References:
Health guide:
1. Actively prevent and treat primary diseases: Upper gastrointestinal bleeding is a complex disease caused by various digestive system diseases. Treating the primary disease can effectively prevent the occurrence of upper gastrointestinal bleeding.
2. Avoid emotional extremes: Strong mental trauma, emotional excitement, excessive worry and thinking may all induce upper gastrointestinal bleeding. We should be emotionally stable and optimistic. Properly handle various contradictions in daily work and life, and establish a relaxed, harmonious and good-neighborly environment.
3. Pay attention to the combination of work and rest: excessive fatigue and lack of sleep can cause autonomic nerve dysfunction, promote gastric mucosal self-digestion, and cause gastric mucosal inflammation, ulcer and bleeding. So life should be regular, avoid overwork and get enough sleep.
4. Pay attention to diet adjustment: improper diet, abnormal hunger and satiety, irregular hot and cold, or overeating fat, spicy, smoked, fried, cold and so on. It will damage the defense function of gastric mucosa for a long time and cause gastric mucosal lesions. The diet distribution of three meals a day should be reasonable, fresh and clean, light and easy to digest. Appropriately increase protein and vitamins. Drinking alcohol can make gastric mucosa hyperemia, edema and erosion, and it can also cause vitamin deficiency, decrease coagulation factors, increase vascular fragility and lead to bleeding. Nicotine in tobacco has a strong harmful stimulating effect on gastric mucosa, which can make bile reflux, damage digestive tract mucosa, and cause inflammation, erosion, ulcer and bleeding. You must absolutely give up smoking and drinking.
5. Strengthen physical exercise: weak constitution and low disease resistance of digestive tract are the most fundamental reasons for upper gastrointestinal bleeding. The fundamental way to effectively prevent upper gastrointestinal bleeding is to strengthen physique and improve the body's resistance. You can choose swimming, ball games, Tai Ji Chuan, Qigong, disco and other sports suitable for the elderly according to your age and physical strength, so that you can persevere.
Upper gastrointestinal bleeding
Upper gastrointestinal bleeding is a common digestive system emergency in clinic. The mortality is about 10%. It is often caused by mucosal inflammation, erosion, ulcer or diverticulum and vasodilation of esophagus, stomach, duodenum, upper jejunum, pancreatic duct and bile duct. It can also cause some systemic diseases, such as acute infection, tumor, diseases of blood system and connective tissue, chronic nephritis, uremia, cerebral hemorrhage and coma. The main clinical manifestations are hematemesis and melena, as well as systemic symptoms caused by bleeding. The degree depends on the nature, location, amount and speed of bleeding, and is also related to the general situation of patients when bleeding.
(1) symptoms
Most of them have a history of peptic ulcer and liver and kidney diseases. Esophageal hematemesis is bright red. Hematemesis in stomach and duodenum is brown. Vomiting bright red blood or blood clot indicates massive bleeding; If the amount of bleeding is small and slow, it is brown. The typical black stool is shiny tar-like paste stool, and the bleeding is mostly purple stool.
Laboratory examination: platelet count, bleeding, coagulation time, blood routine, prothrombin time and blood ammonia concentration are helpful for differential diagnosis with esophageal vein rupture bleeding caused by liver cirrhosis.
The thread swallowing test or fluorescein thread swallowing test can infer the bleeding site according to the coloring and staining site.
Radionuclide imaging can detect active bleeding.
Selective arteriography can find bleeding focus, especially suitable for bleeding caused by vasodilation, malformation, hemangioma and arteriovenous fistula. It is suitable for those who have not been diagnosed by emergency endoscopy but have not stopped bleeding.
Endoscopy: It is of great value in the diagnosis of bleeding sites and lesions.
X-ray barium meal examination and gas barium double contrast can improve the diagnostic rate. The diagnosis of gastric mucosal prolapse and esophageal hiatal hernia bleeding is better than gastroscopy.
(2) Prevention and prognosis
Actively treat primary diseases, such as esophageal inflammation, gastric ulcer, chronic hepatitis, chronic nephritis, etc., to reduce the chance of bleeding. Patients with chronic diseases, such as weakness, often take vitamin C and Chinese medicines that greatly tonify qi and blood to improve their adaptability. Life should be regular, avoid overwork, get enough sleep, avoid emotional tension and maintain emotional stability.
If the disease has a large amount of bleeding or repeated bleeding, the prognosis is poor.
Nursing care of upper gastrointestinal bleeding
According to the general nursing routine of internal medicine and diseases in this system.
[observation of illness]
1. Observe the changes of blood pressure, body temperature, pulse and respiration.
2. If there is massive bleeding, measure the pulse and blood pressure every 15-30 minutes, and conditionally monitor it with an ECG sphygmomanometer.
3. Observe the color, quality and quantity of consciousness, peripheral circulation, urine volume, hematemesis and hematochezia.
4. Have dizziness, palpitation, cold sweat and other shock manifestations, promptly report to the doctor for symptomatic treatment and make records.
[Symptom nursing]
(1) Nursing during bleeding period
1. Stay in bed until the bleeding stops.
2. Give sedatives to restless people, and use sedatives with caution when patients with portal hypertension bleeding are restless.
3. Patiently and meticulously do a good job of explanation, comfort and considerate patients' pain, and eliminate tension and fear.
4. Contaminated clothes should be replaced at any time to avoid bad stimulation.
5. Quickly establish venous access, replenish blood volume as soon as possible, and give drugs in large quantities with 5% glucose saline or plasma substitutes.
Blood should be prepared in time, and double-balloon and three-lumen tubes should be prepared for standby.
6. Keep warm.
(2) Hematemesis nursing
1. According to the condition, let the patient lie on his side or sit in a semi-seated position to prevent aspiration.
2. When washing the stomach tube, observe whether there is any new bleeding.
[general care]
1. oral care fasting during bleeding requires cleaning the mouth twice a day. Oral care should be done at any time when vomiting blood.
The cavity is clean and tasteless.
2. There are many bloody stools, which should be wiped after each defecation to keep the buttocks clean and dry to prevent eczema and bedsore.
3. Dietary care and fasting during bleeding period; After the bleeding stopped, warm and cool liquid, semi-liquid and digestible soft food were given in turn;
If the patient's bleeding is not resolved within 3 days, use laxatives with caution.
4. When using double balloon three-lumen tube compression therapy, refer to the nursing routine of double balloon three-lumen tube.
5. When using special drugs, such as stilamin and pituitrin, the dripping speed should be strictly controlled, such as abdominal pain and abdomen.
When there are side effects such as diarrhea and arrhythmia, you should report to the doctor for treatment in time.
[Health Guidance]
1. Keep a good mood and optimistic spirit, and treat the disease correctly.
2. Pay attention to food hygiene and arrange work and rest time reasonably.
3. Appropriate physical exercise to enhance physical fitness.
Smoking, strong tea, coffee and other foods irritating to the stomach are prohibited.
5. Pay attention to food hygiene and combine work and rest in multiple seasons.
6. For some drugs that can induce or aggravate ulcer symptoms and even cause complications, such as salicylic acid, reserpine, phenylbutazone, etc., they should be avoided.
Excerpted from Nursing Routine published by Shanghai Science and Technology Publishing House.
Upper gastrointestinal bleeding generally refers to gastrointestinal bleeding above Treize ligament, including bleeding caused by esophagus, stomach, duodenum, pancreas and biliary tract. Jejunal bleeding caused by gastrojejunostomy also belongs to this category. Upper gastrointestinal bleeding is a common and serious disease in clinic, with hematemesis and/or melena as the main clinical manifestations. Its severity depends on the bleeding site, blood loss and blood loss rate. At the same time, it is related to the general situation of patients (including age, anemia, heart and kidney function) when bleeding. Effective prescriptions of traditional Chinese medicine are as follows:
Fang 1 Sanqi Bletilla Decoction
Notoginseng Radix, Rhizoma Bletillae powder, Radix et Rhizoma Rhei powder each 6g (washed), Herba et Gemma Agrimoniae, calcined concha arcae each 20g, Fructus Aurantii Immaturus 9 g, Pericarpium Citri Tangerinae, Poria each15g, and Rhizoma Pinelliae10g. Take 150ML once a day, morning and evening.
Efficacy: clearing heat and promoting diuresis. Stop bleeding and remove blood stasis
Source of prescription} comes from hebei journal of traditional chinese medicine Journal 1994, (2).
Fang 2 Yiqi Liang Xue Decoction
Parched Scutellaria baicalensis Georgi 15g, Radix Codonopsis, Radix Angelicae Sinensis, Sanguisorba officinalis charcoal, Flos Sophorae Immaturus charcoal 12g, Pollen Typhae preparata Colla Corii Asini 20g, Squid Bone Powder, Callicarpa Callicarpa 30g, Radix et Rhizoma Rhei powder 3g, and Ginseng panax pseudo-ginseng 6g. Divide the powder of the three herbs evenly into three times and adjust it with warm water. Decoct that rest medicine in water. One dose a day.
Efficacy: Yiqi Buxue, Huayu Convergence.
{Source of Prescription} is extracted from journal of traditional chinese medicine, Sichuan 1994, (1).
Formula 3 Acute gastrointestinal bleeding (internal injury of blood collaterals, circulatory disorder)
Treatment: stop bleeding and remove blood stasis.
Formula name: Sanbai Huangzi mixture.
Handling party; 30g of cogongrass rhizome, 30g of Callicarpa, 0/2g of bletilla striata powder/kloc-0, 2g of Yunnan Baiyao powder/kloc-0, 2g of rhubarb powder.
Bletilla striata powder 12g, Yunnan Baiyao powder 1g, and rhubarb powder 2g. Mix and divide into two parts, take 30 grams of cogongrass rhizome and 30 grams of Callicarpa formosana in the morning and evening, and decoct. One dose a day.
Formula 4 stool with blood
Ingredients: Sophora japonica charcoal 9g Sanguisorba charcoal 9g Auricularia charcoal 9g Persimmon charcoal 30g Coptis chinensis charcoal 6g Honeysuckle charcoal15g peat 30g Radix Rehmanniae 9g Radix Paeoniae Alba15g Pumpkin 30g Bombyx Batryticatus 9g Gleditsia sinensis 9g.
Function: cooling blood to stop bleeding, clearing heat and moistening stool. Main treatment: bloody stool. Symptoms include hemorrhoids, anal fissure and intestinal fever (intestinal wind). The pulse is heavy and thin with white fur. ? Ingredients: Sophora japonica, Cimicifuga rhizome, Imperata rhizome, Akebia stem and licorice. Usage: decoct in water and take it several times. Take 2 doses continuously. Function: clearing heat and cooling blood. Indications: toxic heat and bloody stool. The symptom is bright red blood in the stool. Splash, abdominal pain, burning anus, dry mouth, yellow greasy tongue coating, and rapid pulse.
Self-care of upper gastrointestinal bleeding
Author: Date: 2001-12:12:/4: 25
Upper gastrointestinal bleeding refers to acute bleeding of esophagus, stomach, duodenum, pancreatic duct and biliary tract, and it is also a common emergency. Defining the location and cause of bleeding is of great significance for timely treatment and prognosis. The most common causes are gastric and duodenal ulcers, acute gastric mucosal lesions, liver cirrhosis, esophageal and gastric varices rupture and gastric cancer. Systemic diseases such as biliary tract diseases, hematological diseases and uremia can also be seen. The main clinical manifestations of upper gastrointestinal bleeding are hematemesis and melena, as well as symptoms caused by massive blood loss.
Self-observation essentials
(1) Hematemesis refers to the bleeding of esophagus, stomach and duodenum vomited by mouth, accompanied by nausea, and the blood is often dark red acid color or coffee grounds, which can be mixed with food.
(2) Black stool refers to black or tarry stool, which is black iron sulfide produced by intestinal blood; If the amount of bleeding is large and the bowel peristalsis is too fast, dark red stool can be discharged and even blood clots can be found.
(3) There may be common diseases that cause upper gastrointestinal bleeding, such as chronic periodic rhythmic epigastric pain, hunger pain or nocturnal pain, acid reflux and other symptoms of peptic ulcer; Symptoms of liver cirrhosis such as fatigue, emaciation, anorexia, abdominal distension and jaundice; Gastric cancer manifestations such as upper-middle abdominal pain, anorexia, progressive emaciation and upper abdominal mass.
Self-care measures
1. Drug health ① Hemostatic drugs are commonly used for hemoptysis, each time 10 mg, twice a day, intramuscular injection; Hemostasis, 0.5g or 6- aminocaproic acid each time, 2-4g each time; Or p-carboxybenzyl ammonium, 0.4 g each time, twice a day, intravenous drip. ② For patients with peptic ulcer and acute gastric mucosal lesion bleeding, cimetidine, 0.6g or ranitidine each time, 100 mg each time, twice a day, by intravenous drip. Losec can also be used, 20 mg each time, twice a day, orally; Or norepinephrine, each time 1-4 mg, every 6 hours 1 time, add 20 ml of cold boiled water for oral administration. ③ For patients with esophageal and gastric varices bleeding due to liver cirrhosis, somatostatin or pituitrin, 5- 10 units each time, diluted in 100-500 ml glucose solution, can reduce portal vein static lipid pressure and stop bleeding. ④ Traditional Chinese medicine treatment: hemostatic powder, half a pack for the first time, 3-4 times a day, taken orally. Or use Yunnan Baiyao, each time 1 g, three times a day, orally. Or notoginseng, 3 grams each time, 3 times a day, orally. Or Wu Bei powder, 6 grams each time, 3 times a day, taken orally. In addition, raw rhubarb can also be used to stop bleeding.
2. Nursing ① Patients with massive hemorrhage should fast, stay in bed absolutely, and pay attention to proper warmth. ② The necessary conditions for hemostasis, anti-shock and further emergency endoscopy or surgery should be prepared during emergency rescue. ③ Close observation of body temperature, respiration, pulse, blood pressure, abdominal distension and other manifestations, timely understanding of the bleeding situation, and keeping the blood transfusion, infusion and oxygen delivery pipelines unblocked. ④ After the bleeding stops, you can gradually resume your diet, starting with liquid or soft food.
3. Mental health care patients will be nervous and have fear when they see hematemesis and melena. They should eliminate all blood stains as soon as possible, at the same time, comfort and care patients, eliminate anxiety and fear, indicating that rest and quiet are conducive to hemostasis.
4. Diet and health care ① People with more hematemesis should fast, but they can still eat liquids, such as cold milk, lotus root starch, soybean milk and rice soup, only for hematemesis in black stool or urine. ② Patients with hematemesis and melena quit smoking and drinking. ③ Be careful not to eat or try to avoid rough, hard and irritating foods, such as fried food, spicy food, condiments, etc., so as to avoid bleeding from esophageal varices due to liver cirrhosis.
Upper gastrointestinal bleeding
1. What is upper gastrointestinal bleeding?
The bleeding focus is located at the proximal end of Treize ligament (the junction of duodenum and jejunum), which leads to hematemesis, bloody stool and oily stool.
2. What is the most common cause of upper gastrointestinal bleeding?
Acute gastritis (alcoholic, drug-induced, catatonic), 40%;
Duodenal ulcer,17%;
Gastric ulcer,15%;
Mallory-Weiss laceration,11%;
Esophageal or gastric varices, 8%.
Note: The proportion of the above lesions in different populations is different. For example, the incidence of esophageal varices in alcoholics is high, and acute gastritis is the most common cause of bleeding in all kinds of people.
3. What is the initial treatment for upper gastrointestinal bleeding?
Treatment must precede diagnostic measures, such as endoscopy. Puncture a large-caliber needle or catheter into the peripheral vein to collect blood, determine hematocrit, blood type, cross matching, determine liver function and start transfusion of human crystalloid fluid (normal saline or Ringer's solution).
4. What is the role of nasogastric tube in patients with hematemesis?
The main function of nasogastric tube is to monitor gastric bleeding. This may be the only way to determine the cessation or recurrence of bleeding. The large diameter tube (Ewald) allows aspiration of bleeding clots, with or without saline flushing. However, this kind of tube is inconvenient to handle and apply.
5. How to judge the source of bleeding?
Endoscopic examination of esophagus, stomach and proximal duodenum (EGD) can find the bleeding site of 85% ~ 90% patients even when bleeding.
6. Which endoscopic techniques can be used to control bleeding?
Use unipolar or bipolar electrocoagulation to stop bleeding;
Thermal probe;
Laser (YAG or argon laser);
Inject sclerosing agent or vasoconstrictor directly into bleeding blood vessel;
Sclerosing agent injection or rubber ring ligation of esophageal varices.
7. What is the success rate of endoscopic hemostasis?
The success rate varies with different lesions. 90% of acute gastritis bleeding can be controlled and relieved by itself. Peptic ulcer has a low control rate because of large blood vessel bleeding. 95% patients with Mallory-Weiss laceration were effectively treated by endoscope. 90% patients can stop bleeding by injection of sclerosing agent or ligation of rubber band, but the rebleeding rate is 40%.
8. What other non-surgical measures are effective for bleeding caused by gastritis or ulcer?
If the bleeding site can be seen from the angiographic image, vasopressin can be injected into the artery to constrict the bleeding blood vessels of some patients, and the blood vessels can be blocked by interventional technique.
9. What is the failure rate of conservative treatment (non-surgical treatment) for upper gastrointestinal bleeding?
10%。
10. What are the indications?
(1) Persistent hypotension with progressive bleeding.
(2) Infuse 2500 ml (5 units of blood or 2/3 of the patient's blood volume) in the first 24 hours.
(3) The second 24h blood transfusion volume was 1500ml.
(4) After hospitalization, rebleeding occurred after the maximum dose of medication.
1 1. What is an effective hemostasis operation for acute gastritis?
Most acute gastritis caused by alcohol or drugs is stopped by vagotomy. Because vagotomy affects gastric emptying, pyloroplasty or gastrointestinal anastomosis is needed. Gastrectomy is rarely needed.
12. What is the effective hemostasis method for peptic ulcer?
Duodenal ulcer usually requires ligation of bleeding blood vessels, vagotomy and pyloroplasty (high-risk population) or vagotomy and antrectomy (low-risk patients). Highly selective vagotomy is an emergency measure to treat upper gastrointestinal bleeding. The best hemostasis measure for bleeding of gastric ulcer is local gastrectomy or subtotal gastrectomy. Vagotomy combined with pyloroplasty is an effective measure to treat ulcer at the junction of esophagus and stomach after ligation of bleeding site.
13. what kind of emergency operation can stop bleeding in patients with esophageal varices due to liver cirrhosis?
When esophageal variceal bleeding cannot be stopped by non-surgical methods (sclerotherapy, rubber ring, percutaneous transhepatic portosystemic shunt tip, three-cavity and two-sac tube), emergency surgery should be performed to reduce portal vein pressure. Usually, portacaval shunt or intestinal shunt is performed to implant the graft. In a few cases, the blood supply of proximal stomach and distal esophagus was blocked by modified Susiura operation.
14. What is the mortality rate of esophageal varices?
Nearly 60% patients died within one year after the first varicose bleeding.
15. What is the rebleeding rate after surgical control of upper gastrointestinal bleeding?
10%。
argue
16. Should all patients with upper gastrointestinal bleeding receive endoscopic diagnosis immediately?
Support: Endoscopy is quite safe (incidence of complications: 0. 25%) and accuracy (85% ~ 90%) refer to detecting the bleeding site. Information about the location and type of bleeding helps surgeons to choose the most suitable surgical method.
Objective: Patients with massive bleeding are at risk of aspiration and respiratory disorder when undergoing endoscopic examination. Several randomized trials show that early endoscopic examination of upper gastrointestinal bleeding is not helpful to improve the survival rate.
17. Is it iced saline for gastric lavage?
Supportive: theoretically, washing with iced saline can cause local hypothermia and vasoconstriction of gastric mucosa, in which case, bleeding of small blood vessels may stop.
Objection: Research shows that the use of iced brine does not show better advantages than isothermal brine.
Upper gastrointestinal bleeding
Upper gastrointestinal bleeding refers to the bleeding caused by upper jejunum and biliary and pancreatic diseases after esophagogastrojejunostomy, which is one of the common emergencies.
Diagnostic points
(1) Hemorrhage manifestations: ① Hematemesis and melena are the main symptoms; ② Syncope and shock caused by hemorrhagic peripheral circulation failure; ③ Severe anemia; ④ Low fever often occurs after massive hemorrhage.
(2) Differentiation of bleeding or persistent bleeding in Dali: ① Repeated hematemesis or discharge of thin black stool and dark red bloody stool; ② Increased heart rate, decreased blood pressure, cold sweat and early peripheral circulation failure; ③ Decreased central venous pressure with little or no urine; ④ Red blood cells, hemoglobin and hematocrit decreased sharply; ⑤ Plasma urea nitrogen increased continuously.
(3) Determination of bleeding location and etiology: ① The bleeding location of patients with hematemesis and melena is mostly stomach or esophagus, and the bleeding of patients with melena is often located in duodenum; ② Have a history of chronic rhythmic upper-middle abdominal pain, usually stomach or esophagus, often bleeding due to ulcer disease, especially the pain before bleeding is aggravated, and the pain is relieved or relieved after bleeding; ③ Patients with stress factors before bleeding should first consider stress-induced bleeding; ④ Patients with chronic liver disease and portal hypertension should pay more attention to esophageal and gastric varices bleeding; ⑤ Middle-aged and elderly people with first bleeding, anorexia and weight loss should consider gastric cancer.
2. Auxiliary inspection
(1)X-ray examination: We can know the location of bleeding and the nature of the lesion.
(2) Gastroscopy: It can often diagnose the location and cause of bleeding quickly and correctly, and has been listed as the first choice.
(3) Selective arteriography: it is a supplementary examination when the above diagnosis is not confirmed, and it is more valuable for the diagnosis of vascular malformation.
(4) Radionuclide imaging: By detecting the markers of vascular overflow, we can find the active bleeding focus.
(5) Balloon test: It has certain value in locating bleeding caused by distal and proximal duodenal jejunal lesions.
treat cordially
1, routine treatment: ① The patient was supine,10 mg; When you are upset, you can inject diazepam into the muscle; ② People with hematemesis should fast, and those with simple black stool can enter a liquid diet; ③ Patients with severe illness should take oxygen; (4) placing a gastric tube, sucking out the blood accumulated in the stomach, knowing the bleeding situation, and infusing drugs; ⑤ Strengthen nursing to prevent pneumonia or suffocation caused by vomit inhalation into respiratory tract.
2. Rescue shock: ① Blood transfusion is estimated, and blood transfusion is the main method for mild bleeding, so blood transfusion can be temporarily omitted; Moderate bleeding should be supplemented with 400 ~ 600 ml blood; Severe bleeding requires blood transfusion of 900 ~ 1200ml or even more; (2) The estimation of infusion volume, in principle, is to live within our means. According to the measurement of central venous pressure, the amount and speed of infusion can be adjusted. The liquid is liquid crystal and dextran; ③ Correct acid-base balance and electrolyte balance.
3. Application of hemostatic agent: ① Choose Anluoxue \ Zhixuemin \ or hemostasis and acid prevention as appropriate, and add it into rehydration solution for drip; ② The concentration of norepinephrine or thrombin was 80 mg/L by gastric tube perfusion; ③ Spray hemostatic agent, such as 80 mg/L norepinephrine or thrombin, can be used for local hemostasis under gastroscope; Or inject a hemostatic agent, such as epinephrine 1 ~ 2 mg, and add 10% saline 10ml for acupoint injection; Or high-frequency electrocoagulation to stop bleeding; Or microwave hemostasis; Or laser hemostasis.
4. Etiological treatment: ① Stress lesion or ulcer bleeding, or intravenous injection of H2 receptor blocker cimetidine or ranitidine can be selected; Or oral losec 20mg twice a day; (2) When esophageal and gastric varices rupture and bleed, a three-lumen tube should be placed to stop bleeding. Generally, 200ml of gas or water is injected into the gastric sac at a pressure of 5.3 ~ 6.6 kPa and pulled by a pulley of 1 ~ 2 kg. After 24 hours, the bleeding stops, and the deflation can be observed for another 24 hours. At the same time, pituitrin 20U was added into glucose solution 100ml, and it was intravenously dripped, and repeated every 3 ~ 4 hours 1 time. Inject sclerosing agent, usually 1% ethoxysclerosing alcohol or 5% sodium morrhuate, into varicose veins and veins to cause embolization and hemostasis.
5, surgical treatment: mainly suitable for: ① tumor bleeding; (2) Massive bleeding that is ineffective in medical treatment.
How to prevent upper gastrointestinal bleeding in winter?
Season health
Upper gastrointestinal bleeding refers to gastrointestinal bleeding above flexor ligament, including esophagus, gastroduodenal, biliary tract and pancreas. The most common causes are ulcer, esophageal and gastric varices, gastritis and so on. The main manifestations are hematemesis and black stool, and in severe cases, blood pressure drops and coma, which is life-threatening.
Although the primary disease that causes the disease exists all the year round, it can be observed that the number of patients with upper gastrointestinal bleeding increases significantly in winter. This is because the winter climate is cold and there are many sudden changes in temperature. If you don't pay attention to keep warm, it is easy to have upper respiratory tract infection. Most of the primary diseases that lead to this disease are serious, and patients have weak constitution and low resistance, and are more prone to upper respiratory tract infection. Upper respiratory tract infections such as suppurative tonsillitis, paranasal sinusitis, tracheitis, etc. in nasal cavity, throat and oral cavity, their toxins can enter the esophagus and stomach with secretions such as saliva or sputum, leading to digestive tract mucosal ulcers, which are more likely to aggravate the disease on the basis of existing ulcers, varicose veins and other original lesions, leading to blood output. This is why the incidence of this disease increases with the increase of the incidence of upper respiratory tract infection in winter, which is related to the stimulation of digestive tract by bacteria, viruses and their toxins. In addition, due to the cold climate, my appetite is relatively good. If you eat spicy and hot products, such as hot pot food, mutton, dog meat and so on. , will cause blood burning, forcing blood to rush, which is extremely unfavorable to the original sick digestive tract and may lead to the occurrence of this disease.
Therefore, in winter, patients with this disease should not only actively treat the primary disease, but also pay attention to cold and warmth at ordinary times, especially when the temperature changes suddenly, so as to prevent infection. You can eat on time in your diet. Sometimes you are hungry and the temperature is moderate. Food should be digestible, nutritious and less dregs. Food should be cooked soft, eat more vegetables and fruits rich in vitamins, quit smoking and drinking, quit spicy and fragrant things, and prevent noise and high temperature operation. And pay attention to regulating emotions and keeping happy and open-minded. If the original symptoms get worse, we should be vigilant and seek medical advice in time.
Family first aid for upper gastrointestinal bleeding
The main manifestations of upper gastrointestinal bleeding are hematemesis and melena. It is often caused by gastric and duodenal ulcer, liver cirrhosis complicated with esophageal or gastric varices rupture and gastric cancer.
Before bleeding, most patients were accompanied by nausea, epigastric discomfort or pain. People who bleed too much will have dizziness, cold sweat, general weakness, pale face, rapid pulse and decreased blood pressure. Vomiting blood is often dark red, mixed with food residues (if the bleeding is urgent and large, it can also be bright red), and the ambassador is brown or tar-like, but it is necessary to exclude the "black stool" caused by patients drinking wine, cherry juice, brown drugs or iron.
When gastrointestinal bleeding occurs, first implement family rescue to stabilize the patient's condition, and call "120" for help. Constantly comfort patients, relieve patients' mental tension and anxiety, and family members should not show nervous mood. Patients can lie flat with their heads down and their feet high. Pillows can be placed on their feet at an angle of 30 degrees with the bed surface, which is beneficial to the blood of lower limbs returning to the heart and ensuring the initial blood supply to the brain.
When vomiting blood, the patient's head leans to one side to prevent blood from being sucked into the trachea; Hemostasis in upper abdomen; At the same time, keep warm, fast and forbid drinking water.
For people who have already had shock, the accumulated blood in their mouth should be removed in time to prevent the blood from being inhaled into the trachea and causing suffocation.
Upper gastrointestinal bleeding
From esophagus to rectum is called digestive tract of human body. With the junction of duodenum and jejunum as the boundary, the upper part is the upper digestive tract and the lower part is the lower digestive tract. Therefore, the upper digestive tract should include esophagus, stomach and duodenum, and any one of these three parts is bleeding, which is collectively called upper gastrointestinal bleeding.
I. Clinical manifestations
1. Hematemesis and melena: Anyone who feels sick and vomits after bleeding due to blood stimulation can vomit blood. If you vomit immediately after bleeding, the blood is bright red; If the blood stays in the stomach for a period of time and vomits out after the action of gastric acid, it is brown like coffee grounds. In addition to vomiting blood, it is more excreted from the intestine. Because hemoglobin forms black iron sulfide through intestinal sulfide, the discharged blood is generally tar-like black stool. Only when the amount of bleeding is large and the blood passes through the intestine quickly, the discharged blood is dark red or occasionally bright red. Generally speaking, when the amount of bleeding is large, there are black stools and hematemesis; When the amount of bleeding is small, there is often only black stool. If the bleeding site is in duodenum, hematemesis is rare.
2. Systemic symptoms caused by bleeding: If the bleeding speed is slow and the amount is small, there are generally no obvious systemic symptoms, and anemia will occur after bleeding for a long time. If the amount of bleeding is large and fast, acute blood loss such as palpitation, cold sweat, pallor and even blood pressure drop may occur.
3. Primary symptoms: The most common causes of upper gastrointestinal bleeding are ulcer, esophageal varices rupture, gastric cancer, esophageal cancer or duodenal cancer, acute gastric mucosal injury and bleeding. If it is ulcer bleeding, there is often a history of upper abdominal pain before bleeding; If it is esophageal variceal bleeding, there is a history of cirrhosis and clinical manifestations of cirrhosis.
Second, the diagnosis points
1. According to bleeding symptoms such as hematemesis and melena, it is not difficult to diagnose upper gastrointestinal bleeding, but to make clear the cause and location of bleeding, it is necessary to combine medical history and auxiliary examination.
2. After bleeding, timely gastroscopy or duodenoscopy can find the bleeding focus, determine the cause of bleeding and know whether it is still bleeding. The appropriate time for endoscopic examination is 24-48 hours after the bleeding stops. Because acute gastric mucosal injury and bleeding can often be repaired about 48 hours after bleeding stops, if gastroscopy is performed 48 hours after bleeding stops, the cause of bleeding may not be found. If endoscopic examination is performed during bleeding, the blood will affect the endoscopic field of vision, which may affect the correctness of diagnosis. But sometimes the bleeding does not stop, so emergency surgery should be considered. In order to be "aware" during the operation, acute endoscopy is usually performed at the stage of preoperative bleeding.
3. Gastrointestinal barium meal fluoroscopy (CI for short) is also a common and effective method to understand the diseases of esophagus, stomach and duodenum, but it can only be performed more than one week after the bleeding stops, because swallowing barium and squeezing the stomach during the examination may lead to the possibility of rebleeding of the bleeding focus that has not healed for a long time. At the same time, CI can not clearly show acute gastric mucosal injury, bleeding, superficial ulcer, early cancer and so on, which may lead to missed diagnosis. So endoscopy should be the first choice.
Third, the treatment plan
1. Hemostasis and blood volume supplement should be the main methods of acute bleeding.
2. After the cause of bleeding is known, treatment measures should be taken according to the primary disease. For example, ulcer bleeding should be given antacids and drugs to strengthen the barrier function of gastric mucosa; If esophageal and gastric varices rupture and bleed, drugs to reduce portal vein pressure can be used; Cancer bleeding should be operated as soon as possible.
Acute upper gastrointestinal bleeding
Upper digestive tract refers to acute bleeding caused by diseases of digestive tract (esophagus, stomach, duodenum, pancreas and biliary tract) above flexor ligament.
[Clinical manifestations]
1. Symptoms
(1) Hematemesis and melena: These are the characteristics of gastrointestinal bleeding. Hemorrhage above pylorus is usually hematemesis, and hemorrhage below pylorus is often manifested as melena. People with black stool may not vomit blood, but people who vomit blood will have black stool. Black stool can appear when the amount of bleeding is 50-70 ml at a time. When the blood in the stomach reaches 250-300 ml, it can cause hematemesis.
(2) Symptoms of hemorrhagic peripheral circulation failure: When the patient's bleeding volume exceeds 400-500 ml, general symptoms such as dizziness, fatigue and palpitation may occur. When the short-term bleeding volume is greater than. 1000ml, symptoms of systemic circulation failure appear: besides systemic symptoms, people often feel thirsty, and they often faint to the ground immediately after defecation or defecation.
2. Signs: anemia, listlessness, cold skin and limbs, decreased blood pressure, tachycardia, dull heart sounds, oliguria, low fever, liver palm, spider nevus and other signs.
[diagnosis]
1. Symptoms and signs.
2. Laboratory examination: fecal occult blood is positive. Hemophilia, white blood cells and platelets increased in a short time due to stress reaction after blood loss. Blood biochemical urea nitrogen increased.
3. Endoscopy and selective arteriography can diagnose the disease.
[therapy]
1. General treatment: supine position, keeping respiratory tract unobstructed, fasting.
2. Replenish blood volume: Patients with massive hemorrhage should quickly replenish blood volume and pay attention to the balance of acid, alkali and electrolyte. Patients with liver cirrhosis should be supplemented with new blood during blood transfusion.
3. Treatment of non-variceal bleeding
(1) gastric lavage with ice salt water: the lower part of the gastric tube is repeatedly washed with 4℃ ice salt water, and after washing, Yunnan Baiyao, Notoginseng Radix, Bletilla striata powder and other traditional Chinese medicines can be injected to stop bleeding. You can also add 8mg of norepinephrine to iced saline (100rd), inject it into human body through gastric tube, and suck it out after 30-45 minutes? Br> references:
Guobule CPO physiological health network