According to statistical data, in 5-15% of patients suffering from erosion of the gastric mucosa, sooner or later, ulcer bleeding opens, the intensity of which directly depends on the size of the damaged vessel. It arises suddenly, regardless of the degree and severity of the pathology. In some cases, a violation of the integrity of the veins or arteries becomes the first sign of ulcer manifestation, in others - a consequence of the problem that has been discovered long ago but is not effectively addressed. In any case, bleeding with an ulcer is very dangerous, so for its elimination, professional assistance of doctors is always required. Even if at some point the blood stops to go, then after a few hours or, at most, a day, the process is resumed again.
Ulcerative gastric bleeding is divided into hidden and obvious. In the first case, the integrity of a small vessel is damaged, in the second - a large artery. And most often the erosive artery is the cause that provokes internal bleeding in the stomach ulcer. Much less often, the pathology is venous.
Bleeding for gastric ulcer is not susceptible to prediction on the grounds of localization of erosive formations, as well as the sex or age of the patient. That is, it can not be said that if the erosive focus is located in a certain place, then necessarily internal bleeding occurs with an ulcer. Similarly, there is no difference whether a patient is a man or a woman, and how old he is. However, elderly people with an existing complication are at a special risk group, because they can not independently hemostasis even for short periods of time. This is primarily due to the sclerosis of the vessels and the loss of their natural ability to spasmodic. A continuous ulcer bleeding of the stomach carries a serious threat to human life.
If there is a chronic callous ulcer disease, the bleeding will not itself stop even for a short time, as a scar tissue is formed at the site of the mucosal lesion, which lacks the ability to regenerate. For this reason, open wounds remain gaping until appropriate conservative therapy or surgical treatment is performed. But with acute gastric ulcer, bleeding is usually intermittent, but this does not mean that you can hesitate to consult a doctor. Untimely provision of medical care ends with a significant loss of vital fluid, and the first severity of the patient's condition very quickly develops into the fourth, when a person can be saved only through resuscitation, and that is not always the case. In addition, even a small and intermittent bleeding stomach ulcer with prolonged repetition provokes the development of iron deficiency anemia, exacerbating the problem and hampering the overall treatment of the patient.
What is the danger of a peptic ulcer complicated by bleeding?
In fact, bleeding in itself is a complication of peptic ulcer. In other words, sluggish or so-called erased pathology turns into an aggressive form. A person experiences acute pain after eating, which simply makes him afraid to take any food. As a result, body exhaustion develops, which, combined with blood loss, leads to weakness, lethargy and weight loss.
The most dangerous is peptic ulcer, complicated by profuse bleeding. In this case, large vessels are affected, so for literally half an hour a person loses a large amount of blood. And this is already threatening:
- hypovolemic shock;
- orthostatic hypotension;
- heart failure;
- acute hepatic insufficiency;
- by brain edema;
- intoxication products of the decomposition( hydrolysis) of blood that has entered the intestine.
Thus, a stomach ulcer complicated by bleeding can cause SPON( syndrome of multiple organ failure), in which the body is almost unable to maintain its vital functions. In these cases, the percentage of deaths is very high, therefore, when identifying symptoms that indicate an erosive violation of the integrity of the vein or artery in the stomach, you need to seek help from the gastroenterologist as soon as possible.
How to recognize the symptoms of bleeding ulcers?
With ulcerative( small) ulcer bleeding, symptoms are almost always absent. The general condition of the patient is satisfactory and the person does not feel any changes in the state of health. However, a prolonged outflow can cause mild dizziness, rapid fatigue and pallor. Particular attention should be paid to changes in blood pressure, which decreases when a person is standing or sitting. In order to find the problem in time and prevent its transition to a more severe apparent form, it is necessary to periodically take tests to conduct a laboratory reaction of Gregersen, which allows you to detect even very small pieces of blood in the gastric juice, feces, urine and vomit.
For obvious bleeding in the stomach ulcer, symptoms are always pronounced. They are recognized by such signs as bloody vomiting( hematomesis) and tar-like feces( melena).
With moderate blood loss( 15-25%), the patient pales face, limbs become colder, the volume of urine discharged decreases, palpitation increases significantly even when a person does not experience any physical exertion.
Symptoms of bleeding ulcers with significant blood loss( 25-45%) are recognized by a sharp drop in blood pressure, the appearance of tachycardia and dyspnea. The body can not make up for itself the lost volume of blood, but in this state it is still possible to talk about the reversibility of severe decompensated hemorrhagic shock. People with similar signs of ulcerous bleeding, as a rule, do not lose consciousness, but on the contrary, become restless and irritable, are in a state of very noticeable unhealthy arousal.
If the loss is 50% or more with a bleeding ulcer of the stomach, the symptoms are expressed in the absence of consciousness, a sharp blanching of the skin, protrusion of sticky and cold sweat, a threadlike pulse. In most cases, blood pressure can not be measured. If in such a state the patient does not receive urgent medical assistance, the pathology becomes irreversible and the person dies.
How is ulcerative bleeding treated?
Treatment of bleeding stomach ulcers in 80% of cases occurs with conservative methods without performing an operation. There are cases of independent hemostasis, but this does not give reason to ignore the call to the doctor, since without professional help there is almost a 100 percent probability of an early relapse. Only competent therapeutic actions can lead to a stable positive result.
In all cases, treatment of stomach ulcers with bleeding includes hospitalization of the patient, strict bed rest, prohibition of food and water. At the initial stage, as a rule, injections of Vikasol, a chloride solution, and also droppers of epsilon-aminocaproic acid are put. All these actions are aimed at achieving a haemostatic effect.
With intensive bleeding of stomach ulcers, treatment means transfusion of erythrocyte mass, which avoids an excessive increase in BCC.After recovering the volume, the patient is carefully monitored to identify symptoms that indicate continued bleeding.
In many ways, the way to treat an ulcer with bleeding depends on its location. If this is the lower part of the esophagus, then a balloon catheter is inserted into it through the mouth. After that, the balloon is inflated to create a certain pressure in the area of the damaged vessel. Another technique is to act on a problem focus of a special chemical that causes fibrosis and inflammation of the vein.
In modern medicine, endoscopic therapy is widely used. And the treatment of bleeding with a stomach ulcer is no exception. A damaged vessel is cauterized by the action of an electric current or a substance that provokes blood coagulability is injected into the vein. In the event that all of the above measures do not produce the expected effect, the bleeding stomach ulcer is treated with a surgical procedure.
Diet and Nutrition for bleeding stomach ulcers
One of the most important factors for successful treatment is proper nutrition with a bleeding stomach ulcer. During the first 2-3 days there is complete abstinence from drinking and food. Only thirst quenches with a few teaspoons of water or a small piece of ice, which must be dissolved in the mouth. After 48 hours, the patient is given a small amount of liquid food. So, a diet with ulcer bleeding may include:
- eggs in raw form or soft-boiled, in which the protein is in semi-liquid state;
- sparse jelly;
- juices, etc.
Recently, many specialists have completely abandoned long-term starvation. In their opinion, if the stomach ulcer is complicated by bleeding, the diet should ensure that the body receives enough calories that support vital activity, as well as fats, proteins, carbohydrates, vitamins and salts. The only condition - food should be liquid or in the form of puree. In addition to the above products, such a diet with a bleeding stomach ulcer includes:
- curd or meat soufflé;
- mashed vegetable soups, cooked on mucous broth;
- rubbed porridge;
- fish or meatballs;
- cutlet steamed;
- puree from potatoes;
- tea and cocoa;
- fruit compotes;
- broth briar, etc.
Naturally, alcoholic beverages and acute irritating food are excluded from food. Thus, a diet with stomach ulcer and bleeding is not a strict ban on all foods without exception. The main thing is to coordinate the diet of the patient with the attending physician who will recommend certain edible products that do not harm the body and do not interfere with effective treatment.
What to do if bleeding stomach ulcer?
With ulcerative bleeding, emergency care is the main condition not only for maintaining health, but also for life. First of all, the patient must be completely immobilized, that is, put in a horizontal position on the back, and immediately call an ambulance. In the framework of pre-hospital care, it is recommended to attach a container of ice to the stomach. You can also swallow a small piece of ice, as the cold stops bleeding. It is strictly forbidden to take water or food, move independently. Transportation of a person with this complication is carried out only on stretchers.
In hospital conditions, complex therapeutic measures are carried out, including endoscopic hemostasis with ulcer bleeding, which can be:
- medication( blockage of the focus by vasoconstrictive, hemostatic, coagulating drugs, oil, sclerosing and physiological solutions);
- physical( thermal, electrical or laser).
Operation for bleeding stomach ulcers is done in the most extreme case, when all the possibilities of therapy and endoscopy are exhausted, but the result is not achieved.
Modern treatment completely eliminates this dangerous pathology, virtually eliminating relapse or any complications. Consequences of bleeding stomach ulcers can be irreversible only in case of untimely treatment for medical help or because of underestimation of the severity of the patient's condition.