How to recognize
Signs depend on the level and rate of blood loss. Vomiting scarlet blood indicates active bleeding from the esophagus or stomach, and the contents of the color of coffee grounds means that the blood has already changed under the influence of hydrochloric acid. Black liquid shiny stool appears a few hours after the start of bleeding from the upper sections. Scarlet blood in the stool most often indicates the lower sections, although with very massive upper bleeding it can also be unchanged. Common signs of blood loss are weakness, dizziness, tinnitus, thirst, pallor, rapid pulse and decreased blood pressure.
- Vomiting scarlet blood - active bleeding
- Vomit the color of coffee grounds - the blood is altered by acid
- Black tarry stools - upper parts
- Scarlet blood in the stool - most often in the lower sections
- Weakness, dizziness, pallor, rapid pulse
- Hidden bleeding is manifested only by anemia
Reasons
The most common cause of upper bleeding is a stomach and duodenal ulcer, often associated with H. pylori infection and taking painkillers from the group of non-steroidal anti-inflammatory drugs. A dangerous option is bleeding from dilated veins of the esophagus with cirrhosis of the liver: it can be massive. There are also erosions of the mucous membrane, ruptures of the esophageal mucosa after severe vomiting, and tumors. In the lower sections, bleeding is most often caused by diverticula, angiodysplasia, inflammatory bowel diseases, polyps and tumors, as well as hemorrhoids and anal fissure.
- Stomach and duodenal ulcers
- Dilated veins of the esophagus with cirrhosis
- Erosion of the mucous membrane due to medication use
- Rupture of the esophageal mucosa after vomiting
- Colon diverticula
- Polyps and intestinal tumors
- Hemorrhoids and anal fissure
What to do before the ambulance arrives
The main rule is to call 103 and put the person down. The legs are slightly raised and the head is turned to the side if there is vomiting. You cannot eat or drink, take painkillers and hemostatic drugs at your own discretion, wash your stomach, give an enema or apply a heating pad to your stomach. Cold on the upper abdomen is allowed. It is important to collect information for the doctor: what medications the person is taking, especially blood thinners and painkillers, whether there is peptic ulcer disease or liver disease, when and how the symptoms began. You cannot drive to the hospital on your own.
- Call 103 immediately
- Lay down, raise your legs, head to one side
- Don't eat or drink
- Don't take medications on your own
- Do not warm the stomach or rinse the stomach
- Prepare a list of medications taken
Diagnosis and stop bleeding
In the hospital, first of all, the severity of the condition is assessed, blood tests are taken and the blood type is determined, and intravenous administration of solutions is started. The main method of searching for the source is gastroscopy, which is performed in the early stages. It also allows you to stop bleeding: clip the vessel, coagulate it, puncture the ulcer or apply ligatures to the dilated veins of the esophagus. If the source is not found, a colonoscopy is performed, and if bleeding continues, a computed tomography scan with contrast or angiography is performed. Surgery is required when endoscopic methods are ineffective or bleeding recurs.
- Severity assessment, tests, blood group
- Intravenous fluids and transfusions if necessary
- Early gastroscopy with bleeding control
- Colonoscopy for lower bleeding
- Computed tomography with contrast and angiography
- Surgery if other methods are ineffective
Prevention of recurrent bleeding
After stopping the bleeding, the main task is to eliminate the cause. For peptic ulcers, proton pump inhibitors and H. pylori treatment are prescribed with mandatory control of eradication. For people who are forced to take painkillers or blood thinners, the doctor selects mucosal protection and reviews the regimen. In case of liver cirrhosis, bleeding from the esophageal veins is prevented, including medications and re-ligation. Anemia must be treated with iron supplements. You should not resume taking painkillers on your own after a bleeding episode.
- Treatment of peptic ulcer and eradication of H. pylori
- Review of painkillers and anticoagulants
- Protect the mucous membrane if necessary, continue therapy
- Prevention of bleeding in cirrhosis
- Treatment of iron deficiency anemia
- Control gastroscopy at the appointed time
