Causes and treatments of gastrointestinal bleeding

There are many causes of gastrointestinal bleeding. We all know that the human digestive tract is relatively long from beginning to end. The human digestive tract can be divided into upper digestive tract and lower digestive tract according to its location in the human body. Medically speaking, gastrointestinal bleeding is a common clinical syndrome. Gastrointestinal bleeding can affect the body's normal digestive metabolism and can also cause pain.

Gastrointestinal bleeding can be caused by inflammation, mechanical injury, vascular disease, tumors and other factors of the digestive tract itself, or it can be caused by lesions of adjacent organs and systemic diseases involving the digestive tract.

1. Upper gastrointestinal bleeding

2. Middle and lower gastrointestinal bleeding

(1) Anal canal diseases: hemorrhoids, anal fissures, and anal fistulas.

(2) Rectal diseases: ulcerative proctitis, tumors (polyps), carcinoid, adjacent malignant tumors or abscesses invading the rectum, infections (bacterial, tuberculous, fungal, viral, parasitic), ischemia, etc.

(3) Colonic diseases: infection (bacterial, tuberculous, fungal, viral, parasitic), ulcerative colitis, diverticula, tumors (polyps), ischemia and vascular malformations, intussusception, etc.

(4) Small intestinal diseases: acute hemorrhagic necrotizing enterocolitis, intestinal tuberculosis, Crohn's disease, diverticulitis or ulcer, intussusception, tumor (polyp), hemangioma, vascular malformation, ischemia, etc.

treat:

Treatment principles vary depending on the primary disease, amount of bleeding and rate of bleeding.

1. Upper gastrointestinal bleeding

2. Middle and lower gastrointestinal bleeding

(1) Symptomatic treatment of chronic, small-volume bleeding mainly targets the primary disease (cause). In case of acute massive bleeding, the patient should rest in bed and fast; closely observe changes in the condition, maintain intravenous access and measure central venous pressure. Keep the patient's airway open to avoid suffocation caused by vomiting blood. And take appropriate treatment for the primary disease.

(2) Replenishing blood volume In case of acute massive bleeding, intravenous infusion should be given rapidly to maintain blood volume and prevent a drop in blood pressure. When hemoglobin is lower than 6 g/dl and systolic blood pressure is lower than 12 kPa (90 mmHg), blood transfusion should be considered. Avoid excessive blood transfusion or infusion to prevent acute pulmonary edema or re-bleeding.

(3) Endoscopic treatment has limited hemostatic effect under colonoscopy and small enteroscopy and is not suitable for acute massive bleeding, especially for diffuse intestinal lesions. Specific methods include: argon plasma coagulation (APC), electrocoagulation (including monopolar or multipolar electrocoagulation), cryostasis, thermal probe hemostasis, and spraying of epinephrine, thrombin, leptin and other drugs on the bleeding lesions to stop bleeding. APC, electrocoagulation and other hemostatic methods should not be used for bleeding caused by diverticulum to avoid intestinal perforation.

(4) Minimally invasive interventional treatment: After selective angiography shows the bleeding site, hemostasis treatment can be performed through the catheter. The goal of hemostasis can be achieved in most cases. Although some cases will bleed again during hospitalization, the patient's general condition has improved during this period, creating good conditions for elective surgical treatment. It is worth pointing out that gastrointestinal bleeding caused by intestinal ischemic diseases is contraindicated. Generally speaking, embolization is not recommended for hemostasis in cases of lower gastrointestinal bleeding after arterial catheterization because embolization of the proximal blood vessels can easily cause ischemic necrosis of the intestine, especially the colon.

(5) Surgical treatment: When the cause and site of bleeding are unclear, blind laparotomy is not recommended. Laparotomy may be considered in the following situations: ① Active massive bleeding and hemodynamic instability, arterial angiography or other examinations are not allowed; ② The above examinations did not find the bleeding site, but the bleeding is still ongoing; ③ Similar severe bleeding occurs repeatedly. The operation should be thoroughly and carefully explored, and if necessary, intraoperative endoscopic examination should be performed through the anus and/or enterostomy. It is performed by an endoscopist, with the surgeon assisting in inserting the endoscope and rotating the intestinal tube to flatten the mucosal folds, allowing the endoscopist to obtain a clear field of view, which is conducive to the discovery of small and hidden bleeding lesions. At the same time, the surgeon can sometimes detect lesions from the serosal surface through endoscopic illumination.