Gastric bleeding in children. Bleeding from the digestive tract in children

Gastrointestinal bleeding in children that occurs proximal to the ligament of Treitz is classified as upper digestive tract, and bleeding distal to it - to the lower parts of the digestive tract. Staged correct diagnosis and identifying the source of bleeding, an important circumstance is the comparison of the possible cause of bleeding with the age of the child. First of all, you should clearly imagine where the source of bleeding in a child of this age can most often be localized.

Causes of gastrointestinal bleeding in children

Hemorrhagic disease of the newborn characterized by spontaneous prolonged bleeding from the gastrointestinal tract, which appears between 2-5 days after birth. The disease is associated with a deficiency of prothrombin due to deficiency or lack of vitamin K, which is formed in the intestine in the presence of a stabilized bacterial flora. The most common clinical manifestation of the disease is melena of the newborn. The most common cause of these bleedings is erosion of the mucous membrane of the stomach and duodenum. The clinical picture is characterized by bloody stools in large quantities 3-4 times a day.

Esophagitis. Most common cause esophagitis in newborns and infants is reflux esophagitis due to regurgitation of gastric contents. It is noted in children with shortening of the esophagus, hernias esophageal opening diaphragm. The initial symptom is vomiting, often with an admixture of blood. Frequent admission gastric juice into the esophagus causes the development of ulcers in it, which are the source of bleeding.

Gastritis is an inflammation of the lining of the stomach. In newborns, idiopathic ulcerative gastritis has been described, which progresses rapidly and may result in perforation of the stomach wall. Most probable causes the occurrence of ulcerative gastritis are stressful lesions of the digestive tract due to asphyxic or hypoxic conditions of the newborn. There are three mechanisms of occurrence of stress gastric ulcers and gastrointestinal bleeding in children.

Firstly, any hypoxic state of the newborn leads to an increase in the level of catecholamines, which cause vascular spasm and ischemia of the gastric mucosa. Insufficient blood supply to the gastric mucosa is especially dangerous because it is exposed to the action of digestive juices.

Secondly, glucocorticoids, prostaglandins and serotonin play an important role in stress ulceration of the stomach, their level increases during stress.

Thirdly, great importance in the occurrence of stress ulcer bleeding has coagulopathy, which develops especially often in toxic conditions.

In the neonatal period, in 50% of cases, ulcers are localized in the stomach, in 20% - in the duodenum, and in 30% - a combined lesion. duodenum and stomach, At the age of 2 weeks to 1 year of life, gastric ulcers account for 15%, duodenal ulcers - 56%.

doubling of the stomach may be in the form of a cyst or be tubular in shape. These formations are lined with gastric or intestinal epithelium, are rarely represented by pancreatic tissue and are prone to ulceration and bleeding. Another cause of bleeding may be the retention of gastric contents with the development inflammatory process and ulceration.

Incomplete bowel rotation with obstruction. The combination of compression of the duodenum of the caecum or cords coming from it with a volvulus of the midgut is called Ledd's syndrome. The cause of bleeding in this pathology is intestinal infarction due to impaired blood supply during volvulus of the middle intestine.

Ulcerative necrotic enterocolitis of newborns. At stressful conditions there is a redistribution of blood, an increase in its volume in the vital important organs and a decrease in other organs, in particular the intestines.

Macroscopically, bloating of the intestine is noted, the mucous membrane in early period the lesion looks sharply thickened, dark red in later stages, the mucous membrane becomes gray-dirty with single and multiple ulcerations.

Clinically, newborns show flatulence, regurgitation, vomiting, watery stools mixed with mucus, greenery and blood.

Doubling of the small intestine occurs more often than doubling other parts of the digestive tube. Duplications are located on the mesenteric border or lateral wall of the intestine

Clinical symptoms in duplication of the small intestine are due to compression of the lumen of the main tube, disruption of its blood supply and pathological changes in the wall of the adjacent intestine or duplication, inflammation of the peritoneum. One of the most frequent complications doubling of the small intestine serves as bleeding, which can be massive.

Mallory-Weiss syndrome- this is damage to the mucous membrane of the gastroesophageal junction due to increased vomiting, blunt trauma. This disease is rare in children, but can develop at any age. recurring severe vomiting leads to ruptures of the gastric mucosa and subsequent release of blood in the vomit.

hiatal hernia are of two types: esophageal, in which the esophagus moves upward along with the cardial part of the stomach, and paraesophageal, when the stomach shifts upward, but the esophagus remains fixed. symptoms are vomiting of blood Hemorrhagic syndrome characterized as "esophageal ring syndrome". The origin of bleeding is associated with the throwing of acidic gastric contents into the esophagus and the inflection of the stomach in the esophageal ring. As a rule, chemical and mechanical influences are combined with trauma to the nerve trunks, which leads to degenerative processes not only in the mucous membrane, but also in more deep tissues esophagus and stomach.

In the 1 to 3 year old group, the most common causes of gastrointestinal bleeding in children from upper divisions The gastrointestinal tract has peptic ulcers of the stomach and duodenum.

In this age group, ulcerative lesions of the stomach and duodenum clinical course different from ulcers in older children. They tend to be sharp and very hard. Their beginning is always acute. The ulcerative defect penetrates the muscle layer, affecting the integrity blood vessels, which leads to massive bleeding and perforation of the organ. Most peptic ulcers in children are associated with stress, especially traumatic. The literature describes ulcers that occur in children as a result of a burn injury (Curling's ulcer), craniocerebral injury (Cushing's ulcer).

The cause of gastrointestinal bleeding in children from the lower gastrointestinal tract aged 1 to 3 years is intestinal polyps. More than 90% of all cases of colon polyps in children are juvenile (hamartoma) polyps. Hamartoma polyps are nodular formations that arise due to a violation of the embryonic development of the tissues of the colon. The favorite localization of juvenile polyps is the rectum and sigmoid colon. The sizes of polyps range from a few millimeters to 3 cm. Their surface is covered with mucus, it bleeds easily when injured by dense fecal masses. Polyps can also ulcerate and lead to bleeding with hypochromic anemia. Severe complication is the twisting of the legs of the polyp, followed by its necrosis and bleeding. The generalized form of juvenile gastrointestinal polyps, characterized by diarrhea, bleeding, hypoproteinemia, and ascites in children under 2 years of age, is fatal in 100% of cases.

The cause of bleeding from varicose veins of the esophagus is their rupture due to hypertensive crisis in the portal system, pathological (erosive and ulcerative) changes in the mucous membrane of the stomach and esophagus or disorders of the blood coagulation system,

Clinical practice shows that the harbingers of bleeding are signs of a sharp deterioration in the condition: weakness increases, pallor of the skin and mucous membranes becomes noticeable, thirst, dry mouth, and icterus of the sclera appear. Tachycardia increases, pulse filling decreases, arterial pressure. Absolute symptom bleeding is the emerging vomiting of scarlet blood or "coffee grounds". Vomiting of scarlet blood indicates massive bleeding from the veins of the cardiac region. Vomiting reflex caused by rapid filling of the stomach. That is why the vomit contains unchanged blood.

A few hours later, tarry stools appear. With profuse gastrointestinal bleeding in children, stools in the form of "raspberry jelly" may appear within the next few minutes. It depends on the severity of the gag reflex and the rate of blood flow into the intestine.

Eosinophilic gastroenteropathy- a chronic relapsing disease in which eosinophils form large-cell inflammatory infiltrates in the gastrointestinal tract.

Clinical manifestations depend on the extent of eosinophilic infiltration (diffuse or local type) and the depth of organ damage (mucous, muscular or serous membranes). The entire digestive tract may be affected, but the stomach and small intestine are most commonly affected. Involvement of the pathological process of the mucous membrane of the stomach or small intestine is accompanied by bleeding. Eosinophilic infiltration of the muscle membrane can cause strictures hollow organ. The allergic nature of the disease is up to 70% of all cases, in particular, the role of food is considered, as well as high sensitivity to immunoglobulin E).

Clinical symptoms of eosinophilic gastroenteropathy may include vomiting, abdominal pain, growth retardation, frequent liquid stool with an admixture of blood, anemia and hypoproteinemia.

Gastrointestinal bleeding in children with Peutz-Jeghers syndrome occurs in 19% of patients aged 10-15 years. (intestinal polyposis) is a congenital hereditary disease that is characterized by multiple polyps in the small (sometimes in the large) intestine and small-spotted brown pigmentation of the mucous membrane of the mouth, skin, lips, eyelids. Polyps are regarded as hamartomas of the intestinal wall containing all elements of the intestinal mucosa. The cause of bleeding is the torsion of polyps with the development of heart attacks, ulceration of the intestinal mucosa.

The colon is characterized by the growth of the mucous membrane of the colon with the formation of multiple adenomatous polyps with a stalk. Some patients have lymphoid hyperplasia small intestine follicles and colonic lymphoid polyps. 5% of untreated children develop adenocarcinoma by age 5

Gardner syndrome is a type of familial adenomatous polyposis of the colon in combination with subcutaneous tumors, epidermoid and sebaceous cysts, bone tumors of the jaws and bones of the skull.

The cause of bleeding in children from the lower digestive tract may be Tarcot's syndrome - a variant of familial adenomatous polyposis of the colon and a malignant tumor of the central nervous system - medulloblastoma. It is a tumor of undifferentiated neuroectodermal embryonic stem cells that have a double potency of differentiation towards neural and glial elements,

non-specific- a disease of the colon, which is based on inflammation of the intestine with suppuration, ulceration and sclerotic scarring. Children make up about 10% of the total number of patients and 5% of patients under 10 years of age.

The clinical picture of ulcerative colitis is manifested by increased stools, which are bloody-mucous in nature, cramping pains in the abdomen, periodic increase body temperature, loss of appetite. Characteristic signs are general weakness, anemia, exhaustion, delayed physical development.

Macroscopically, the mucous membrane of the large intestine is plethoric, edematous, with multiple superficial and deeper ulcers, merging with each other and forming extensive ulcerative fields. Between the ulcers are pseudopolyps - areas of preserved edematous mucosa.

Malformations of the gastrointestinal tract are rare causes of gastrointestinal bleeding in children. However, they must be taken into account when differential diagnosis diseases that cause bleeding. In accordance with existing classification two groups of vascular pathologies of the gastrointestinal tract are considered: and vascular malformations.

Hemangiomas are vascular tumors characterized by rapid growth, endothelial hyperplasia, an increased number of mast cells, and are considered as vascular malformations that do not undergo reverse development.

Vascular malformations usually appear from the moment the child is born and grow in proportion to his growth. Morphologically, they are characterized by the presence of embryonic rudiments of capillary, arterial, venous and lymphatic vessels. All congenital vascular malformations can be divided into venous, arteriovenous malformations, aneurysms and lymphatic malformations.

Venous malformations of the gastrointestinal tract can be presented in the form of phlebectasia. Clinically, they are manifested by acute or chronic bleeding, most often from the small intestine. Venous malformations in the rectum can be manifested by the outflow of fresh blood.

Arteriovenous malformations - pathological communications between arteries and veins, can be a source of acute or chronic bleeding from the intestine. Multiple lesions of the intestine with arteriovenous malformations are combined with Rendu-Osler-Weber syndrome,

Gastrointestinal aneurysms, as a rule, occur in Menkes syndrome, which is characterized by weakness of the vascular wall due to impaired copper absorption processes. Up to 25% of vascular malformations of the gastrointestinal tract occur in children of the first year of life and are manifested by the clinical picture of acute or chronic gastrointestinal bleeding.

Diagnosis of gastrointestinal bleeding in children

In the process of diagnosis given state you need to answer the following questions.

Is this really bleeding and does it come from the gastrointestinal tract? Gastrointestinal bleeding in children, as a rule, is acute and is characterized by vomiting with an admixture of blood or its release through the rectum. However, when the bleeding is less pronounced or chronic, the diagnosis is difficult, it must be remembered that some foods and drugs can simulate intestinal bleeding.

How much blood is shed with bleeding, and what color is the vomit or intestinal discharge characterized by? Vomiting of fresh red blood or "coffee grounds" is usually associated with a source of bleeding from the proximal GI tract to the ligament of Treitz. Melena is a sign of significant upper GI bleeding in children. Dark blood in the stool usually indicates a source of bleeding located in the ileum or colon. Blood streaks on the outside of the stool indicate damage to the anal canal or rectum.

Is the child's bleeding acute or chronic? When examining children with gastrointestinal bleeding, Special attention for signs of anemia or shock. Children can often adapt well to blood loss, so there are often no signs of organ or circulatory dysfunction. If the bleeding is slow, then even with a loss of 15% of the total circulating blood, there may be no pronounced hemodynamic disturbances.

Clinical examination should look for signs portal hypertension, hemorrhagic rash, bruising, telangiectasia, pigmentation of the mucous membranes of the lips (Peutz-Jeghers syndrome), soft tissue or bone tumors (Gardner's syndrome). The anus should be examined for cracks.

Is the present gastrointestinal bleeding ongoing? The physiological reactions of the body depend on the amount of blood loss and its speed. That is why monitoring of pulse, blood pressure, respiratory function are mandatory for all children with this condition.

Laboratory diagnostics

Includes a study of the concentration of hemoglobin, erythrocytes, hematocrit. It is necessary to perform simple biochemical blood tests to study the function of the liver and kidneys. For example, a normal creatinine level in the presence of a high level of urea nitrogen indicates an accumulation of blood in the small intestine.

Nasogastric intubation is an important diagnostic tool for upper GI bleeding in children.

Allows you to identify the source of bleeding from the upper gastrointestinal tract in 90% of children in the first 2 hours from the onset of bleeding. It is especially helpful in diagnosing esophagitis, gastritis, stress ulcers, Mallory-Weiss syndrome, which are a possible cause of bleeding.

Helps to diagnose the source of bleeding from the lower intestines in 80% of cases Colonoscopy is a highly effective method for diagnosing conditions such as juvenile, adenomatous and hamartoma polyps, vascular malformations of the colon, rectal varicose veins, hyperplasia of lymphoid nodes, chronic, Gardner's syndrome, adenocarcinoma.

The article was prepared and edited by: surgeon

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

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 outflow of brown (dark red) blood (venous blood has a low oxygen content and a high carbon dioxide content).

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. By signs, bleeding is similar to capillary bleeding, but much more dangerous, since the blood vessels in these organs do not collapse.

Depending on the site of injury, bleeding is divided into internal(hemorrhage occurs in the cavity, tissues, organs) and outdoor(blood leaks out of a damaged vessel). With internal bleeding, blood can flow into the abdominal and chest cavities, the joint cavity, the pericardial sac, etc.). Bleeding may also occur from different cavities: nasal cavity, lungs, stomach, female genital organs, urinary tract, anus. There are also hidden bleeding, which are detected using laboratory tests.

Children often experience spontaneous nosebleeds in various infectious diseases (influenza, acute respiratory infections, 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 tolerate, since the compensatory capabilities of the body are not sufficiently developed in children. For example, for a 1-year-old child, a blood loss of 200 ml is serious danger. And the rapid loss of 1/3 of the total amount of circulating blood is a mortal danger for the child.

In most cases, the cause of death from 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 nutrients in the myocardium (heart muscle) and brain.

First aid for bleeding

In the event of bleeding, it is very important to take all necessary measures to temporarily stop it until the patient is provided with qualified health care. Such measures are in the nature of emergency assistance, which must be provided on the spot.

To temporarily stop bleeding, you can use different methods:

- compression of the site of bleeding pressure bandage: a sterile gauze (previously folded several times) is applied to the bleeding site, on which a layer of cotton wool is placed and tightly fixed with a circular bandage (instead of a sterile material, you can use a clean piece of cloth);

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

- finger pressing of the main (main) arterial trunks directly to a nearby bone (for example, the 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 pressing in places of the main arterial trunks

Compression of the abdominal aorta

- maximum bending 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 dragging with a tourniquet of the damaged limb above the site of bleeding (for example, Esmarch's tourniquet or twist). Esmarch's tourniquet is applied over clothing (or some piece of cloth) so as not to damage the skin, before applying the tourniquet, you need to stretch it, make 2-3 turns around the damaged limb, squeezing with some force soft tissues. Then the ends of the bundle are fixed 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 tourniquet application bleeding stops and the peripheral pulse disappears on the injured limb. Immediately after applying the tourniquet, it is necessary to make a record, which indicates 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 delivered to a medical facility, the tourniquet is loosened for a while;

Esmarch's tourniquet

- tamponade consists in introducing a sterile tampon into the wound cavity (a long sterile gauze bandage), thus filling the entire cavity of the wound, a regular cotton-gauze bandage is applied over it.

Internal bleeding is an acute life-threatening condition in which, through a rupture of the vessel wall, blood flows out of the bloodstream either into the lumen of a hollow organ (uterus, stomach, lungs) or into a cavity artificially created by the amount of leaked blood (for example, intermuscular space). Such bleeding is never a separate 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, can be fatal. Bleeding with less blood loss (less than 1.5 liters) is still very serious. Spilled blood can compress nearby vessels, disrupt the functioning of internal organs, exit through the mouth, for example, with gastric bleeding, and be accompanied by other serious manifestations.

Internal bleeding is called due to the fact that the outflowing 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 the physiological openings - the mouth, anus, vagina - it is advisable to refer to them as internal.

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

The elimination of uterine bleeding is handled by a gynecologist, intestinal - by a proctologist, pulmonary - by a thoracic surgeon, post-traumatic - by a traumatologist, intracranial - by a neurosurgeon.

Untimely provision of medical care when a person turns to 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 sheets of the pleura, i.e., in the slit-like space between the special membranes surrounding each lung

Hemarthrosis - in the joint

Cavitary - into the cavity of the peritoneum, pleura

Explicit - easily determined by visual inspection

Arrosive - in case of damage to the vascular wall due to germination or decay of the neoplasm, destructive or necrotic process (with tissue death)

Diapedetic - with leakage of blood through the vascular wall with scurvy, scarlet fever, malaria

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

Massive - up to 2.5 liters

Lethal - from 2.5 to 3 liters

Absolutely fatal - over 3-3.5 liters

Venous - with a rupture of the vein wall

Arterial - from an artery

Mixed - from different vessels

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

Secondary - after a while 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.

1. Open and closed injuries of the abdomen and lumbar region with damage or rupture of internal organs, more often the spleen or liver, less often the intestines and pancreas. Massive bleeding into the abdominal cavity causes a blow during a fight or during a car accident, compression pressure- when pressed down with a heavy object, etc.
2. Fracture of the ribs leads to the outflow of blood into the pleural cavity.
3. Traumatic brain injury. Bleeding inside the skull is life-threatening, because the volume of the cranium is limited. Any hematoma leads to compression of brain structures and serious consequences. It can develop not only immediately after the injury, but also after a few hours or days after it.
4. 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, formation of a through hole with a duodenal or stomach ulcer.
5. Gynecological diseases and pathological conditions - ovarian apoplexy (rupture), ectopic pregnancy, malignant neoplasm, ovarian cyst rupture. In obstetrics and gynecology, uterine bleeding can provoke an abortion, presentation or premature detachment of the placenta. It can begin after childbirth due to rupture of the birth canal or uterus, late release placenta.
6. Ruptured aortic aneurysm.
7. Hemophilia is a hereditary disease of men with a failure of the blood clotting process.

Symptoms

Symptoms depend on the amount of blood loss and its location. There are common signs and characteristic of a particular species.

Common symptoms of blood loss

General - the appearance of weakness, darkening or clouding in the eyes, drowsiness, dizziness, cold sweat, thirst. Loss of consciousness is not ruled out. The intensity of blood loss is determined by the pulse rate, blood pressure and characteristic complaints of the patient.

• Small blood loss often does not manifest itself in any way, but in some people the pulse slightly quickens, blood pressure (BP) slightly decreases.
• Manifestations of bleeding of moderate severity: heart rate up to 100 beats per minute, a decrease in systolic pressure to 80 mm Hg. Art., moderate shortness of breath, dry mouth, cold hands and feet, cold perspiration, dizziness, severe weakness, slow reactions, fainting.
• With severe blood loss, the symptoms are more pronounced. Note the fall in blood pressure more than 80 mm Hg. Art., tachycardia more than 110 beats per minute, shortness of breath, hand trembling, excruciating thirst against the background of a decrease in urine output, apathy. There may also be a sharp blanching of the mucous membranes and skin, cyanosis of the extremities and the area around the lips, clouding or loss of consciousness.
• Among the clinical manifestations of massive hemorrhage, cyanosis of the skin and mucous membranes, confusion, and delirium are observed. sink inside eyeballs, facial features are sharpened, the pulse reaches 160 beats per minute, blood pressure drops to 60 mm Hg. Art.
• With fatal and absolutely fatal blood loss, we are already talking 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 excreted. The patient falls into a coma, his skin is dry, pale and marbled. 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 a sharp pain in the problem area, difficulty in breathing, cough with foamy bloody sputum. On x-ray, the mediastinum (the space in the middle part of the chest cavity) is displaced towards the healthy lung.

Signs of uterine bleeding

Symptoms of internal bleeding in women may be pulling, bursting or sharp pains in the 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

• A tar-colored stool with a fetid odor - melena - indicates bleeding from the upper intestine or other digestive organs.
• With a hemorrhage in the stomach, a person begins vomiting with blood clots, in the lumen of the duodenum 12 - it becomes the color of coffee grounds.
• Bleeding out hemorrhoids manifested by bright bloody discharge from the anus.
• Blood entering the kidney area urinary tract, comes out with urine - hematuria.

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

The life of a person often depends on the correctness of the provision of first aid. Before the arrival of doctors, you need to put the patient, further actions should be carried out only after he has taken a horizontal position, and with hemothorax, a semi-sitting position. On the area of ​​​​the alleged source of the problem, focusing on complaints, put ice. Then, as soon 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, to apply pressure bandage, insert candles, use a laxative, do an enema (for intestinal bleeding), offer painkillers and medicines that stimulate the heart.

Neglect of the above actions can lead to increased blood loss and death.

Stationary medical care

Based on symptoms and primary medical examination, presumably find out which organ was damaged, and the patient is hospitalized in the appropriate department. In the presence of objective symptoms of a large loss of blood - in intensive care.

The main goals of treatment:

1. Stop bleeding.
2. Restoration of the lost volume of blood constantly circulating in the body (BCC).
3. Normalization of microcirculation.

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

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

To replenish the BCC, 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.

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What are the symptoms of internal bleeding?

Internal bleeding is a situation in which heme is poured into the body cavity, as well as into the spaces between organs and tissues. Most diseases are manifested by pain syndrome. 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 done to the health, which poses a great threat to the life of the sick person.

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 is received, when the liver or spleen, intestines or omentum are damaged.

With fractures of the ribs with injury to the pleura and blood vessels, pleural blood loss is manifested.

Cranio-cerebral injuries make internal bleeding of the skull probable.

Blood in the pleural cavity

Important! Blood with penetration into 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 perforation of the intestine, gastra, gulam vein dilatation, 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 pallor of the skin,
• apathy,
• lowering blood pressure,
• tachycardia.

Important! Internal bleeding threatens the possibility of developing a pre-shock state. His harbingers consider a strong thirst, weakness, a state of anxiety. The skin turns pale, cold, the pulse becomes frequent and thready, breathing is shallow and uneven.

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

Signs of internal bleeding in the abdomen:

• bloating. It becomes painful, hard;
• blood in faeces.

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

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

Isolation of scarlet heme from the anus indicates hemorrhoidal inflammation.

Possible bloating with abdominal bleeding

Types and signs of internal bleeding are presented in the table:

Bleeding into the abdominal cavity caused by ruptured organs

2. Specific: a sign of "Vanka-vstanka". If a person lies, pain in the shoulder appears, 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 in the lower abdomen.

2. Specific: pain on palpation in the area of ​​the pubic bones, with serious condition Sign of "Roly-Vstanki"

Bleeding into the retroperitoneal space

with ruptures of the kidneys and abdominal aorta

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

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

Bleeding in gastr and duodenum

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

2. Specific: vomiting with heme or "coffee sediment", brown; bloody diarrhea, the color of feces is black or dark cherry; no pain.

Diagnostic studies

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

• Detailed inspection. They check the pulse, pressure, listen to the chest, feel and tap the abdominal cavity.
• Hematological research.

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

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

With hidden hemorrhages, pay attention to general syndrome internal bleeding: dizziness, weakness, hypotension, tachycardia, coldness and pallor of the skin.

Important! An objective sign of blood entering the lung is the disappearance lower bound organ on 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 the fastest delivery of the patient to the clinic. The first aid is to provide rest.

Assuming the presence pulmonary hemorrhage, the patient is provided with a semi-sitting position. When internal bleeding occurs in other places, until the arrival of emergency care, the patient should be laid on a leveled surface, apply cold to the place possible bleeding. You can not apply heat and give medicines to support the heart.

Methods for stopping blood

Patients are admitted to the hospital. The department is selected according to the source of bleeding: traumatological, thoracic, neurosurgical, gynecological or general surgery. The first concern in the first stage is how to stop the bleeding.

The video shows how to give first aid

In some cases, tamponade helps. In others - cauterization of a bleeding place. However, most often it is required surgery under anesthesia.

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

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

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

It will be useful for you to learn also 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, hourly diuresis. The number of administered infusion drugs is determined based on the amount of blood loss.

• Blood substitutes with hemodynamic properties are used: reopoliglyukin, stabizol or infuctol.
• Salt preparations: saline, 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. Apply if necessary antishock therapy. After the threat to life has passed, the balance of basic and acidic elements of the blood is corrected.

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 state and seek medical attention immediately. Frequent 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 externally

From the perspective of the average person, internal bleeding describes an outwardly imperceptible loss of blood. Medical specialists tend to clarify such a 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.

The loss of blood can be so imperceptible 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, so that a person can assess the severity of the injury.

Internal bleeding is much more dangerous, because the victim cannot assess the severity of his condition. That is why after the accident Ambulance delivers even seemingly unharmed people to the hospital for diagnosis.

By itself, internal bleeding is associated with damage to an artery or vein. Blood from 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 trauma, but also with a chronic disease. Most often, this type of blood loss occurs in the gastrointestinal tract. A person can gradually and permanently lose blood due to chronic ulcer stomach or intestines, polyps, inflammatory pathologies of the large intestine.

Patients taking blood thinners or anticoagulants are more prone to internal bleeding. The same applies to patients suffering from pathologies of the blood coagulation system.

The main causes of the condition

Signs of internal bleeding

Sometimes it is easy to determine the cause and source of bleeding. An accident injury or any other past trauma may have characteristic features that indicate the nature of internal bleeding.

Also, the diagnosis of blood loss is not difficult if the doctor is aware of various pathologies of the organs 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 that deposits blood. Vessels can be of different caliber, which affects the severity of bleeding.

Damage main arteries leads to the death of a person as soon as possible, and capillary rupture can lead to loss of a small amount of blood.

The main non-traumatic causes of bleeding:

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

Causes associated with critical blood loss:

1. Injury. Car accidents, falls from heights, fights, and other situations can damage organs and their associated blood vessels.
2. Fracture of bones. A closed fracture of large bones can lead to damage to the arteries.
3. Ectopic pregnancy. This condition can cause massive blood loss.
4. Surgical intervention. Volumetric bleeding is often a consequence of the actions of the surgeon.

There are also private causes of internal bleeding.

Signs of internal bleeding

When bleeding, cold is shown

Symptoms and manifestations of internal bleeding depend on the source and duration of blood loss. Also an important factor determining the signs of the condition is the area of ​​damage.

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

It must also be understood 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 hands and feet.
• Severe sudden headache.
• Difficulty swallowing and chewing.
• Deterioration of vision and hearing.
• Loss of coordination and balance.
• Confused speech.

Internal bleeding resulting from an injury or a ruptured aneurysm will first of all be manifested by an acute pain symptom.

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

A neurological examination of a patient with this bleeding may reveal conditions ranging from mild confusion to coma. A stroke associated with the release of blood into the brain will be manifested by more severe mental and neurological symptoms.

Intra-abdominal bleeding is often almost asymptomatic. Pain in this condition may be unexpressed. Patients with this type of internal bleeding often complain of weakness, confusion, difficulty breathing, and dizziness.

Signs of bleeding in the chest or abdomen:

Pain in the joints and muscles, difficulty in 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 situation organism, caused by an acute violation of the functions of the cardiovascular system.

Shock can cause conditions of varying severity - from a 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 bleeding. For example, anemia is usually associated with slow, chronic bleeding in the digestive organs. This condition may cause constant weakness, fatigue and shortness of breath.

Diagnosis and treatment of internal bleeding

Internal bleeding is not always accompanied by pain

Certain diagnostic procedures are usually required to detect internal bleeding, including a 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 by various scans. The main instrumental diagnostic methods:

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

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

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

The video will acquaint you with the symptoms and signs of gastric bleeding:

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Krasnoyarsk medical portal Krasgmu.net

Internal latent 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 to the outside.

Exist specific symptoms internal bleeding, knowledge of which can help in the timely diagnosis of this complex problem.

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

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

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

AT modern surgery special attention is paid to internal bleeding. This is due to the fact that internal bleeding compared to open bleeding is much harder to diagnose. This means that the medical assistance provided may be belated. Internal bleeding is called bleeding, characterized by an outpouring of blood into the natural cavities of the body or artificially created spaces.

Depending on the amount of blood shed, three degrees of bleeding are distinguished: 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 of the liver, spleen, intestines, complications of diseases of such organs as the esophagus (with varicose veins), stomach and duodenum, liver, female genitalia.

The 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 be revealed only after some time:

• Blue skin (hematoma formation in the area of ​​injury)
• Soft tissues are painful, swollen, or hard to the touch
• Feelings of agitation or anxiety in the victim
• Fast, weak pulse, rapid breathing, nausea or vomiting, decreased level of consciousness
• Pale skin that is cool or damp to the touch
• Feeling of unquenchable thirst
• Bleeding from natural body openings (nose, mouth, etc.)

First aid for internal bleeding:

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

Frequency of internal bleeding

Most often, bleeding occurs with damage to the organs of the gastrointestinal tract. Therefore, it is worth getting acquainted with the methods of emergency treatment of gastrointestinal bleeding. In total, about 20 diseases are distinguished, the most significant and common among which are: acute erosive gastritis and stomach cancer, esophageal varicose veins, cirrhotic liver disease. In the case of stomach cancer, the danger is a decaying tumor. The only sign that allows the patient to suspect something is wrong is the darkening of the feces, which occurs due to the coagulated blood contained in it. If vomiting occurs, then the vomited masses, again due to clotted 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, stomach from bleeding with a damaged lung. In the case of lung pathology, foamy, unaltered scarlet blood is released.

Diseases of the female reproductive system can also cause internal bleeding. The most common cause is a tubal abortion. When the 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 the anus is also quite common. In the future, irritation of the peritoneum with blood occurs, which leads to the development of a state of shock, loss of consciousness, and fainting. The pulse in this case becomes frequent and thready. On examination, abdominal distention, stool and gas retention are detected. The patient becomes pale, covered with a cold sweat.

Symptoms of a hemothorax (blood in the chest)

How to identify and recognize internal bleeding in the chest? In the case of accumulation of blood in the pleural cavity, the so-called hemothorax develops. The pleural cavity is a small space that separates the lungs from 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, stab wounds, lung cancer, lung abscesses (that is, the formation of abscesses in the lung tissue).

With the accumulation of blood in the pleural cavity, there is difficulty breathing when inhaling and coughing, sharp pains in the chest, a violation of 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 above the affected half, weakening or complete absence of breathing. On the radiograph, it is possible to determine signs of mediastinal displacement towards a healthy lung.

Hemarthrosis (blood in the joint cavity)

Frequent damage to the joints is the development of hemarthrosis, which means the accumulation of blood in the joint cavity. There is a similar condition as a result of trauma, less often with hemophilia, scurvy. The anemic symptom is expressed slightly in contrast to the local symptoms. The clinic distinguishes three degrees. With hemarthrosis of the 1st degree, mild pain is noted, 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 a pronounced pain syndrome, which increases with stress, smoothness of the joint is noted. There is an increase in the circumference of the affected joint by 1.5 - 3 cm compared to the healthy one. In the case of hemarthrosis of the knee joint, balloting 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. In circumference, the joint increases to 5 cm, mobility is sharply limited. The volume of blood is more than 100 ml.

General symptoms

Thus, there are signs of bleeding that occur in any case, regardless of the source of bleeding. Early signs include: pale skin and visible mucous membranes, cold sweat, general weakness, dizziness, darkening in the eyes, with damage to the lungs - a cough with streaks of blood, with the involvement of the digestive system in the process - hematemesis or bloody diarrhea, symptoms of peritoneal irritation that occurs when internal organs (spleen, liver, kidney) are ruptured. 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 these 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 blood loss, the pulse is not more than 75 beats per minute, systolic pressure drops to 100 mm Hg. Art.; with an average - the pulse rises to 100 beats per minute, blood pressure decreases by damm Hg. Art.; in severe cases, the pulse rises to beats per minute, systolic blood pressure drops below 80 mm Hg. Art.

Diagnostics

With a combined injury, laparocentesis is performed, it is a simple, fast, affordable and sparing method for diagnosing damage to the abdominal organs and internal bleeding. Also sometimes produce ultrasound of the abdominal cavity.

An important point in confirming the diagnosis is the conduct of 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 faster the recovery process will be.

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

How to identify internal bleeding

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

Types of internal bleeding and their manifestation

Significant internal loss blood occurs for two reasons:

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

No matter how much blood is shed, the body tends to push it out. It comes out along with feces, the contents of the stomach, from the internal genital organs in women, is expectorated with sputum from the bronchi and lungs. However, do not think that the bleeding will stop on its own, the wound will heal by itself. 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, the problem can be recognized by vomiting with an admixture of bloody clots of a dark, almost black color. Another feature internal bleeding into the digestive organs - stool, resembling tar in color and consistency. It can appear in 1–2 and even 9–10 hours after the onset of blood loss.

craniocerebral

Otherwise, this kind of internal bleeding is called a stroke. In such a situation, the fluid does not find a way out and accumulates in the cranium. Only blood clots can be removed surgically. The danger of blood clots in the brain cannot be underestimated: they can cause complete or partial paralysis, disruption of the organs for which the affected area is responsible, and even death. In addition to a severe head injury, a stroke often leads to:

• high blood pressure;
• diabetes;
• brain tumors;
• vascular aneurysms;
• encephalitis.

Pelvis

This is about uterine bleeding. It can occur in women for various reasons. Changes in the hormonal background, tumors, ectopic pregnancy, miscarriage, placental abruption during childbearing, rupture of the uterus or ovaries - all these factors hidden from human eyes provoke internal bleeding. They can open after the end of menstruation or during it. One of the signs of internal bleeding - blood comes out profusely in the form big clots dark color. Accompanied process aching pains in the lower abdomen.

In the abdominal cavity

Powerful 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, in order to relieve it a little, is forced to sit with his knees pulled up to his chest. Most often, doctors are faced with external mechanical damage:

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

In the organs of the respiratory system

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

• the pulse rate noticeably decreases with heart injuries and increases if the lungs are affected;
• difficulty breathing, lack of oxygen if blood has filled the pleural cavity;
• there are pains in the chest 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 experts, there are numerous common symptoms of internal bleeding, regardless of which particular organ or part of the body is affected. These signs include:

• severe dizziness;
• inability to practice daily 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, a person falls into a coma.

By some signs it is possible to judge which vessels are damaged. Capillary bleeding is very weak and does not pose a particular danger to life. Parenchymal, in which all channels are involved, is very long and abundant. Arterial is characterized by the ejection of blood of a bright red color, and it pours out jerkily. The main signs of venous bleeding are unhurried uniform outflow of blood of a dark color.

First aid for internal bleeding

It is difficult to determine the source of internal bleeding without a doctor's examination. However, if the sufferer is left without help at all, the situation can noticeably worsen. Several simple actions will help to alleviate the condition of the victim and give him a chance for a successful outcome:

• try to provide the victim with peace and the greatest possible comfort;
• if by some indication you can assume that internal hemorrhage occurred in the upper body, arrange the person reclining. Otherwise, lay on your back;
• make sure that the victim moves as little as possible;
• put something cold on it (a bag of frozen food, cold water, ice cubes) to the place where you think internal bleeding occurs;
• you should not give the sufferer any medicines, drinks other than water, carry out any procedures. What is necessary in each case, can only be determined by a specialist;
• make sure the doctor arrives as soon as possible.

After watching the video below, you will learn how to properly help a person suffering from internal bleeding in the street. A professional doctor tells how competently, armed with the usual improvised items, to alleviate the patient's pain before the appearance of an ambulance doctor. You will learn about the first symptoms of internal bleeding, which will give you a signal to act, because you should never leave such a problem 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 individual features specific patient.

The health of children plays an extremely important role, so parents need to be especially attentive to the well-being of their babies and pay attention to the development various violations well-being. Doctors say that it is better to be overly vigilant than to ignore various alarming signals from the body. One of the frightening conditions that pediatricians and gastroenterologists face is bleeding from the digestive tract in children.

Such bleeding in children can be different reason occurrence, and in any case are a rather alarming symptom. The main unifying sign of such conditions is the appearance of bloody vomiting or bloody stools, such symptoms can be combined. If the bleeding is unexpressed, and the blood in the stomach is for a relatively long time, the vomit becomes like coffee grounds. And with heavy bleeding, scarlet blood is visible in them. After about eight to ten hours, or when blood is swallowed, tarry stools are found. If bleeding occurs from the lower parts of the intestine, then little changed (scarlet) blood is visible in the child's stool.

The type of bleeding from the digestive tract and their causes are largely determined by the age of the children.

At the age of three to seven years, bleeding is most often provoked by polyposis of the large intestine. And in children older than seven years, they find varicose veins, esophagus or stomach, as well as ulcerative lesions of the stomach or duodenum, erosive and allergic form of gastritis.

In addition, gastrointestinal bleeding in children can occur with many blood ailments, represented by hemophilia, hemorrhagic vasculitis, Wergolf's disease, leukemia, aplastic anemia, etc.

Dangerous symptoms bleeding

The classic manifestation of bleeding from the digestive tract in children, as we already wrote on this page "Popular about health", is bloody vomiting or bloody stool. If the bleeding is profuse, it is accompanied by thirst, drying of the mucous membranes of the oral cavity, rapid progression of weakness and dizziness. Loss of consciousness is also possible. The skin is painted in pale tones, cold sweat appears on it, the limbs become cold. Patients may become agitated or prostrated, and their facial features sharpen rather quickly. Sometimes there is yawning, nausea and repeated vomiting.

Pathological processes lead to increased heart rate, but it has a weak filling. The pulse eventually becomes thready, breathing becomes more frequent, and the pressure drops.

The appearance of the described symptoms is a reason for immediate and for hospitalization in the inpatient department. Small patients with bleeding from the digestive tract are usually sent to the department of surgery.

Treatment of bleeding

Transportation of patients with bleeding should be carried out with special care. The child is placed on his back and upper half stomach have an ice pack. With severe bleeding, blood transfusion is carried out, intravenous infusions of solutions and are also carried out. At the same time, the introduction vitamin preparations- vitamins K, PP and C.

If bleeding continues, doctors raise the question of the need for surgery to find the source of bleeding and eliminate it.

On the first day after the bleeding stops, children should not be fed. They are shown intravenous administration of glucose in combination with saline. The next day, doctors prescribe the Meilengracht diet, which consists of well-mashed vegetable purees (they are mixed with pureed meat or fish), cooled milk, eggs, and cream.

Of course, in parallel, doctors carry out active treatment of the underlying disease.

Uncomplicated bleeding from the lower parts of the digestive tract (with anal fissures or hemorrhoids) can be successfully treated at home - after a full examination, selection correct therapy and diet food.

Surgical treatment bleeding from the digestive tract in children

Sometimes it is possible to cope with bleeding or prevent its recurrence only with the help of surgical intervention. It can be open, or involve a series of minimally invasive procedures. Just the latter include methods for the treatment of bleeding caused by gastritis and ulcerative lesions of the digestive tract. In such situations, the doctor may decide to perform an endoscopic intervention - for cauterization or chipping of the affected areas. But such measures do not always give stable results. positive effect, in this case, you can not do without an open operation to suture the problem area.

Also surgery it is also carried out if bleeding has developed due to diverticulosis and some other pathologies.

It is worth noting that the appearance of any pronounced bleeding from the digestive tract in a child is a reason to immediately call an ambulance.

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 general symptoms of bleeding, regardless of the site of bleeding.

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

4. Methods of examination of children with gastrointestinal tract.

5. Additional Methods examinations of children with gastrointestinal tract.

2. Determining the objectives of the lesson

The student should 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. ZhKK clinic. 5. Diagnosis and differential diagnosis of gastrointestinal tract. 6. Additional examination methods for gastrointestinal tract. 7. First aid for gastrointestinal bleeding. 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 a plan for emergency care and treatment. 5. Draw up a program for examining a child with gastrointestinal tract. 6. Estimate the volume and diagnostic value 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 childhood. v.t.1,2 ed. Yu.F. Isakova Moscow ed. house "GOETAR-Med" 2004. 5. I. Andreev, I. Voptarov, H. Mikhov, A. Angelov. Differential diagnosis of the most important symptoms of childhood diseases. Med and Fizk Sofia 1981.

3. Tasks for independent work

1. Specify the main symptoms of gastrointestinal bleeding.

general weakness, dizziness, noise and ringing in the ears, darkening in the eyes, shortness of breath, pain in the heart, tachycardia, pallor, excessive sweating, cold extremities, drowsiness, confused consciousness, pulse of weak filling and tension, low blood pressure, pallor of the skin and mucous membranes,
fatigue, dizziness, glossitis, stomatitis, anemia, melena is possible, the absence of vomiting with blood or "coffee grounds" is characteristic.

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

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

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

The secreted blood is dark red in color, but in some cases it may appear as melena. Intussusception usually develops in infants but occasionally occurs at any age. The child has cramping pains in the abdomen, accompanied by stretching of the legs, a high-pitched cry, and the release of stools consisting of blood and mucus ("redcurrant jelly").

4. Symptoms of bleeding from the colon?

Diverticular disease is complicated by bleeding, causing massive colonic. Cause 70-90% of bleeding from right half colon are diverticula, in 70% of these bleedings stop spontaneously. It is believed that diverticular bleeding is the result of rupture of 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. Diverticular bleeding is not characterized by abdominal pain. Massive bleeding in diverticulosis of the colon in 10-20% of cases ends in death.

5. Depending on the level of bleeding, what are the main research methods to be carried out?

Bleeding from the upper GI tract

well-recorded 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 had previous surgery for peptic ulcer or portal hypertension? Does he have other medical conditions that could lead to bleeding, such as cirrhosis of the liver or coagulopathy? Does the patient abuse alcohol, regularly take aspirin or NSAIDs? Does he have nosebleeds? It is desirable to get an answer to these questions if the patient is conscious and sufficiently contact, for example, is not in a state of intoxication. Examination of the skin and visible mucous membranes reveals stigmata of liver cirrhosis, hereditary vascular anomalies, signs of capillary toxicosis, and paraneoplastic manifestations. Palpation of the abdomen may reveal tenderness ( peptic ulcer), splenomegaly (cirrhosis of the liver or thrombosis of the splenic vein), tumor of the stomach. Intraperitoneal bleeding (for example, with a disturbed ectopic pregnancy) is sometimes manifested by signs of acute anemia similar to GCC. The presence of symptoms of peritoneal irritation, characteristic of bleeding into the abdominal cavity, can help in the differential diagnosis of these conditions. If auscultation of the abdomen reveals increased peristalsis, there is reason to assume that it is caused by blood that has entered the intestine from the upper gastrointestinal tract. Most important information gives esophagogastroduodenoscopy (EGDS); it allows not only to establish with a high degree of accuracy the localization 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 with 99 Tc colloidal sulfur or albumin) and angiography are very important in some situations, but they are of little practical importance, since they can rarely be performed for emergency reasons.

Bleeding from the lower GI tract

In the presence of blood in the stool, it is important to find out whether the blood is mixed with feces (the source is located high) or is excreted in a relatively unchanged form at the end of a bowel movement, which is more typical for low-lying bleeding tumors and hemorrhoids. Palpation of the abdomen and digital examination anus are required in all patients. Digital rectal examination, according to statistics, can detect up to 30% of all tumors of the colon, including those complicated by bleeding. The next stage of diagnostics is anoscopy and rectosigmoscopy, the effectiveness of which in oncological diseases of the colon is 60%. In the presence of tarry stools, which may be the result of both gastroduodenal bleeding and bleeding from ileum and right colon, nasogastric aspiration through a tube and endoscopy are recommended to rule out pathology of the stomach and duodenum. Colonoscopy is the most informative method for diagnosing colonic pathology, however, with heavy bleeding it is quite difficult to perform. If the bleeding stops at least for a while, then with the help of this procedure a wide variety of pathologies, including vascular ones, can be diagnosed. Mesenteric arteriography in intestinal bleeding allows you to identify extravasation of the 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, arteriography can detect vascular pathology, which is the cause of bleeding. Scintigraphy with erythrocytes labeled with 99 Tc, or with platelets labeled with radioactive In, - more than sensitive method; the source of bleeding is detected even at a relatively low intensity, but scintigraphy takes a long time and therefore it can hardly be considered an emergency diagnostic method. Contrast methods of X-ray examination (irrigoscopy and irrigography) are not able to identify the source of bleeding, but can help in the diagnosis of 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 the coagulation properties of blood (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 abdomen - by special indications

Medications are not alternative treatments acute bleeding if surgery is indicated, but they can help stop bleeding and prevent its recurrence. The effectiveness of drug treatment is determined by many circumstances, but regardless of them, the appointment of ranitidine (Zantac), omeprazole (Losek) or famotidine (Kvamatel) is justified. One of them is administered intravenously (Zantac 50 mg, Kvamatel 20 mg, Losek 40 mg) for 2-5 minutes 3 times a day at intervals of 8 hours to 3 days. This reduces the risk of stress ulcers and rebleeding, but does not stop ongoing bleeding. After stopping the intravenous 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 the veins of the esophagus with their varicose expansion.

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

3. Laser photocoagulation.

4. Diathermocoagulation.

Due to insufficient 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 have been confirmed. Somatostatin (Sandostin) inhibits the secretion of gastric and pancreatic juice, reduces blood flow in the organs - abdominal cavity which helps to stop ulcer bleeding and bleeding from dilated veins of the esophagus. It is administered intravenously at a dose of 250 mcg / hour until the onset of affect. In hemorrhagic gastritis, omeprazole is prescribed twice a day at 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 injected intramuscularly daily at 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, 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

in) peptic ulcer stomach or duodenum

d) Meckel's diverticulitis

e) nonspecific ulcerative colitis

B) A 12-year-old child has a clinic of gastrointestinal bleeding, melena. It is advisable to start the survey:

a) from a contrast study of the stomach and duodenum 12

b) gastroduodenoscopy

c) laparoscopy

d) laparotomy and revision abdominal wall

e) colonoscopy.

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

Chronic bleeding from the digestive tract in children occurs when:

non-spice ulcerative colitis, Meckel's diverticulum, intestinal angimatosis, rectal polyp, intestinal polyposis

9. Compose 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 vomiting, resembling coffee grounds. Today was tarry stool.

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

preliminary diagnosis. Treatment tactics.

Ulcer of the duodenal bulb 12. The following drugs are used for treatment: Omez, De Nol, third-generation antibiotics

10. Make a clinical task: the child has scarlet blood in the stool.

A district pediatrician examines a 6-year-old child with complaints of a tendency to constipation during last year and the allocation of scarlet blood at the end of the act of defecation in the last 2 days.

preliminary diagnosis. Tactics of examination and treatment.