Xuất huyết tiêu hóa
Xuất huyết tiêu hoá là hiện tượng máu thoát ra khỏi lòng mạch chảy vào ống tiêu hoá, biểu hiện lâm sàng là nôn ra máu đi ngoài ra máu.
Gastrointestinal bleeding phenomenon escape intravascular blood flow to the gastrointestinal tract, the clinical presentation was vomiting blood bloody diarrhea.
The circumstances of gastrointestinal bleeding
Gender: Meet the men and women but common in men than in women.
Age: Meet at any age, but commonly from 20-50 years old.
A number of favorable factors
Changing weather: Spring-summer, autumn-winter.
After taking anti-inflammatory, analgesic (NSAIDS), corticoi ...
Epigastric pain more intense every day in people with gastric ulcer or duodenal ulcer.
Feeling gnawing, burning epigastric, exhausted after taking NSAIDs or corticosteroids.
Staff at changing weather, after excessive exertion or no natural reason dizzy, dizziness, fatigue, fainting glance, nausea and nausea and vomiting.
Sometimes, no warning vomiting bright red blood ộc much, met so broken veins of the esophagus.
Vomiting blood due to broken veins stretch the esophagus:
There are no warning signs.
Natural ộc vomiting bright red blood, no food, vomit blood can clot.
Gastric ulcer, duodenal:
The number of more or less depending on the level.
Blood clots such as corn, beans.
Dark brown or reddish.
Mixed with food, mucus thinners.
Biliary tract bleeding:
Vomiting blood clots long shaped like small bars in pencils.
Black thick, ragged as asphalt, or viscous liquids like coffee grounds.
The odor of the exam (such as dead toad).
Number of times going beyond: option can be 2-3 times the level of 24 or more.
Signs of blood loss level:
Fainting, sweating, cold limbs, goosebumps, skin pale mucous membranes; sometimes struggling, struggling paper. + Circuit dial (heartbeat) fast 120 times / min, small elusive.
Maximum arterial pressure decreased 100-90-80mmHg, sometimes not measure blood pressure. + Diabetes little or no urine.
RBC reduced (depending on level).
Reticulocyte increase (normally 0.8 to 1.2%).
Reaction Weber- Meyer (+).
Endoscopic gastric, esophageal:
Seeing blood drive in any position, the amount of one or more drives, bleeding or oozing rays.
Diagnosis of gastrointestinal bleeding
Diagnosis is confirmed
Case in point:
See bloody vomit or stool blood of patients.
In case of difficulty:
Without witnesses, based on patient asked:
Ask carefully vomit and feces.
Ask the history of stomach problems, had used NSAIDs, corticoi ...
Check the skin, pale mucous membranes, tachycardia little elusive. Measuring blood pressure: blood pressure low maximum 100-90-80mmHg.
Tests: decreased hemoglobin, decreased hemoglobin, decreased hematocrit, reticulocyte count increased.
Laparoscopic gastric-esophageal: location bleed level.
Stool test: Weber- Meyer (+).
The significance level of diagnostic gastrointestinal bleeding:
Diagnosing the extent appropriate treatment regimens, resulting rapid hemostasis, patients recover faster.
For prognosis, treatment with reasonable efficiency (surgical, endoscopic hemostasis injection ...).
Classification level of gastrointestinal bleeding:
Targets / Level
Circuit dial (beats / min)
100 - 120
Blood pressure (mmHg)
Red blood cells (million / mm3)
40 - 60
20 - 30
Be differential diagnosis
Coughing up blood: after coughing blood, bright red blood with saliva, blood should be gradually extended at the tail concepts such as blood.
Nosebleeds: nasal examination will show the nasal mucosa lesions, vascular lesions have.
Eating pudding; vomiting after eating pudding, overall good condition, mucocutaneous still rosy.
After taking bismuth, charcoal, black stools, but not rotten part of the exam, ask before you use it on drugs.
Black stool so much honey: a closer look green stool not rot.
Black stool constipation due to a long, hard stool, dark, not black.
Causes gastrointestinal bleeding
Causes gastrointestinal bleeding high (from the Treitz ligament or higher)
The reason lies in the digestive system:
Reflux esophagitis gastric chemicals.
In the esophagus:
U esophagus, esophageal polyp.
Foreign objects: hormones bone, pink beads, jackfruit seeds ...
In the stomach:
-Duodenal ulcer by step.
Making the superficial veins of the esophagus, stomach and can stretch to break.
The cause of portal hypertension is common:
Portal vein thrombosis.
Squeezing into the portal vein (pancreatic cancer, stomach rarely chronic pancreatitis, hepatic stem nodes tuberculosis, fibrosis after liver stem cholangitis, cystic pressed on).
Portal vein obstruction due to many reasons.
Bloc Liver Cirrhosis, congenital hepatic fibrosis, secondary liver cancer.
Bloc on Hepatic vein obstruction central lobule (venous disease) or switch on the body to the liver veins (Budd-Chiari syndrome).
Biliary tract bleeding: Blood from the liver into the bile duct into the duodenum.
The cause of bleeding is usually biliary:
Gallstones or bile duct worms up.
Hepatic artery malformations.
The causes beyond the digestive system:
Some blood diseases:
Acute leukemia, chronic leukemia.
Bone marrow failure: Platelets decreased leading to bleeding.
Retarding blood disease: Lack of factors that make prothrompin.
Hemophilia: Lack of quantity and quality of platelets.
Liver failure; cirrhosis, hepatitis as prothrombin ratio decreased bleeding.
Due to a variety of drugs:
Some drugs have complications in the stomach: corticosteroids, anti-inflammatory steroi (NSAIDS) ...
Anticoagulants: Deparin, dicoumarol.
Causes of lower gastrointestinal bleeding (fresh blood or black stools)
The cause of the digestive system :
In the small intestine: Uncommon
Small bowel tumors
Rectal Crohn's disease.
In the colon:
Colon tumor is in-cecal ...
In-cecal ulcers due to typhoid.
Direct-ulcer bleeding colon.
Lao colon common in back-cecum.
Nonspecific ulcers (of unknown cause).
Causes of anal-rectal:
Consisting largely of reasons such as the small intestine, the colon; in addition can add the following reasons:
Hemorrhoids anus (internal and external).
Sa anal mucosa.
Dysentery (amoeba or bacilli) may be in the entire colon but always cause ulcers in the rectum.
Anal inflammation (usually due to infection).
The causes beyond the digestive system:
Including the reasons stated at the high digestibility.
Also can meet other rarer causes:
Ectopic endometrial bleeding coincides with the period, allergies, mucosal edema gastrointestinal tract bleeding. Especially Schonlein syndrome or gastrointestinal bleeding, easily confused with necrotizing enterocolitis.
High blood pressure, gastrointestinal bleeding complications.
To diagnose the cause of gastrointestinal bleeding is not easy. Today with the help of ultrasound, endoscopy, radiology, laboratory, biochemistry hepatobiliary, diagnosing causes of gastrointestinal bleeding faster and more accurate.
Some principles for emergency treatment
Quickly find ways to stop the bleeding.
Patient lying in bed absolute.
Winter is the place warm, summer is fresh but not windy.
Test immediately: HC, hemoglobin, hematocrit, blood group.
For patients infusion, blood transfusion, hemostatic drugs.
Anti-shock, if any.
Determining the extent of gastrointestinal bleeding to positive attitudes appropriate processing (treatment, exchange, or injection endoscopic hemostasis ...).
Subscribe pulse, blood pressure, or excrement really close each time.
If determine the cause, can be combined treatment causes.