What are the symptoms of gastric bleeding? How is the treatment carried out?

The stomach is an important organ in the human body. If the stomach is diseased, it will have a great impact on the body's digestive function. Gastric bleeding is a relatively serious disease. Patients generally have symptoms such as vomiting blood, anemia, and fever. If the amount of bleeding is large, it may even cause shock, fainting, weakness, and low blood pressure. Treatment methods include general treatment, blood volume replacement therapy, or other measures to stop bleeding.

1. Symptoms

1. Vomiting blood and/or black stools: are characteristic manifestations of upper gastrointestinal bleeding. Patients with bleeding above the pylorus often experience vomiting blood and black stools, while patients with bleeding below the pylorus may only experience black stools. However, lesions above the pylorus with a small amount of bleeding and a slow bleeding rate may only cause black stools, while lesions below the pylorus with a large amount of bleeding and a fast bleeding rate may cause vomiting of blood due to the reflux of blood into the stomach.

2. Hemorrhagic peripheral circulatory failure: Bleeding within 400 ml may be asymptomatic. Moderate bleeding may cause anemia or progressive anemia, dizziness, weakness, and sudden standing may cause syncope, thirst, cold limbs and low blood pressure. Massive bleeding reaching 30% to 50% of the total blood volume can cause shock, which is manifested as irritability or confusion, pale complexion, cold and clammy limbs, cyanosis of the lips, difficulty breathing, blood pressure dropping to unmeasurable levels, decreased pulse pressure difference, and a rapid and weak pulse. If not handled properly, it can lead to death.

3. Azotemia.

4. Anemia and changes in blood picture: After acute massive bleeding, there will be hemorrhagic anemia. In the early stage of bleeding, there may be no obvious changes in hemoglobin concentration, red blood cell count and hematocrit. Generally, it takes more than 3 to 4 hours for anemia to appear. After 2 to 5 hours of massive upper gastrointestinal bleeding, the white blood cell count may increase significantly and return to normal 2 to 3 days after the bleeding stops. However, in patients with cirrhosis and hypersplenism, the white blood cell count may not increase.

5. Fever: In cases of moderate or massive bleeding, fever occurs within 24 hours, mostly below 38.5 degrees, and lasts for several days to a week.

2. Treatment Methods

1. General treatment: Patients with heavy bleeding should lie flat with their lower limbs raised and their heads turned to the side to avoid suffocation caused by blood reflux when vomiting a lot of blood. Oxygen inhalation and fasting should be performed if necessary. If there is a small amount of bleeding, the patient can take liquid food appropriately. Morphine and barbiturates should be avoided for patients with liver disease. Nursing should be strengthened, blood pressure, pulse, bleeding volume and hourly urine output should be recorded, intravenous access should be maintained, and central venous pressure measurement and electrocardiogram monitoring should be performed when necessary.

2. Replenish blood volume: When hemoglobin is lower than 70g/L and systolic blood pressure is lower than 90mmHg, sufficient amount of whole blood should be transfused immediately. People with cirrhosis should receive fresh blood transfusions. Infusion should be started quickly, but the elderly and patients with heart failure should not receive too much or too fast transfusion, otherwise it may cause pulmonary edema. It is best to monitor central venous pressure. If blood supply is difficult, dextran or other plasma substitutes can be given.

3. Hemostasis measures

(1) Drug treatment: targeted treatment of peptic ulcer.

(2) Compression hemostasis with three-chamber balloon tube

(3) Endoscopic hemostasis

(4) Vascular interventional technology

(5) Surgical treatment: After the above treatment, most upper gastrointestinal bleeding can be stopped. If it still doesn't work, surgical treatment can be considered.

3. Dietary precautions

It is better to start with liquid food, rice soup, and lotus root powder, and drink milk in moderation. Do not drink foods that are too sour or too sweet, as these will increase acid production. Eat small meals frequently and keep the food warm. Overheated food may dilate the blood vessels in the gastric mucosa, which is not conducive to stopping bleeding. Strong tea and strong coffee should be avoided. If the food is bland, adding a little salt is harmless. After the bleeding stops, you can gradually increase the variety and quantity of food.

Gastric bleeding is a common complication of peptic ulcer disease. Generally speaking, you can eat when you have gastric bleeding as long as you don't vomit blood. However, patients with vomiting blood must fast to prevent vomiting after eating, which may cause suffocation due to vomiting or vomiting blood. Usually, you can consider resuming eating 12 hours after vomiting blood stops, regardless of whether black stools are still present. If vomiting blood occurs again, fasting should be resumed.