pericardial sac with blood

Hemothorax - between the layers of the pleura, i.e. in the slit-like space between the special membranes surrounding each lung

Hemarthrosis – in the joint

Abdominal - into the cavity of the peritoneum, pleura

Explicit – easily determined by visual inspection

Arrosive - when the vascular wall is damaged due to the germination or disintegration of a neoplasm, a destructive or necrotic process (with tissue death)

Diapedetic - with blood leaking through the vascular wall during scurvy, scarlet fever, malaria

Severe – blood loss is no more than one and a half liters of blood

Massive – up to 2.5 l

Lethal - from 2.5 to 3 l

Absolutely lethal - over 3–3.5 l

Venous – when the vein wall ruptures

Arterial - from an artery

Mixed - from different vessels

Parenchymal - blood pours out from the vessels of a parenchymal organ (these are the spleen, liver, lungs, pancreas, kidneys and others - these are internal organs built from solid tissue)

Secondary – some time after the injury. In the first 1–5 days it is considered early, after 10–15 days – late

Causes of internal bleeding

Each type of bleeding has its own causes, the most common of which are injuries and illnesses in acute or chronic form.

Open and closed injuries abdomen and lumbar region with damage or rupture of internal organs, most often the spleen or liver, less often the intestines and pancreas. Massive bleeding into the abdominal cavity is caused by a blow during a fight or during a car accident, compression - when pressed with a heavy object, etc.
A rib fracture leads to bleeding into the pleural cavity.
Traumatic brain injury. Bleeding inside the skull is life-threatening because the volume of the skull is limited. Any hematoma leads to compression of brain structures and serious consequences. It can develop not only immediately after an injury, but also several hours or days after it.
Chronic diseases of the digestive tract. Bleeding into the cavity of the corresponding organ occurs with varicose veins of the esophagus, erosive gastritis, cirrhosis of the liver, peptic ulcer, malignant tumor process, the formation of a through hole in an ulcer of the duodenum or stomach.
Gynecological diseases and pathological conditions - apoplexy (rupture) of the ovary, ectopic pregnancy, malignant neoplasm, rupture of an ovarian cyst. In obstetrics and gynecology, uterine bleeding can provoke abortion, previa or premature placental abruption. It can begin after childbirth due to rupture of the birth canal or uterus, late exit placenta.
Ruptured aortic aneurysm.
Hemophilia – hereditary disease men with a malfunction of the blood clotting process.

Symptoms

Symptoms depend on the amount of blood loss and its location. There are general signs and those characteristic of a specific species.

General symptoms of blood loss

General – the appearance of weakness, darkening or clouding of the eyes, drowsiness, dizziness, cold sweat, thirst. Loss of consciousness is possible. The intensity of blood loss is determined by pulse rate, blood pressure and characteristic complaints patient.

Minor blood loss often does not manifest itself in any way, but for some, the pulse increases slightly and blood pressure (BP) decreases slightly.
Manifestations of moderate bleeding: heart rate up to 100 beats per minute, decrease in systolic pressure to 80 mmHg. Art., moderate shortness of breath, dry mouth, cold hands and feet, cold sweat, dizziness, severe weakness, slow reactions, fainting.
With severe blood loss, symptoms are more pronounced. A drop in blood pressure of more than 80 mmHg is noted. Art., tachycardia more than 110 beats per minute, shortness of breath, hand tremors, excruciating thirst against the background of a decrease in the volume of urine excreted, apathy. There may also be a sharp pallor of the mucous membranes and skin, cyanosis of the limbs and the area around the lips, clouding or loss of consciousness.
Among clinical manifestations massive hemorrhage, blueness of the skin and mucous membranes, confusion, and delirium are observed. The eyeballs sink inward, facial features become sharper, the pulse reaches 160 beats per minute, blood pressure drops to 60 mm Hg. Art.
For fatal and absolutely fatal blood loss we're talking about already about a threat to life. The pupils dilate, convulsions appear, the number of heart beats (bradycardia) sharply decreases to 2–10 beats per minute, breathing becomes agonal, urine and feces are spontaneously released. The patient falls into a coma, his skin is dry, pale with a marbled pattern. The result is agony, death.

Signs of hemothorax

Hemothorax is the entry of blood into the pleural cavity. In addition to general symptoms, it manifests itself as sharp pain in the problem area, difficulty in breathing, cough with foamy bloody sputum. On x-ray, the mediastinum (the space in the middle of the chest cavity) is shifted towards the healthy lung.

Signs of uterine bleeding

Symptoms of internal bleeding in women can be pulling, bursting or sharp pains lower abdomen with irradiation to the lower back and anus, the urge to defecate, a feeling of swelling of the mucous membranes.

Signs of hemorrhage in the urinary and digestive organs

Tar-colored, foul-smelling stool—melena—indicates bleeding from the upper intestine or other digestive organs.
When there is a hemorrhage in the stomach, a person begins to vomit with bloody clots; into the lumen of the duodenum, it becomes the color of coffee grounds.
Bleeding from hemorrhoids appears bright bloody discharge from the anus.
Blood that gets into the renal area, urinary tract, comes out with urine - hematuria.

For any type of internal blood loss, you should immediately call an ambulance. Although with mild blood loss a person can go to a medical facility and get help, it is better not to risk it, because it is not known whether the bleeding has stopped, whether the general condition will worsen further or not.

A person’s life often depends on the correct provision of first aid. Before the doctors arrive, you need to put the patient in bed, further actions carry out only after he has assumed a horizontal, and in case of hemothorax, a semi-sitting position. Apply ice to the area of the suspected source of the problem, focusing on the complaints. Then, as quickly as possible, transport the victim in this position to the nearest medical facility. institutions or wait for the ambulance to arrive.

It is strictly forbidden to: heat the bleeding area, apply a pressure bandage, insert suppositories, use laxatives, do an enema (for intestinal bleeding), offer painkillers and medications that stimulate the heart.

Neglecting the above steps can lead to increased blood loss and death.

Inpatient medical care

Based on symptoms and primary medical examination, presumably they find out which organ was damaged, and the patient is hospitalized in the appropriate department. If there are objective symptoms of large blood loss, go to intensive care.

Main goals of treatment:

Stopping bleeding.
Restoring the lost volume of blood constantly circulating in the body (BCV).
Normalization of microcirculation.

Often massive blood loss can be stopped by performing emergency surgery:

in case of a stomach ulcer, its resection is carried out - part of it is removed along with the ulcer;
for pneumothorax, a thoracotomy is performed - the chest is opened, the cause of bleeding is found and eliminated;
in case of a hematoma in the cranial cavity, trepanation is performed: through holes made in the bones of the skull, the neurosurgeon gains access to the structures of the brain and the resulting hematoma, from which the blood is sucked out;
in some cases, internal bleeding can be stopped by performing tamponade: for example, to tamponade the bronchus, a sterile gauze swab or foam sponge is inserted into it through a bronchoscope.

To replenish the blood volume, infusion solutions, blood substitutes, and blood products are administered intravenously. The remaining funds are used for their intended purpose.

The prognosis depends on the competent provision of pre-medical and timely medical care.

What are the symptoms of internal bleeding?

Internal bleeding is a situation in which heme is poured into the body cavities, as well as into the spaces between organs and tissues. Most diseases manifest themselves as pain. With internal bleeding, this symptom is absent, and other signs do not appear immediately. This makes timely diagnosis difficult.

Symptoms of internal bleeding become noticeable only when significant damage has already been caused to the health, posing a great threat to the life of the patient.

Provoking factors

Internal hemorrhage occurs either due to trauma or as a result of a chronic process.

Deadly post-traumatic internal bleeding of the abdomen develops when a blunt injury occurs when the liver or spleen, intestines or omentum are damaged.

In case of rib fractures with injury to the pleura and blood vessels, pleural blood loss occurs.

Craniocerebral injuries make internal bleeding of the skull likely.

Blood in pleural cavity

Important! Blood entering the joint cavity, which may be caused by a fracture or bruise, does not pose a clear threat to life, but causes significant harm to health.

The causes of chronic internal bleeding are erosion of the walls of blood vessels as a result of the development of neoplasms, chronic diseases such as ulcerative perforations of the intestines, gastra, dilation of the gulam veins, gynecological diseases: ovarium ruptures, ectopic pregnancy, graviditate and genus pathologies.

Symptoms and signs

Common symptoms of intraorgan hemorrhage include:

weakness and malaise,
fainting, dizziness,
excessive paleness of the skin,
apathy,
lowering blood pressure,
tachycardia.

Important! Internal bleeding threatens the possibility of developing a pre-shock state. Its harbingers are considered to be severe thirst, weakness, and anxiety. The skin turns pale and cold, the pulse becomes rapid and thready, breathing becomes shallow and uneven.

Specific symptoms arise in connection with the place of bleeding and shedding of blood: into the chambers or into the tissues.

Signs of internal bleeding in the abdominal cavity:

bloating. It becomes painful, hard;
blood in feces.

Internal hemorrhage in the urinary organs is detected by the appearance of blood in the urine. When blood accumulates in the heart sac, symptoms of cardiac tamponade, cyanosis, and an increase in venous pressure appear.

The outpouring of blood into the pleural cavity produces compression of the lung, which is detected by shortness of breath and confirmed by the absence of respiratory sounds during auscultation.

The release of scarlet heme from the anus indicates hemorrhoidal inflammation.

Possible bloating with abdominal bleeding

The types and signs of internal bleeding are presented in the table:

Bleeding into the abdominal cavity caused by organ ruptures

2. Specific: “Vanka-Vstanka” sign. If a person lies down, pain in the shoulder appears; if he gets up, the pain disappears. On palpation, abdominal pain is felt.

Bleeding in the pelvis. Ruptures of the uterus and ovarium

1. General: pain, discomfort lower abdomen.

2. Specific: pain on palpation in the area of the pubic bones, in severe conditions the sign of “Vanka-Vstanka”

Bleeding into the retroperitoneal space,

with ruptures of the kidneys and abdominal aorta

1. General: dizzy, weakness, low blood pressure, tachycardia, pale, cold skin.

2. Specific: lumbar pain. When you knock on the lower back, the pain intensifies.

Bleeding in the gastric and duodenum

1. General: dizzy, weakness, low blood pressure, tachycardia, pale, cold skin.

2. Specific: vomiting with heme or “coffee sediment”, Brown; bloody diarrhea, feces color black or dark cherry; no pain.

Diagnostic tests

If internal bleeding is suspected, the following general measures are taken:

Detailed inspection. They check the pulse, blood pressure, listen to the chest, palpate and tap the abdominal cavity.
Hematological studies.

Specific diagnostic methods are carried out taking into account the preliminary diagnosis:

rectal examination;
esophagogastroduodenoscopy;
colonoscopy;
bronchoscopy;
cystoscopy;
sigmoidoscopy.

In case of hidden hemorrhages, pay attention to general syndrome internal bleeding: dizziness, weakness, hypotension, tachycardia, coldness and pale skin.

Important! An objective sign of blood entering the lung is the disappearance of the lower border of the organ on an x-ray.

When diagnosing bleeding in the abdominal cavity, laparoscopy is used, and intracranial hematoma identified by echoencephalography.

Echoencephalography of the brain can detect hematomas

Primary care

Important! The main thing is to get the patient to the clinic as quickly as possible. First aid is to ensure peace.

If pulmonary hemorrhage is suspected, the patient is provided with sitting position. When internal bleeding occurs in other places, before emergency help arrives, the patient should be laid on a leveled surface and cold applied to the area possible bleeding. Do not apply heat or give medications to support the heart.

Methods to stop bleeding

Patients are hospitalized in a hospital. Select a department based on the source of bleeding: traumatology, thoracic, neurosurgical, gynecological or general surgery. The first concern at the first stage is how to stop the bleeding.

The video shows how to provide first aid

In some cases, tamponade helps. In others - cauterization of the bleeding area. However, most often surgery is required under general anesthesia.

If shock from blood loss is observed or the possibility of its occurrence, blood transfusion is performed. If blood flows into the lung area, bronchial tamponade is performed. If hemothorax is observed, a pleural puncture is performed. If bleeding occurs in the abdominal cavity, laparatomy is performed and the liver defect or other damaged organ is sutured.

Intracranial hematoma is cured with craniotomy. If the cause of bleeding is a gastric or duodenal ulcer, gastric resection or vessel suturing and vagotomy are performed.

In case of successful stopping of bleeding, before determining a rehabilitation scheme after blood loss, it is necessary to restore the mass of circulating fluid. This is achieved by injecting glucose, saline and blood substitutes.

It will also be useful for you to learn about gastrointestinal bleeding on our website.

Prevention of complications

To prevent complications, infusion therapy is used. It is carried out with strict control of blood pressure, cardiac output, and hourly diuresis. The amount of infusion drugs administered is determined based on the volume of blood loss.

Blood substitutes with hemodynamic properties are used: rheopolyglucin, stabizol or infuctol.
Saline preparations: saline solution, Ringer's solution.
Heme preparations: frozen blood serum, erythrocyte biomass, albumin, glucose and other sugars.

To normalize blood pressure in emergency situations, adrenaline and its analogues are used. If necessary, antishock therapy is used. After the threat to life has passed, the balance of basic and acidic elements in the blood is adjusted.

Signs of internal bleeding: symptoms of the condition and treatment

Medical emergencies require special medical supervision. In many critical situations, minutes count, and the patient’s life depends on the qualifications of a medical specialist.

Sometimes the patient himself needs to recognize the signs dangerous condition and consult a doctor immediately. A common critical condition after injury is blood loss. Signs of internal bleeding may not be as obvious.

What is internal bleeding?

Internal bleeding is not visible from the outside

From the average person's point of view, internal bleeding describes an outwardly imperceptible loss of blood. Medical specialists tend to clarify this term as the source of blood loss and the place where blood accumulates in the body.

Internal bleeding can occur in tissues, organs, or body cavities, including the brain, spinal canal, abdomen, and chest cavity.

Blood loss can be so unnoticed and insignificant that the patient will quickly pay attention to anemia resulting from a constant decrease in the number of blood cells.

Open bleeding is quite easy to recognize and stop. An injury or cut is immediately followed by bleeding on the surface of the skin, allowing a person to assess the severity of the injury.

Internal bleeding is much more dangerous, since the victim cannot appreciate the severity of his condition. That is why, after accidents, ambulances take even apparently unharmed people to the hospital for diagnosis.

Internal bleeding itself is associated with damage to an artery or vein. Blood from the vessels forms accumulations in tissues, organs or body cavities. The amount of blood loss depends on the degree of damage and the size of the affected vessels.

The most important and functional active organs form the most acute bleeding when damaged. These organs include the brain, heart, liver, spleen and kidneys.

Internal bleeding can be associated not only with injury, but also with a chronic disease. Most often, this type of blood loss occurs in the gastrointestinal tract. A person may gradually and continuously lose blood due to chronic ulcer stomach or intestines, polyps, inflammatory pathologies of the large intestine.

Patients taking blood thinners or anti-clotting medications are more likely to experience internal bleeding. The same applies to patients suffering from pathologies of the blood coagulation system.

Main causes of the condition

Signs of internal bleeding

Sometimes it is easy to determine the cause and source of bleeding. Damage from an accident or any other trauma suffered may have characteristic signs indicating the nature of internal bleeding.

Also, diagnosing blood loss is not difficult if the doctor is aware of various organ pathologies that can lead to internal bleeding. However, not all cases of internal blood loss are so obvious.

The main cause of bleeding is always the same - damage to the vessel and tissue depositing blood. Vessels can be of different sizes, which affects the severity of bleeding.

Damage to the main arteries leads to human death in as soon as possible, and rupture of capillaries can lead to the loss of a small volume of blood.

Basic non-traumatic causes bleeding:

Inflammation of the vessel walls can lead to minor bleeding. Dissection of large arteries, on the contrary, leads to massive blood loss.
Insufficiency of blood clotting factors. The human body produces special substances that block bleeding. The lack of these substances leads to frequent bleeding.
Taking certain medications. Bleeding may occur due to anti-clotting drugs prescribed to fight blood clots.
Chronically high blood pressure. High pressure weakens the walls of blood vessels and leads to the formation of aneurysms.
Inherited bleeding disorders. Hemophilia is a genetic pathology in which blood clotting is impaired. Even a minor injury can cause severe bleeding in a patient with this condition.
Gastrointestinal diseases. Most often, blood loss in the digestive organs occurs due to inflammation and erosion. Typical diseases include colon polyps, colitis, Crohn's disease, gastroenteritis, esophagitis and ulcers.
Lifestyle factors. Alcohol, drug use and smoking may be associated with chronic blood loss in the stomach.

Causes associated with critical blood loss:

Injury. Car accidents, falls from heights, fights and other situations can damage organs and related blood vessels.
Bone fracture. A closed fracture of large bones can damage the arteries.
Ectopic pregnancy. This condition can cause massive blood loss.
Surgical intervention. Massive bleeding is often a consequence of the surgeon’s actions.

There are also private causes of internal bleeding.

Signs of internal bleeding

Cold is indicated for bleeding

Symptoms and manifestations of internal bleeding depend on the source and duration of blood loss. Also important factor The area of damage that determines the signs of the condition is the area of damage.

When damaged, some organs lose a small amount of blood (thick skin), while others cause massive bleeding (kidneys, liver).

You must also understand that the blood released from the vessel irritates the tissues and causes inflammation and pain.

The main signs of intracranial bleeding:

Dizziness and weakness.
Loss of consciousness.
Paralysis of individual muscles or sides of the body.
Tingling in arms and legs.
Severe sudden headache.
Difficulty swallowing and chewing.
Deterioration of vision and hearing.
Loss of coordination and balance.
Confused speech.

Internal bleeding resulting from injury or a ruptured aneurysm will primarily manifest itself as an acute pain symptom.

In second place will be psychological and neurological manifestations associated with shock. Subarachnoid bleeding often causes headache and dizziness.

Neurological examination of a patient with such bleeding may reveal conditions ranging from mild confusion to coma. A stroke involving blood leaking into the brain will present with more severe mental and neurological symptoms.

Intra-abdominal bleeding is often almost asymptomatic. Pain in this condition may not be expressed. Patients with this type of internal bleeding often complain of weakness, confusion, difficulty breathing, and dizziness.

Signs of bleeding in the chest or abdominal cavity:

Joint and muscle pain, difficulty motor functions may indicate bleeding in the musculoskeletal system.

Other symptoms

Paleness and shock are signs of internal bleeding

Often internal bleeding associated with damage to internal organs causes shock. Shock is critical condition the body, caused by acute dysfunction of the cardiovascular system.

Shock can cause conditions varying degrees severity - from short-term loss of consciousness to coma. Symptoms of shock include:

Accelerated heartbeat.
Low blood pressure.
Paleness of the skin.
Neurological disorders: headache, drowsiness, lethargy, stupor.
General weakness.

The presence of other manifestations will help the doctor determine the source of the bleeding. For example, anemia is usually associated with slow, chronic bleeding in the digestive organs. This condition can cause constant weakness, fatigue and shortness of breath.

Diagnosis and treatment of internal bleeding

Internal bleeding is not always accompanied by pain

Detection of internal bleeding usually requires certain diagnostic procedures, including physical examination, laboratory tests and instrumental methods.

Diagnosis may vary depending on the suspected causes of blood loss. Signs of gastrointestinal bleeding require examination of the digestive organs.

Intracranial bleeding can be confirmed various types scanning. Basic instrumental diagnostic methods:

The cause of blood loss may not be so obvious. Doctors often need to prescribe several diagnostic procedures to exclude various pathological conditions. Laboratory confirmation, including stool, urine, and blood tests, is often required.

If symptoms indicate critical blood loss, the doctor may have little time to make an accurate diagnosis. In this case it is often necessary surgery, during which the cause of blood loss is determined and its source is discovered.

Treatment of blood loss also depends on its nature. Most often, surgery is required. Unlike open bleeding, internal bleeding is much more difficult to stop without special skills.

This video will familiarize you with the symptoms and signs of stomach bleeding:

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Krasnoyarsk medical portal Krasgmu.net

Internal hidden bleeding, i.e. bleeding into closed body cavities, occurs mainly as a result of damage to internal organs (liver, lung, etc.), and blood is not released outside.

There are specific symptoms of internal bleeding, knowledge of which can help timely diagnosis this complex problem.

Such bleeding can be suspected only by changes in the general condition of the victim and by symptoms of fluid accumulation in a particular cavity.

Bleeding into the abdominal cavity is manifested by pallor, weak frequent pulse, thirst, drowsiness, darkening of the eyes, fainting. When bleeding into the chest cavity, these symptoms are combined with shortness of breath.

When bleeding into the cranial cavity, signs of compression of the brain come to the fore - headache, impaired consciousness, breathing difficulties, paralysis, etc.

IN modern surgery Special attention given to internal bleeding. This is due to the fact that internal bleeding is much more difficult to diagnose compared to open bleeding. And that means the provided health care may be late. Internal bleeding is characterized by the outpouring of blood into the natural cavities of the body or artificially created spaces.

Depending on the amount of blood shed, there are three degrees of bleeding: moderate, moderate and severe.

The main reasons include: rib fractures with rupture of intercostal vessels and damage to lung tissue, malignant neoplasms internal organs, closed injuries to the liver, spleen, intestines, complications of diseases of organs such as the esophagus (with varicose veins), stomach and duodenum, liver, female genitals.

Main signs of internal bleeding:

Sticky cold sweat
Pallor
Shallow breathing
Pulse is frequent and weak

Signs and symptoms that are not so pronounced and may only become apparent after some time:

Blue skin discoloration (hematoma formation in the area of injury)
Soft tissues that are tender, swollen, or hard to the touch
The victim feels nervous or restless
Rapid weak pulse rapid breathing, nausea or vomiting, decreased level of consciousness
Pale skin that feels cool or damp to the touch
Feeling of unquenchable thirst
Bleeding from natural orifices of the body (nose, mouth, etc.)

First aid for internal bleeding:

Provide complete rest
Place the victim in a semi-sitting position
Apply ice or cold water to the suspected bleeding site
Urgently transport the victim to a surgical hospital

Frequency of internal bleeding

Most often, bleeding occurs when the gastrointestinal tract is affected. Therefore, it is worth getting acquainted with emergency treatment methods for gastrointestinal bleeding. In total, there are about 20 diseases, the most significant and common among which are: acute erosive gastritis and stomach cancer, varicose veins of the esophagus, cirrhotic liver disease. In the case of stomach cancer, the danger is a disintegrating tumor. The only sign that allows the patient to suspect something is wrong is the darkening of the stool, which occurs due to the coagulated blood contained in it. If vomiting occurs, the vomited masses, again due to coagulated blood, have the color of coffee grounds.

Symptoms of internal bleeding depend on its location and the degree of blood loss. In some cases, it is necessary to distinguish bleeding from the esophagus or stomach from bleeding from a damaged lung. In case of lung pathology, foamy, unchanged scarlet blood is released.

Diseases of the female reproductive system can also cause internal bleeding. The most common cause is tubal abortion. When a fallopian tube ruptures, blood accumulates in the abdominal cavity, creating a feeling of tension and some pressure in the pelvis, especially on the rectum. By the way, bleeding from anus is also quite common. Subsequently, irritation of the peritoneum occurs with blood, which leads to the development of a state of shock, loss of consciousness, and fainting. The pulse in this case becomes frequent and thread-like. Upon examination, abdominal bloating, stool and gas retention are revealed. The patient becomes pale and covered in cold sweat.

Symptoms of hemothorax (blood in the chest)

How to identify and recognize internal bleeding in the chest? If blood accumulates in the pleural cavity, the so-called hemothorax develops. The pleural cavity is a small space that separates the lungs from the chest. The reasons leading to the development of hemothorax include the following: falls from a height, injuries with damage to the ribs and intercostal vessels, knife wounds, lung cancer, lung abscesses (that is, the formation of abscesses in the lung tissue).

When blood accumulates in the pleural cavity, there is difficulty breathing when inhaling and when coughing, sharp pain in the chest, a disturbance in the general condition - dizziness, weakness, fainting, pallor of the skin, increased heart rate and breathing, sweating. Percussion of the patient's chest reveals a shortening of the percussion sound over the affected half, weakening or complete absence of breathing. On an x-ray, it is possible to determine signs of mediastinal displacement towards the healthy lung.

Hemarthrosis (blood in the joint cavity)

A common joint lesion is the development of hemarthrosis, which means the accumulation of blood in the joint cavity. A similar condition occurs as a result of injury, less often with hemophilia, scurvy. The anemic symptom is expressed insignificantly, in contrast to the local symptoms. The clinic distinguishes three degrees. With hemarthrosis of the 1st degree, it is noted mild pain, the contours of the joint are slightly smoothed, the range of motion is not changed. In general, the volume of blood in the joint is up to 15 ml. Grade 2 is characterized by severe pain, which intensifies with exercise, and smoothness of the joint is noted. There is an increase in the circumference of the affected joint by 1.5–3 cm compared to a healthy one. In the case of hemarthrosis of the knee joint, voting of the patella is observed. The blood content in the cavity is up to 100 ml. At grade 3, the pain syndrome is acute, the outlines of the joint are completely changed. The joint's circumference increases to 5 cm, and mobility is severely limited. Blood volume is more than 100 ml.

General symptoms

Thus, there are signs of bleeding that occur in any case, regardless of the source of the bleeding. Early signs include: pallor of the skin and visible mucous membranes, cold sweat, general weakness, dizziness, darkening of the eyes, if the lungs are affected - cough with streaks of blood, if organs are involved in the process digestive system– bloody vomiting or bloody diarrhea, symptoms of peritoneal irritation, which occurs when internal organs (spleen, liver, kidney) rupture. With moderate bleeding, a number of symptoms may be either mild or not appear at all

In other words, bleeding leads to the development of anemia. In addition to the above symptoms, anemia is manifested by increased heart rate and hypotension, that is, a decrease in blood pressure. The changed parameters directly depend on the degree of blood loss: with moderate - pulse no more than 75 beats per minute, systolic pressure drops to 100 mm Hg. Art.; with average - the pulse rises to 100 beats per minute, blood pressure decreases to 100 mHg. Art.; in severe cases, the pulse increases to beats per minute, systolic blood pressure drops below 80 mmHg. Art.

Diagnostics

In case of combined trauma, laparocentesis is performed; it is a simple, fast, affordable and gentle method for diagnosing injuries to the abdominal organs and internal bleeding. An ultrasound of the abdominal organs is also sometimes performed.

An important point in confirming the diagnosis is laboratory blood tests. The analysis reveals a decrease in the number of red blood cells, the amount of hemoglobin and a drop in hematocrit.

If such symptoms and diagnostic data are detected, it is necessary to immediately identify the cause of the underlying disease and begin treatment. It should be remembered that the earlier the cause of internal bleeding is identified, the more effective and rapid the recovery process will be.

Internal bleeding is one of the most dangerous types of bleeding, requiring immediate hospitalization.

How to spot internal bleeding

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 when there are severe external injuries, but some chronic diseases also cause a similar condition. The danger is that a person does not always experience pain. However, if urgent measures are not taken, 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.

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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. Blood clots can only be removed 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 death. In addition to severe head injury, stroke often results from:

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

Small pelvis

We are talking 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 this type of bleeding special is the fact that a person, experiencing acute pain in the peritoneum, is forced to sit with his knees pulled up to his chest in order to relieve it at least a little. 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 blood fills the 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 exercise everyday affairs, 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 happened in top part body, arrange the person reclining. Otherwise, lay on your back;
make sure that the victim moves as little as possible;
Apply something cold (a bag of frozen food, cold water, ice cubes) to the area where you think the 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.

The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and make recommendations for treatment based on the individual characteristics of a particular patient.

1. Questions to test the initial level of knowledge.

1. List of diseases that can cause bleeding from the gastrointestinal tract (GIT).

2. List the common symptoms of bleeding, regardless of the location of the bleeding.

3. List the changes that occur in the body during bleeding.

4. Methods for examining children with gastrointestinal tract problems.

5. Additional methods for examining children with gastrointestinal tract problems.

2. Determining the goals of the lesson

The student must know: 1. Classification of bleeding depending on the level of bleeding. 2. List of diseases causing bleeding from all three levels of the gastrointestinal tract. 3. Diseases that can cause bleeding from any part of the gastrointestinal tract. 4. Gastrointestinal tract clinic. 5. Diagnosis and differential diagnosis of gastrointestinal tract. 6. Additional examination methods for gastrointestinal tract. 7. First aid for gastrointestinal tract infections. 8. Methods of treatment of gastrointestinal tract: conservative and surgical. The student should be able to: 1. Determine the severity of blood loss. 2. Conduct a differential diagnosis of the level of bleeding. 3. Taking into account the anamnesis and clinical data, identify the disease that caused the gastrointestinal tract. 4. Make an emergency care plan and carry out treatment. 5. Draw up a program for examining a child with gastrointestinal tract. 6. Assess the scope and diagnostic value of laboratory and instrumental research methods (blood tests, ultrasound, endoscopic, x-ray). 7. Formulate a clinical diagnosis. 8. Substantiate indications for surgical treatment.

Literature: 1. Yu.F. Isakov, E.A. Stepanov, L.K. Krasovskaya. Abdominal surgery in children. M.1998 2. Surgical diseases, ed. M.I. Kuzina Medicine M. 2006. 3. A.I. Zaprudnov, K.N. Grigoriev, N.F. Dronov. Gastrointestinal bleeding in children Medicine M. 1998. 4. Surgical diseases of childhood. t.t.1,2 ed. Yu.F. Isakov Moscow ed. house "GOETAR-Med" 2004. 5. I. Andreev, I. Voptarov, H. Mikhov, A. Angelov. Differential diagnosis the most important symptoms childhood diseases. Med and Physics Sofia 1981.

3. Tasks for independent work

1. Specify the main symptoms of gastrointestinal tract infections.

general weakness, dizziness, noise and ringing in the ears, darkening of the eyes, shortness of breath, pain in the heart, tachycardia, pallor, increased sweating, cold extremities, drowsiness, confusion, weak pulse and tension, low blood pressure, pallor of the skin and mucous membranes,
fatigue, dizziness, glossitis, stomatitis, anemia, possible melena, characteristically no vomiting of blood or “coffee grounds”.

2. What are the main symptoms of upper gastrointestinal bleeding?

vomiting blood (hematemesis) and black, tarry stools (melena)

3. What are the main symptoms of bleeding from small intestine?

The blood released is dark red in color, but in some cases may appear as melena. Intussusception usually develops in infants, but sometimes occurs at any age. The child experiences cramping pain in the abdomen, accompanied by stretching of the legs, a shrill cry, and the passage of stool consisting of blood and mucus (“red currant jelly”).

4. Symptoms of bleeding from the colon?

Diverticular disease is complicated by bleeding, causing massive colonic ulcers. The cause of 70-90% of bleeding from right half colon are diverticula, in 70% of these bleedings stop spontaneously. It is believed that diverticular bleeding is a consequence of rupture of blood vessels located near the diverticulum. In most patients, bleeding caused by diverticular disease is minor and stops on its own. A third of patients have massive bleeding due to colonic diverticulosis and develop posthemorrhagic anemia. Abdominal pain is not typical for diverticular bleeding. Massive bleeding with diverticulosis of the colon ends in death in 10-20% of cases.

5. Depending on the level of bleeding, what basic research methods should be performed?

Upper gastrointestinal bleeding

well collected anamnesis. Has the patient had previous episodes of GI bleeding? Did he have a previously diagnosed stomach or duodenal ulcer? Whether he makes complaints, specific to a peptic ulcer? Has he previously been operated on for peptic ulcers or portal hypertension? Does he have other diseases that could lead to bleeding, such as liver cirrhosis or coagulopathies? Does the patient abuse alcohol, regularly take aspirin or NSAIDs? Does he have nosebleeds? It is advisable to get an answer to these questions if the patient is conscious and sufficiently communicative, for example, is not intoxicated. Examination of the skin and visible mucous membranes allows us to identify stigmata of liver cirrhosis, hereditary vascular anomalies, signs of capillarotoxicosis, and paraneoplastic manifestations. Palpation of the abdominal cavity may reveal tenderness (peptic ulcer), splenomegaly (liver cirrhosis or splenic vein thrombosis), and gastric swelling. Intraperitoneal bleeding (for example, with impaired ectopic pregnancy) sometimes manifests itself with signs of acute anemia similar to those of gastrointestinal tract. The presence of symptoms of peritoneal irritation characteristic of bleeding into the abdominal cavity may help in differential diagnosis these states. If auscultation of the abdomen reveals increased peristalsis, there is reason to assume that it is caused by blood entering the intestine from the upper gastrointestinal tract. The most important information is provided by esophagogastroduodenoscopy (EGD); it allows not only to establish with a high degree of accuracy the location of the source of bleeding and its nature, but also to carry out hemostatic measures, which in a significant number of cases make it possible to stop the bleeding. Radioisotope scanning (labeled 99 Tc colloidal sulfur or albumin) and angiography are very important in certain situations, but most practical significance do not have, since they can extremely rarely be performed for emergency indications.

Bleeding from the lower gastrointestinal tract

If there is blood in the stool, it is important to find out whether the blood is mixed with the feces (the source is located high) or is released in a relatively unaltered form at the end of the bowel movement, which is more typical for low-lying bleeding tumors and hemorrhoids. Palpation of the abdominal cavity and finger examination anus are required in all patients. Digital rectal examination, according to statistics, allows us to identify up to 30% of all colon tumors, including those complicated by bleeding. The next stage of diagnosis is anoscopy and rectosigmoidoscopy, the effectiveness of which for oncological diseases of the colon is 60%. If you have tarry stools, which can be a consequence of both gastroduodenal bleeding and bleeding from ileum and right parts of the colon, nasogastric aspiration through a probe and endoscopy are recommended to exclude pathology of the stomach and duodenum. Colonoscopy is the most informative method for diagnosing colonic pathology, but with intense bleeding it is quite difficult to perform. If the bleeding stops at least temporarily, then with the help of this procedure a wide variety of pathologies, including vascular ones, can be diagnosed. Mesenteric arteriography during intestinal bleeding allows you to identify extravasation of contrast and determine the side and approximate localization of the source of bleeding. Angiography is the only method for diagnosing bleeding in the small intestine; it makes it possible to inject vasopressin directly into the bleeding artery. Extravasation is determined only with sufficiently massive bleeding, but even in the absence of its signs, arteriogrophy can detect vascular pathology that is the cause of bleeding. Scintigraphy with erythrocytes labeled with 99 Tc or with platelets labeled with radioactive In is a more sensitive method; the source of bleeding is detected even at a relatively low intensity, but scintigraphy requires a lot of time and therefore can hardly be considered an emergency diagnostic method. Contrast X-ray examination methods (irrigoscopy and irrigography) are not able to identify the source of bleeding, but can help in the diagnosis of tumors, diverticulosis, intussusception and other diseases complicated by bleeding.

6. Make a plan for treatment and examination for bleeding from the upper gastrointestinal tract.

1. Blood test (hemoglobin, reticulocytes, hematocrit, platelets, etc.).

2. Study of blood coagulation properties (prothrombin time, etc.).

3. Electrolytes, urea and blood creatinine.

4. Blood type and Rh factor.

5. Blood gases.

6. ECG.

7. Chest X-ray (X-ray of the abdominal cavity - for special indications

Medications are not alternative treatments acute bleeding, if surgery is indicated, but they can help stop bleeding and prevent its recurrence. Efficiency drug treatment is determined by many circumstances, but regardless of them, the prescription of ranitidine (Zantac), omeprazole (Losec) or famotidine (Quamatel) is justified. One of them is administered intravenously (Zantac 50 mg, Quamatel 20 mg, Losec 40 mg) for 2-5 minutes 3 times a day at intervals of 8 hours up to 3 days. This reduces the risk of stress ulcers and recurrent bleeding, but does not stop ongoing bleeding. After stopping the IV administration of an antisecretory drug when erosive and ulcerative bleeding it is justified to prescribe it orally (ranitidine 150 mg, or famotidine 20 mg 3 times a day, or omeprazole 20 mg 2 times a day).

Endoscopic therapycarried out depending on the source of bleeding:

1. Sclerotherapy of esophageal veins for varicose veins.

2. Injection of liquid fibrinogen or instillation of liquid thrombin in the ulcer area.

3. Laser photocoagulation.

4. Diathermocoagulation.

Due to lack of effectiveness, gastric lavage is not recommended ice water, the use of vasoconstrictors (adrenaline, etc.) and antacids. The hemostatic effect of somatostatin in ulcerative bleeding, omeprazole and sucralfate in hemorrhagic gastritis, and sinestrol in hereditary telangiectasias has been confirmed. Somatostatin (Sandostin) inhibits the secretion of gastric and pancreatic juice, reduces blood flow in the abdominal organs, which helps stop ulcerative bleeding and bleeding from dilated veins of the esophagus. 250 mcg/hour is administered intravenously until the onset of affect. For hemorrhagic gastritis, omeprazole is prescribed twice a day, 20 mg at intervals of 12 hours, in combination with sucralfate (12-16 g per day) for several days, followed by a reduction in the daily dose of omeprazole to 20 mg, and sucralfate to 4 g. Sinestrol 1 ml of 2% oil solution is administered intramuscularly daily to prevent repeated episodes of bleeding from hereditary telangiectasias.

7. Solve test tasks:

A) A 13-year-old child has vomiting with blood and tarry stools. History of hunger and night pain in the epigastric region. The abdomen is soft and painless. Most likely diagnosis:

a) gastroduodenitis

b) bleeding from dilated veins of the esophagus

c) peptic ulcer of the stomach or duodenum

d) Meckel's diverticulitis

e) nonspecific ulcerative colitis

B) A 12-year-old child has gastrointestinal bleeding and melena. It is advisable to start the examination:

a) from a contrast study of the stomach and duodenum

b) gastroduodenoscopy

c) laparoscopy

d) laparotomy and revision abdominal wall

d) colonoscopy.

8. Compose a test task according to the sample above.

Chronic bleeding from the digestive tract in children occurs when:

Non-spoke ulcerative colitis , Meckel's diverticulum, intestinal angimatosis, rectal polyp, intestinal polyposis

9. Make up questions for the clinical problem and give the correct answer:

A 13-year-old boy was taken to the emergency department. Yesterday the child had a single vomit that resembled coffee grounds. Today I had tarry stools.

From the anamnesis: over the past 1.5 years, the child had pain in the epigastric region, belching, and sometimes vomiting food, after which relief came. On examination, the abdomen is not swollen, soft on palpation, moderately painful in upper half. A control X-ray examination reveals persistent deformation of the duodenum.

preliminary diagnosis. Treatment tactics.

Ulcer of the duodenal bulb. The following are used for treatment medications: Omez, De Nol, third generation antibiotics

10. Create a clinical problem: a child has red blood in his stool.

A local pediatrician examines a 6-year-old child with complaints of a tendency to constipation over the past year and the release of scarlet blood at the end of defecation in the last 2 days.

preliminary diagnosis. Tactics of examination and treatment.

Bleeding is not uncommon among children. Moreover, the etiology of bleeding is varied. Depending on the etiological factors bleeding is divided into different groups.

There are, for example, sudden bleeding. That is, they occur unexpectedly under the influence of certain factors. Moreover, factors associated with the influence of mechanical influence.

A group of bleeding associated with various diseases is also considered. For example, with a congenital pathology of the hematopoietic system, which is associated with a blood clotting disorder. These could be respiratory diseases.

Pathology of various organs leads to the development of repeated bleeding. Bleeding does not occur once, but can bother the child again and again. Which leads to massive blood loss.

What it is?

Bleeding in children is a process of blood clotting disorder or a state of massive blood loss. Massive blood loss in children can be a consequence of trauma. Moreover, injuries of various types.

But it should be noted that bleeding associated with gastrointestinal pathology is rare. Precisely in children. Nosebleeds are common in children.

What exactly causes nosebleeds in children? Nosebleeds in children are associated with pathology or exposure to foreign bodies. But your susceptibility to nosebleeds depends on a number of factors. These factors include:

high air temperature;
a certain position of the child’s body;
active games.

Often, nosebleeds in children occur as a result of the influence of infectious agents. These infectious agents are infections. For example, syphilis.

Causes of bleeding

What are the main causes of bleeding in children? The causes of bleeding in children are different. But most often the following etiological factors can be traced:

injuries;
acute infectious diseases;
respiratory diseases.

Hypertension can cause bleeding in children. That's high blood pressure. Children with high blood pressure may develop bleeding. Even with high blood pressure, nosebleeds are not uncommon.

There is also a hereditary pathology of bleeding. In this case, the cause of bleeding is hemophilia. But hemophilia occurs predominantly in boys.

Any concomitant factor can cause bleeding in hemophilia. Concomitant factors for hemophilia in children include:

skin wounds;
damage to the mucous membranes of the nose and mouth;
hemorrhages.

The cause of bleeding may be thrombopenic purpura. But at the same time, certain symptoms occur. As for bleeding from the lungs, they occur as a consequence of tuberculosis. The following diseases contribute to nosebleeds in children:

adenoids;
telangiectasia of the mucous membrane of the nasal septum;
foreign bodies.

Symptoms of bleeding

When bleeding occurs in children, certain symptoms occur. More often, symptoms depend on the causes and type of disease that caused the bleeding. In case of injury, bleeding is temporary. In this case, it is enough to perform hemostasis.

In case of injuries, bleeding can be arterial and capillary in nature. Depending on the damaged body part. If there is prolonged bleeding in children, the following symptoms occur:

dizziness;
weakness;
pallor;
loss of consciousness;
hemorrhagic shock.

But bleeding may not be significant. Which in this case is accompanied by the manifestation of a pain threshold and bleeding. If the bleeding is caused by an infection, the symptoms may be acute.

The most dangerous thing is repeated bleeding. It is repeated bleeding that leads to the development of massive blood loss and can also cause anemia. With malignant pathology, the disease has the following symptoms:

asthenia;
violation of the child's condition.

In thrombopenic purpura, bleeding symptoms are associated with bleeding from the mucous membranes. This may include nosebleeds. But the disease is not limited to bleeding. In addition to bleeding, hemorrhages may occur.

Hemorrhages occur in the skin. But more often, hemorrhages are observed in the affected area. With tuberculosis, pulmonary bleeding is observed. Moreover, hemoptysis is characteristic.

In children of early age, bleeding from the nose may be observed. In this case, it is often against the background of a disease or the influence of unfavorable factors. If there is a foreign body in the septum, certain symptoms are observed:

violation of nasal breathing;
mucus department;
bleeding;
the presence of swelling in the septum area.

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Be sure to consult a specialist!

Diagnosis of bleeding

To diagnose bleeding in children, it is necessary to conduct an examination. A medical examination suggests the presence of certain clinical signs. For example, if there is an injury, bleeding is detected.

If the bleeding is caused by an infectious disease, then the infection should be identified. To determine the infectious agent, it is enough to conduct a study using laboratory diagnostics:

blood picture;
bacteriological examination of stool;
urine test.

For determining hereditary disease It is enough to use the anamnesis data. After all, anamnesis allows one to identify pathology based on information from the child’s medical history. To determine the heart defect that caused the disease, a study using a cardiogram is necessary.

It is the cardiogram and echogram that can determine heart defects. X-rays are also relevant. X-ray of the lungs allows you to determine the presence of tuberculosis foci.

By measuring blood pressure, hypertension can be determined. Pressure is measured using a tonometer. If hemorrhages are present, the diagnosis of hemophilia can be confirmed.

If the bleeding was caused by the presence of thrombopenic purpura, then it is advisable to conduct a clinical study. This reveals the following picture:

decreased platelet count;
enlarged spleen.

To determine it, it is important to conduct a sputum examination. Sputum allows you to identify Mycobacterium tuberculosis. During examination, namely, x-ray of the nasal septum, a foreign body can be identified.

Prevention of bleeding

Prevention of bleeding is a complex of preventive measures. Most often, it is necessary to prevent the child from receiving various types of injuries. If you have hemophilia, you must:

prevent injury;
prevent damage to the mucous membrane of the nose and mouth.

It is also important to prevent the development of infectious diseases. Or they should be cured on time. In case of heart defects, it is advisable to carry out preventive actions aimed at surgical intervention.

If you have high blood pressure, it is important to use prophylactic agents. These funds should be aimed at normalizing blood pressure. It is also necessary to treat thrombopenic purpura in a timely manner.

If there is a malignant pathology of hematopoiesis, for example, chemotherapy is necessary. Chemotherapy eliminates bleeding. If a foreign body is present, it is important to immediately provide the child with assistance in removing the foreign body.

If the child is hypertensive and prone to bleeding, then it is necessary to exclude the influence of hot weather. High temperatures must be avoided. You should also avoid sitting during mental activity.

Long, tedious games are also contraindicated for children. Therefore, you should do more quiet games to prevent nosebleeds. The following diseases must be treated promptly:

syphilis;
hemorrhagic diathesis.

Treatment of bleeding

For bleeding in children, it is necessary to carry out a complex of therapeutic measures. It is important to create a comfortable psychological environment for the child. That is, the child needs to be reassured. But it is also advisable to determine the etiological factor.

If you have nosebleeds, there are certain treatment measures. These treatment measures include:

place the child in an elevated position;
throw your head back;
prevent the child from blowing his nose;
Avoid nose picking.

Be sure to provide your child with a cotton swab. But the tampon must be moistened with the following solutions:

hydrogen peroxide solution;
table vinegar solution;
pieces of raw meat.

If bleeding from the nose is profuse, then treatment is aimed at pressing the wings of the nose to the septum. It is advisable to put cold lotions on the bridge of the nose and the back of the head. To improve blood clotting function, the following measures are taken:

give the child a solution of table salt to drink;
ten percentage solution calcium chloride;
calcium gluconate orally.

Table salt is diluted using next steps. One teaspoon of table salt per glass of water. Take one dessert spoon every half hour. Calcium gluconate solution is used one dessert spoon several times a day.

Vitamin K is widely used in the treatment of bleeding in children. It is also necessary to use a heating pad when the extremities become cold. At pulmonary hemorrhage the sick child is given a sitting or semi-sitting position.

Give orally for pulmonary hemorrhage table salt. Vitamin K is also used for treatment. An ice pack is placed on the chest. In case of hemoptysis, tourniquets are applied for hemostasis. Medications are also indicated:

camphor;
cardiac drugs.

In case of gastric bleeding, it is necessary to create rest and a supine position. It is advisable to place an ice pack on your stomach. For heart failure, heart warmers are used on the legs.

For any bleeding, a blood transfusion must be provided. But besides this, injections must be given. Injection of gelatin is most indicated.

Doctors' forecast for bleeding

At minor bleeding the prognosis is good. That is, nothing threatens life if the bleeding is minor. Therapy for bleeding also plays a role.

Therapy aimed at stopping bleeding must be comprehensive. Only in this case the prognosis is the best. Especially if the disease is hereditary.

For acquired pathology, treatment should also be comprehensive. Otherwise, consequences may occur. The consequences boil down to the development of shock situations.

Outcome of bleeding

Bleeding can also lead to death. For example, with massive bleeding and coagulation disorders. Therefore, care not provided properly leads to death.

Once the bleeding is stopped, the outcome is good. This is due to direct hemostasis. But in some cases, bleeding may recur.

With repeated bleeding, the outcome is not favorable. Conditions bordering on terminal reactions may develop. Including hemorrhagic shock.

Life expectancy with bleeding

With bleeding, life expectancy is either impaired or increased. But this depends on the reasons that led to the disease. If the cause is not eliminated, bleeding may recur.

Repeated bleeding leads to irreversible processes. They are based on the development of anemia. And of a difficult nature. In this case, the quality of life is impaired.

Life expectancy is also affected by bleeding caused by malignant pathologies. For example, with leukemia. In this case, the development of a fatal outcome is clear.

Bleeding occurs as a result of a violation of the integrity of the blood vessel. Bleeding can be primary (occurs immediately after damage to the vessel) and secondary (some time after the bleeding has stopped).

Types of bleeding and ways to stop it

Types of bleeding

Arterial bleeding characterized by an intense pulsating blood stream of scarlet (bright red) color (the blood in the arteries is saturated with oxygen), the height of which changes with each pulse wave.

Venous bleeding characterized by a uniform flow of brown (dark red) blood (venous blood has low oxygen content and great content carbon dioxide).

capillary bleeding, as a rule, is mixed, since small arteries and veins are damaged.

Parenchymal bleeding occurs with damage to the lungs, liver, kidneys and spleen. The symptoms of bleeding are similar to capillary bleeding, but it is much more dangerous, since in these organs the blood vessels do not collapse.

Depending on the location of the injury, bleeding is divided into internal(hemorrhage occurs in cavities, tissues, organs) and external(blood flows out from the damaged vessel). In case of internal bleeding, blood can flow into the abdominal and chest cavities, joint cavity, pericardial sac, etc.). Bleeding can also occur from different cavities: the nasal cavity, lungs, stomach, female genital organs, urinary tract, anus. Hidden bleeding also occurs, which is detected through laboratory tests.

Children often experience spontaneous nosebleeds with different infectious diseases(flu, ARVZ, erysipelas, typhoid fever, measles, scarlet fever, diphtheria, etc.) and diseases of the hematopoietic organs (anemia, hemorrhagic diathesis, hemophilia, etc.).

IN childhood blood loss is difficult to bear, since the compensatory capabilities of the body are not sufficiently developed in children. For example, for a 1-year-old child, blood loss of 200 ml represents serious danger. And the rapid loss of 1/3 of the total amount of circulating blood poses a mortal danger for the child.

In most cases, the cause of death due to bleeding in children is a sharp decrease in the amount of fluid in the vessels, which leads to a significant decrease in blood pressure, as well as acute shortage oxygen and nutritional components in the myocardium (heart muscle) and brain.

First aid for bleeding

If bleeding occurs, it is very important to take all necessary measures to temporarily stop it until the patient receives qualified medical care. Such measures are in the nature of emergency assistance, which must be provided on site.

To temporarily stop bleeding, you can use different methods:

- pressing the bleeding site pressure bandage: sterile gauze (pre-folded several times) is applied to the site of bleeding, on which a layer of cotton wool is placed and tightly secured with a circular bandage (a clean piece of fabric can be used instead of sterile material);

- elevated position of the injured limb helps stop venous bleeding by reducing blood supply;

- finger pressure of the main (main) arterial trunks directly to a nearby bone (eg carotid artery should be pressed against the transverse processes of the cervical vertebrae or against the inner edge of the sternocleidomastoid muscle); carried out in case of damage to large vessels;

Finger pressure in the areas of the main arterial trunks

Pressure of the abdominal aorta

- maximum flexion or hyperextension in the joints of the injured limb(for example, if the subclavian or axillary artery is damaged, both elbows with bent forearms are pulled back and fixed with a bandage);

- circular pulling of a tourniquet on the injured limb above the bleeding site (for example, with an Esmarch tourniquet or twist). The Esmarch tourniquet is applied over clothing (or some piece of fabric) so as not to damage the skin; before applying, the tourniquet must be stretched, made 2-3 turns around the damaged limb, squeezing with some force soft tissues. Then the ends of the rope are secured with a hook or chain (or simply tied with a knot). Note that when applying a tourniquet, the first ter should be the tightest. At correct application of the tourniquet the bleeding stops and the peripheral pulse on the injured limb disappears. Immediately after applying the tourniquet, it is necessary to make a record indicating the exact time of its application (the record can be made directly on the limb, clothing, attached sheet of paper, etc.). The tourniquet can be applied for no more than 2 hours, then, if the patient could not be transported to a medical facility, the tourniquet is loosened for a while;

Esmarch tourniquet application

- tomponade consists of introducing a sterile swab (a long sterile gauze bandage), thus filling the entire wound cavity, a regular cotton-gauze bandage is applied on top.