What to do if you have gastrointestinal bleeding?

Treatment of gastrointestinal bleeding:

1. General treatment: bed rest; observe whether facial expression and limb skin are cold, wet or warm; record blood pressure, pulse, bleeding volume and hourly urine output ; Maintain venous access and measure central venous pressure. Keep the patient's respiratory tract open to avoid suffocation when vomiting blood. Those who bleed a lot should fast, and those who bleed a little can drink fluids appropriately. Most patients often have fever after bleeding and generally do not need antibiotics.

2. Supplement blood volume: When hemoglobin is lower than 9g/dl and systolic blood pressure is lower than 12kPa (90mmHg), a sufficient amount of whole blood should be transfused immediately. For patients with liver cirrhosis and venous hypertension, beware of the possibility of rebleeding caused by increased portal vein pressure due to blood transfusion. It is necessary to avoid excessive blood transfusion or fluid infusion, which may cause acute pulmonary edema or induce further bleeding.

3. Hemostatic treatment of massive upper gastrointestinal bleeding

(1) Cooling down the stomach.

(2) Oral hemostatic agents.

(3) Inhibit gastric acid secretion and protect gastric mucosa.

(4) Stop bleeding under direct endoscopic vision.

(5) Non-surgical treatment of esophageal variceal bleeding.

4. Treatment of lower gastrointestinal bleeding: Lower gastrointestinal bleeding is a common intestinal disease. The main symptom is blood in the stool. If blood in the stool lasts for a long time, it will cause serious consequences.

(1) General treatment: The general principle is to determine treatment plans according to different causes. When a clear diagnosis cannot be made, anti-shock and other treatments should be actively given. The patient must rest in a supine position, fast or eat a low-residue diet, and be given sedatives if necessary. Hemostatic agents are administered intravenously or intramuscularly. During treatment, blood pressure, pulse, and urine output should be closely observed. Pay attention to the condition of the abdomen, record the frequency and quantity of melena or blood in the stool, and regularly review hemoglobin, red blood cell count, hematocrit, urine routine, blood urea nitrogen, creatinine, electrolytes, liver function, etc.

(2) Surgical treatment: When the cause and location of bleeding are unclear, blind laparotomy is not recommended. Exploratory laparotomy may be considered if the following conditions exist: ① There is still active massive bleeding and If hemodynamic instability occurs, TCR-BCS, arteriography or other examinations are not allowed; ② The bleeding site is not found in the above examinations, but the bleeding continues; ③ Similar severe bleeding occurs repeatedly. During the operation, a comprehensive and careful exploration should be carried out. The digestive tract should be carefully touched throughout the entire process, and the intestine should be lifted out and combined with transillumination under light. Small intestinal tumors or other lesions can sometimes be found. If no lesions are found (about 1/3), transanal and/or transenterostomy introduction intraoperative endoscopy can be used. It is performed by an endoscopist. The surgeon assists in guiding the endoscope, and can rotate the intestinal tube and flatten the mucosal folds, allowing the endoscopist to obtain a clear field of view, which is helpful for discovering small and hidden bleeding lesions. At the same time, the surgeon can sometimes find lesions from the serosal surface through endoscopic transillumination.

The above is about the treatment methods for lower gastrointestinal bleeding. For the above-mentioned treatment methods, everyone should choose carefully, because each patient's situation is different, so symptomatic treatment is the most important.

5. Surgical treatment

(1) Esophageal and gastric variceal bleeding

Non-surgical treatment such as blood transfusion, drug hemostasis, three-chamber therapy, and sclerotherapy If bleeding still cannot be controlled by embolization, emergency variceal ligation should be performed. Although this method has a hemostatic effect, the rate of recurrent bleeding is high. If splenorenal vein shunt surgery can be performed at the same time, the recurrence rate can be reduced. Other surgeries such as portal azygous vein devascularization, H-shaped superior mesenteric vein inferior vena cava shunt, splenocaval shunt, etc. are also in clinical application. The surgical mortality of elective portocaval shunt is low and has preventive significance. Liver transplantation may also be considered for patients with severe cirrhosis.

(2) Ulcer bleeding

When upper gastrointestinal bleeding continues for more than 48 hours and does not stop; blood transfusion of 1500ml within 24 hours still cannot correct blood volume and blood pressure instability; conservative treatment If rebleeding occurs during this period; if arterial active bleeding is found under endoscopy, the mortality rate is as high as 30%, and surgery should be performed as soon as possible.

(3) Superior mesenteric artery thrombosis or arterial embolism

It often occurs in middle-aged and elderly people with atherosclerosis, sudden abdominal pain and blood in the stool, causing extensive intestinal necrosis and mortality Up to 90.5% require surgical removal of necrotic intestinal tissue.