How to recognize internal bleeding in a child. Internal bleeding

Gastrointestinal bleeding in children is quite common and can occur from mechanical damage Gastrointestinal tract inadvertently swallowed sharp objects and aggressive liquids, and can be a symptom of a very serious disease. The health and often the life of the baby depends on how quickly parents take action. Of course, self-medication is unacceptable here; you should immediately consult a doctor.

The causes of such bleeding may be different. In children under three years of age, the reasons may be:

1. intussusception is a type intestinal obstruction caused by the ingrowth of one section of the intestine into another;
2. Meckel's diverticulum is a protrusion of the intestine into weak point and the formation of the so-called “abnormal sac”;
3. doubling of the large intestine, which may be accompanied by doubling of other organs;
4. hernia hiatus in the diaphragm.

In children under seven years of age, gastrointestinal bleeding can be caused by polyps in the intestines; they usually occur in the rectum and sigmoid colon.

In children over seven years of age, the reasons may be:

1. stomach ulcer, duodenum;
2. various types of gastritis;
3. ulcerative colitis;
4. bleeding from varicose veins different departments Gastrointestinal tract;
5. thermal ileitis or Crohn's disease, this is an inflammation of the ileum small intestine, accompanied by the appearance of ulcers and polyps and destruction of the mucous membrane.

In addition, in children of all ages, bleeding can occur if they swallow any solid or sharp objects, as well as aggressive liquids. It is also possible to contract dysentery or typhoid fever. Infants may have blood in their stool if the mother has cracks in her nipples and through them her blood enters the baby's intestines.

There are several blood diseases that are also characterized by bleeding in the gastrointestinal tract. There can be many reasons for bleeding and parents should not make a diagnosis themselves. Their task is to notice the beginning of bleeding in time.

Symptoms of stomach bleeding in children

Sometimes the warning signs of bleeding are sharp deterioration child's condition. All signs of blood loss occur: lethargy and weakness, the child feels dry mouth and extreme thirst, the skin and mucous membranes become pale, a rapid heartbeat appears, and may decrease blood pressure.

And if bloody vomiting appears, as well as bloody stools, or all together, then this is already acute stage diseases. Moreover, by the color of the blood you can understand in which part the bleeding occurred. If bloody vomiting occurs, the bleeding cannot be below the duodenum. There is red blood in the vomit, if the bleeding is in the esophagus or stomach, if it is dark, then the source of bleeding is further away.

If there is blood in the stool, then the bleeding has occurred in the lower gastrointestinal tract. Dark Blood in the stool or even black stool indicates bleeding in the ileum or colon. If the blood in the stool is bright, this indicates that it entered the stool from the rectum or from the anal fissures.

Emergency care for gastric bleeding in children

If these signs appear, you should call as soon as possible. ambulance" Before she arrives, it is necessary to put the child to bed, apply ice to the site of suspected bleeding, and you can even let the child swallow pieces of ice. When vomiting, place the head on one side to prevent the child from choking. There is no need to water or feed the child; you also cannot rinse the stomach or give an enema.

Treatment

The doctor determines the child’s treatment after full examination patient, it is usually performed inpatiently. Depending on the intensity of the bleeding, treatment may be therapeutic for mild or surgical for severe. The operation allows you to identify the focus heavy bleeding and take measures to eliminate it. This may include ligation of veins, a sigmostoma (this is the removal of a section of intestine to the outside), and resection of part of the stomach or intestines. In any case, the treatment is long and serious; restoring the child’s health after surgery requires great dedication from the parents.

Conservative treatment is more gentle and consists of a number of therapeutic measures:

1. for bleeding resulting from burns chemicals, perform gastric lavage with neutralizing substances;
2. administration of medications to help stop bleeding;
3. removing blood from the gastrointestinal tract using a probe or, if there is no danger, using enemas;
4. restoration of blood loss, usually carried out by transfusion of donor blood;
5. general support for the body. Since feeding the child on the first day is not recommended, therefore a mixture of glucose and saline solution is administered intravenously, starting from the second day they begin to feed carefully dietary food recommended by a doctor;

diagnosis and treatment of the disease. Usually this stage is long-term; treatment continues even after the child has been discharged from the hospital. Here, parents are required to strictly follow the recommended treatment.

is a condition in which blood flows either into a natural cavity of the body (stomach, bladder, uterus, lungs, joint cavity, etc.), or into the space artificially formed by shed blood (retroperitoneal, intermuscular). Symptoms of internal bleeding depend on its location and the degree of blood loss, usually including dizziness, weakness, drowsiness, and loss of consciousness. Pathology is diagnosed based on external examination data, X-ray results, CT, MRI and endoscopic studies. Treatment - infusion therapy, prompt elimination source of bleeding.

ICD-10

K92.2 S27.1 S06.4 O08.1

General information

Internal bleeding- loss of blood, in which the blood flows not outward, but into one of the cavities human body. The cause may be injury or chronic disease. The massive nature of blood loss, late seeking of help by patients and diagnostic difficulties in identifying this pathology increase the seriousness of the problem and turn internal bleeding into serious threat for the lives of patients. Treatment is carried out by specialists in the field of clinical traumatology, abdominal and thoracic surgery, neurosurgery, vascular surgery.

Reasons

The cause of internal bleeding can be either trauma or certain chronic diseases. Massive, life-threatening post-traumatic bleeding into the abdominal cavity can develop as a result of blunt trauma to the abdomen with damage to the spleen and liver, less commonly the pancreas, intestines or mesentery (due to an impact, a fall from a height, a car accident, etc.). Bleeding in pleural cavity usually occurs with multiple rib fractures with damage to the intercostal vessels and pleura. IN isolated cases its cause is fractures of 1-2 ribs.

Bleeding into the cranial cavity is one of the dangerous complications traumatic brain injury. Since the skull, unlike other natural cavities, has a rigidly fixed volume, even a small amount of spilled blood causes compression of the brain structures and poses a threat to the patient’s life. It should be borne in mind that intracranial bleeding can develop not only immediately after injury, but also several hours or even days later, sometimes against the background of complete well-being.

Bleeding into the joint cavity can be caused by both an intra-articular fracture and a bruise. It does not pose an immediate threat to life, but if left untreated it can lead to serious complications.

A significant proportion of the total amount of internal bleeding consists of bleeding into the cavity of an organ that develops as a result of chronic diseases gastrointestinal tract: malignant tumors, peptic ulcer of the stomach and intestines, erosive gastritis, varicose veins of the esophagus with cirrhosis of the liver, etc. In surgical practice, Mallory-Weiss syndrome is also often encountered - cracks in the esophagus due to alcohol abuse or a single generous intake food.

Another fairly common cause of internal bleeding is gynecological diseases: ovarian ruptures, ectopic pregnancy, etc. B gynecological practice Internal bleeding occurs after abortion. Internal bleeding is also possible with placental previa or premature abruption, postpartum bleeding with retained placenta, uterine rupture and birth canal.

Classification

There are several classifications of internal bleeding:

• Taking into account the cause of occurrence: mechanical (due to damage to blood vessels during trauma) and arrosive (due to damage to vascular wall during necrosis, germination and disintegration of the tumor or destructive process). In addition, diapedetic bleeding occurs due to increased wall permeability small vessels(for example, with scurvy or sepsis).
• Taking into account the volume of blood loss: light (up to 500 ml or 10-15% of the circulating blood volume), moderate (500-1000 ml or 16-20% of the bcc), severe (1000-1500 ml or 21-30% of the bcc), massive (more than 1500 ml or more than 30% of the bcc), fatal (more than 2500-3000 ml or more than 50-60% of the bcc), absolutely fatal (more than 3000-3500 ml or more than 60% of the bcc).
• Taking into account the nature of the damaged vessel: arterial, venous, capillary and mixed (for example, from an artery and vein or from a vein and capillaries). If blood flows from the capillaries of any parenchymal organ(liver, spleen, etc.), such bleeding is called parenchymal.
• Taking into account localization: gastrointestinal (into the cavity of the esophagus, stomach or intestines), into the pleural cavity (hemothorax), into the pericardial sac (hemopericardium), into the joint cavity, etc.
• Taking into account the location of the accumulation of spilled blood: abdominal (into the pleural, abdominal and other cavities) and interstitial (into the thickness of tissues with their impregnation).
• Taking into account presence or absence obvious signs bleeding: obvious, in which the blood, even after some time and in a changed form, “comes out” through natural openings (for example, turning the stool black), and hidden, in which it remains in the body cavity.
• Taking into account the time of occurrence: primary, occurring immediately after traumatic injury vascular wall, and secondary, developing some time after injury. In turn, secondary bleeding is divided into early (develops on days 1-5 due to the slipping of the ligature or pushing out of a blood clot) and late (usually occurs on days 10-15 due to purulent melting of the blood clot, necrosis of the vessel wall, etc.) .

Symptoms of internal bleeding

General early signs of this pathology are general weakness, drowsiness, pale skin and mucous membranes, dizziness, cold sweat, thirst, darkening of the eyes. Fainting is possible. The intensity of blood loss can be judged both by changes in pulse and blood pressure, and by other clinical signs. With low blood loss, a slight increase in heart rate (up to 80 beats/min) and a slight decrease in blood pressure are observed; in some cases, clinical symptoms may be absent.

A fall indicates moderate internal bleeding systolic pressure up to 90-80 mm. rt. Art. and increased heart rate (tachycardia) up to 90-100 beats/min. The skin is pale, there is coldness in the extremities and a slight increase in breathing. Possible dry mouth, fainting, dizziness, nausea, adynamia, severe weakness, slow reaction.

In severe cases, a decrease in systolic pressure to 80 mm is observed. rt. Art. and lower, increased heart rate to 110 or higher beats/min. There is a strong increase and disturbance in the rhythm of breathing, sticky cold sweat, yawning, pathological drowsiness, tremors of the hands, darkening of the eyes, indifference, apathy, nausea and vomiting, a decrease in the amount of urine excreted, excruciating thirst, blackouts, severe pallor of the skin and mucous membranes, cyanosis limbs, lips and nasolabial triangle.

With massive internal bleeding, the pressure drops to 60 mm Hg. Art., there is an increase in heart rate to 140-160 beats/min. Characteristic periodic breathing(Cheyne-Stokes), absence or confusion of consciousness, delirium, severe pallor, sometimes with a bluish-gray tint, cold sweat. The look is indifferent, the eyes are sunken, the facial features are pointed.

With fatal blood loss, coma develops. Systolic pressure drops to 60 mmHg. Art. or not determined. Agonal breathing, sharp bradycardia with a heart rate of 2-10 beats/min, convulsions, dilated pupils, involuntary release of feces and urine. The skin is cold, dry, “marbled”. Then comes agony and death.

Treatment of internal bleeding

It is necessary to ensure that the patient is transported to the department as quickly as possible specialized assistance. The patient needs to be kept at rest. If hemothorax or pulmonary hemorrhage is suspected, the patient is placed in a semi-sitting position; if there is blood loss in other areas, the patient is placed on a flat surface. Apply cold (such as an ice pack) to the area of ​​suspected bleeding. It is strictly forbidden to heat the painful area, give enemas, give laxatives or introduce drugs into the body that stimulate cardiac activity.

Patients are hospitalized in a hospital. The choice of department is made taking into account the source of internal bleeding. Treatment of traumatic hemothorax is carried out by traumatologists, non-traumatic hemothorax and pulmonary hemorrhages– thoracic surgeons, intracranial hematomas– neurosurgeons, uterine bleeding – gynecologists. In case of blunt abdominal trauma and gastrointestinal bleeding, hospitalization is carried out in the general surgery department.

The main tasks in this case are to urgently stop internal bleeding, compensate for blood loss and improve microcirculation. From the very beginning of treatment, to prevent empty heart syndrome (reflex cardiac arrest due to a decrease in the volume of circulating blood volume), restore the volume of circulating fluid and prevent hypovolemic shock, a jet transfusion of a 5% glucose solution is performed, saline solution, blood, plasma and blood substitutes.

Sometimes internal bleeding is stopped by tamponade or cauterization of the bleeding area. However, in most cases, emergency surgery under anesthesia is required. When signs hemorrhagic shock or the threat of its occurrence at all stages (preparation for surgery, surgery, period after surgery) transfusion measures are carried out.

Internal bleeding due to ectopic pregnancy is an indication for emergency surgical intervention. In case of dysfunctional uterine bleeding, tamponade of the uterine cavity is performed; in case of massive bleeding due to abortion, birth trauma, and after childbirth, surgical intervention is performed.

Infusion therapy is carried out under blood pressure control, cardiac output, central venous pressure and hourly diuresis. The volume of infusion is determined taking into account the severity of blood loss. Blood substitutes with hemodynamic action are used: dextran, rheopolyglucin, solutions of salts and sugars, as well as blood products (albumin, fresh frozen plasma, red blood cells).

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 of various diseases. internal organs, internal hemorrhage occurs.

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 the most important reasons the appearance 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 general condition child;
• Anemic state of the body;
• Fatigue, weakness.

So, based on this, the most dangerous bleeding is the one that repeats again and again. In this case, you need to urgently contact medical care, 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.

At various diseases heart, 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 conduct an x-ray examination of the 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 you need to take urgent measures. 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 observed 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.

1. Questions to test the initial level of knowledge.

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

2. List general symptoms 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 examinations of 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 infections. 7. First aid for gastrointestinal tract infections. 8. Methods of treatment of gastrointestinal tract infections: conservative and surgical. The student must 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 causing the gastrointestinal tract. 4. Create a delivery plan emergency care and carry out treatment. 5. Draw up a program for examining a child with gastrointestinal tract problems. 6. Estimate the volume and diagnostic value laboratory and instrumental methods studies (blood tests, ultrasound, endoscopic, x-ray). 7. Formulate a clinical diagnosis. 8. Justify indications for surgical treatment.

Literature: 1. Yu.F. Isakov, E.A. Stepanov, L.K. Krasovskaya. Abdominal surgery in children. M.1998 2. Surgical diseases edited by 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 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 and tense pulse, low blood pressure, pallor 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 bleeding from upper sections Gastrointestinal tract?

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

3. What are the main symptoms of bleeding from the 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 colon diverticulosis 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 gastrointestinal tract infections? Did he have a previously diagnosed stomach or duodenal ulcer? Does he have any complaints specific to peptic ulcer disease? 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 or 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 in a state alcohol intoxication. 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), stomach tumor. Intraperitoneal bleeding (for example, with a disturbed ectopic pregnancy) is sometimes manifested by signs of acute anemia similar to gastrointestinal bleeding. The presence of symptoms of peritoneal irritation, characteristic of bleeding into the abdominal cavity, can 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 intestines from the upper gastrointestinal tract. Most important information gives esophagogastroduodenoscopy (EGDS); 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 lower sections Gastrointestinal tract

If there is blood in the stool, it is important to determine whether the blood is mixed with feces(the source is located high) or is released in a relatively unaltered form at the end of defecation, which is more typical for low-lying bleeding tumors and hemorrhoids. Palpation of the abdominal cavity and finger examination anus mandatory for all patients. Finger 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, which are effective in oncological diseases colon is 60%. In the presence of 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 diagnosis of colon pathology, however, 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 with 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 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 - 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. Contrasting methods x-ray examination(irrigoscopy and irrigography) are not able to identify the source of bleeding, but can help in diagnosing a tumor, 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. X-ray chest(X-ray of the abdominal cavity - according to 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 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 for 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 organs -abdominal cavity, 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 decrease daily dose omeprazole up to 20 mg, and sucralfate up to 4 g. Sinestrol is administered intramuscularly daily, 1 ml of a 2% oil solution in order 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

V) peptic ulcer 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 of the abdominal wall

d) colonoscopy.

8. Make up test task according to the above example.

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. During the control x-ray examination persistent deformation of the duodenum is revealed.

Preliminary diagnosis. Treatment tactics.

Ulcer of the duodenal bulb. The following are used for treatment medicines: 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 during last year and the release of scarlet blood at the end of the act of defecation in the last 2 days.

Preliminary diagnosis. Tactics of examination and treatment.

The question of why a child may be bleeding is not easy to answer. There can be many reasons for bleeding. In other words, bleeding is a symptom large number diseases. In order to understand what is going on, it is necessary to understand the nature of the outpouring. It could be:

• traumatic, that is, one that arose due to traumatic injury blood vessels(blow, injection, laceration);
• non-traumatic, that is, one that arose due to the erosion of the vascular wall by the focus of the disease.

Symptoms

The first signs of bleeding are the appearance of blood where it should not be. However, one must understand that the outpouring does not always happen outside. Bleeding may also occur internally. child's body. In order to understand in time what is happening, it is necessary to pay attention to the child’s discharge. A simple example is gastrointestinal bleeding, which can be diagnosed by bloody vomiting or bloody stool. But do not forget: blood can penetrate into digestive tract not only due to diseases of the organs of this system. The effusion may occur in another place, for example, in the lungs. And after that it gets into the stomach.

Parents should know that in case of any alarming symptom, it is necessary to call a doctor or go to an appointment with him to find out the causal circumstances of the child’s unhealthy condition.

To understand the symptoms of hemorrhage, you also need to know that this phenomenon is divided into several types according to clinical manifestations:

• external bleeding - when blood flows out of the body, that is, into the external environment;
• cavitary or internal bleeding - a hidden effusion during which blood penetrates into one or more internal organs or cavitary parts of the body (most common reason such bleeding in children - gastrointestinal diseases, especially ulcers).

Diagnosis of bleeding in a child

It is not difficult to detect external hemorrhage. It is impossible not to notice the red liquid released from the child’s body. But how to diagnose internal bleeding? By what signs can it be recognized?

The first signs of internal bleeding in a child are as follows:

• weakness,
• drowsiness,
• pale skin,
• cold sweat,
• constant thirst,
• possible fainting.

You can find out if your baby is bleeding internally by measuring his pulse. If the blood loss is insignificant, the pulse will increase to eighty beats per minute. If the effusion is characterized by moderate severity, then the pulse per minute will be from ninety to one hundred beats. If the case is severe, the pulse can rise to one hundred and ten beats within sixty seconds.

Bleeding that threatens the life of a child has the following symptoms:

• reduction in systolic pressure to sixty millimeters of mercury,
• convulsions,
• severe bradycardia,
• coma,
• dryness and coldness of the skin,
• pupil dilation.

Complications

The following may occur due to bleeding:

• the tissues of the child’s body will no longer be supplied with blood in the required quantity;
• a small patient will lose too much blood;
• organs will no longer be supplied with oxygen to the required extent, as a result of which their functions will be seriously impaired.

Treatment

What can you do

If parents suspect internal bleeding in their child, they should immediately consult a doctor. In this situation, they, without proper experience and medical education, can only help their child in this way.

If the bleeding is external, mom and dad, as well as those around them who notice the bleeding, can easily provide first aid to the baby. In the vast majority of cases, a bandage helps stop blood loss. It is noteworthy that the children’s body is able to stop the outpouring on its own. If the child is less than three years, in case of bleeding, a pressure bandage is relevant. If a small patient is more than three years old, it is important to use a tourniquet. It is worth knowing that such a tourniquet differs from an “adult” tourniquet in its increased elasticity.

The most common mistakes when applying a tourniquet:

• the use of this method of stopping bleeding is unfounded (a tourniquet is relevant for arterial effusion),
• applying a tourniquet too far from the injured area,
• application on a naked body,
• too tight or too loose.

What can a doctor do?

Bleeding is not a disease. This is a symptom painful condition. That is why the treatment of bleeding involves the fight against the disease, which provoked a violation of the integrity of the blood vessels.

The main goals of first aid for bleeding are:

• stopping bleeding in a child,
• replenishment of lost blood,
• treatment of coagulopathy,
• prevention of recurrent hemorrhage,
• prevention of deterioration of liver function.

If a small patient with internal bleeding comes to the doctor, the doctor examines him, talks with relatives and the child himself, and then prescribes a series of laboratory research and analyses. The main task is to determine what exactly provoked the violation of the integrity of the blood vessels.

If a child with external arterial bleeding, the doctor, with the help of nurses or orderlies, will do what the parents did not have time to do - apply a special bandage. For this purpose, the doctor will apply sterile gauze to the area of ​​the body that is bleeding. Afterwards, a bandage is applied on top, folded several times. As soon as pressure bandage will be pressed, the outpouring of blood will stop.

If for age little patient It is more important to apply a tourniquet instead of a bandage, the doctor will do just that. By applying a tourniquet correctly, the hemorrhage will be stopped immediately. Next, the doctor will decide other issues. Namely, to treat what provoked the violation of the integrity of the blood vessels.

Prevention

Preventive measures, designed to prevent the development of bleeding in children, directly depend on the cause of the bleeding. Main preventative measure aimed at reducing the risk of external bleeding - storing cutting and piercing objects away from children.