Watch for gastrointestinal bleeding

Gastrointestinal bleeding is a common emergency in hospitals, with a relatively high mortality rate (10-15%), so it is important to be studied.

Gastrointestinal bleeding can manifest in acute form, vomiting blood, defecating blood or chronic, hidden as long-term anemia. The disease can be severe, moderate or mild, bleeding or stopped, stopped or temporarily stopped and bleed again. It may stem from damage in the upper gastrointestinal tract or lower gastrointestinal tract. The following article should mention acute gastrointestinal bleeding.

Common causes

Colon tumor causes lower gastrointestinal bleeding.(Photo: TTO)

The most common cause is bleeding from hemorrhoids and rectal rectal diseases, but usually only causes bleeding at least, mixed and feces.

Colonic tumors (neoplasmo): benign polyps and rectal cancer can cause hidden, chronic bleeding or episodes of massive bleeding through the anus. Uterine - colon is a common in the world and Vietnam needs surgery as soon as possible; colitis caused by infection (shigella, salmonella, campylobacter of E. coli .; dilated aneurysm in the colon or small intestine; inflammation of the rectum - bleeding colon; ischemic colitis (ischormic colitis): severe bleeding that occurs suddenly, usually in older people, can cause bleeding but rarely in large amounts, drug-induced colitis.

And other less common causes include: radiation-induced colitis (bleeding may occur decades after treating melanoma in the pelvis, prostate gland), vascular malformations or tumors in the colon, upper gastrointestinal lesions.

Tests needed

Remember that if severe bleeding, which can be shocking, emergency treatment should be prioritized first. Diagnostic steps include asking a patient, full body examination, anal, rectal, early colonoscopy (urgent colonoscopy). In the past, people were afraid of colonoscopy when there was bleeding, but now with the progress and experience gained in endoscopic science, the tendency is to widely use early colonoscopy in bleeding because of showing Very useful in detecting the source of bleeding (70-85% of cases) without or very little complication.

Only when there is a reason for not having a colonoscopy, can a colon X-ray be used because Xquang is less sensitive, leaving many injuries.

If colonoscopy and colon X-ray do not find the source of bleeding, try gastric aspiration by nasogastric tube, if there is blood, conduct gastroscopy - duodenum, may have duodenal ulcer, dilate ulcer capillary or capillary deformity . bleeding in the duodenum.

If both colonoscopy and gastroscopy - duodenum do not find bleeding lesions, bleeding continues, in modern equipped centers, one can continue to examine by colonoscopy. or hanging coronary artery x-ray, or sparkling shooting using technetium radioisotopes.

How to treat it effectively?

Medical treatment: The vast majority of patients with lower gastrointestinal bleeding self-stop bleeding with medical conservative treatment. Hemorrhoids: often treat conservative, suppositories and Western medicine, and soak warm water . ligation or later surgery if necessary. Treatment of infectious colitis aims at pathogenic bacteria with appropriate drugs and antibiotics.

Drug-induced colitis, caused by antibiotics; Immediately stop the drug, notice aspirin and anti-inflammatory drugs. Immediately stop the antibiotic causing the disease. If necessary, transfer platelets. Hemorrhagic colitis: specific treatment (5ASA, corticosteroids, azathioprin .). Ischemic colitis: blood transfusion, good maintenance of cardiovascular state.

Endoscopic treatment: In the past colonoscopy was only used for diagnosis, now serves for the treatment of severe bleeding injuries such as bleeding bleeding bag, or a blood vessel or a vasodilator bleed. Hemostasis by endoscopic treatment, hemostatic drug: 1: 10,000 adrenalin solution, or absolute alcohol, salt water . Can also use electric burning, laser burning equipment.

Vaseline treatment : Injecting vasopressin vasopressin through selective mesenteric arteries stops bleeding, bleeding or malformed vascular deformities, but is easy to recur, so there is a tendency to induce occlusion. selective circuit, creating more stable hemostasis.

Surgical treatment: Finally, if bleeding is large, conservative treatments fail, blood still flows dangerously. If the bleeding site is identified, the surgery is limited to the bleeding place. If the bleeding site cannot be identified, it is compulsory to have a colonectomy close to completely bleeding but the mortality rate is high (15-20 %) and heavy postoperative with older people.

Prof. Dr. Ha Van Mao