Gastrointestinal bleeding

I believe many of my friends are familiar with the disease of massive gastrointestinal bleeding. In our lives, we often hear about the occurrence of this disease. I wonder if you know much about the symptoms of this common disease. Now, let us learn about the specific symptoms of massive gastrointestinal bleeding and learn about it in case of emergency in life.

For the disease of massive gastrointestinal bleeding, it may be caused by inflammation, damage or tumors of the digestive tract itself. This disease is a relatively dangerous disease for us. If it is not handled properly, it may endanger our life and health. The following are the specific clinical manifestations of this disease.

1. General Condition

The amount of blood loss is small, below 400 ml, and the blood volume is slightly reduced, which can be compensated by tissue fluid and spleen blood storage. The circulating blood volume is improved within 1 hour, so there may be no subjective symptoms. When symptoms such as dizziness, palpitations, cold sweats, fatigue, and dry mouth appear, it means that the acute blood loss is more than 400ml; if there is fainting, cold limbs, little urine, and irritability, it means that the amount of bleeding is large and the blood loss is at least more than 1200ml; if the bleeding continues, in addition to fainting, there is also shortness of breath and anuria, then the acute blood loss has reached more than 2000ml.

2. Pulse

Changes in pulse are an important indicator of the extent of blood loss. In acute gastrointestinal bleeding, blood volume decreases sharply and the initial compensatory function of the body is to increase the heart rate. Reflex spasm of small blood vessels causes blood stored in the sinusoids of the liver, spleen, and skin to enter the circulation, increasing the amount of blood returning to the heart and adjusting the body's effective circulation volume to ensure blood supply to important organs such as the heart, kidneys, and brain. Once the amount of blood loss is too great and the body's compensatory function is insufficient to maintain effective blood volume, the person may enter a state of shock. Therefore, when there is heavy bleeding, the pulse is fast and weak (or thin and weak), and when the pulse increases to more than 100 to 120 beats per minute, the blood loss is estimated to be 800 to 1600 ml; when the pulse is subtle or even unclear, the blood loss has reached more than 1600 ml.

3. Blood pressure

Changes in blood pressure, like pulse, are a reliable indicator for estimating blood loss.

When acute blood loss is more than 800 ml (accounting for 20% of the total blood volume), systolic blood pressure may be normal or slightly elevated, and pulse pressure is small. Although the blood pressure is still normal at this time, it has entered the early stage of shock and the dynamic changes in blood pressure should be closely observed. In case of acute blood loss of 800-1600 ml (accounting for 20%-40% of the total blood volume), the systolic blood pressure can drop to 9.33-10.67 kPa (70-80 mmHg) and the pulse pressure is small. In case of acute blood loss of more than 1600 ml (accounting for 40% of the total blood volume), systolic blood pressure can drop to 6.67-9.33 kPa (50-70 mmHg). In more severe bleeding, blood pressure can drop to zero.

4. Blood picture

Hemoglobin measurement, red blood cell count, and hematocrit can help estimate the extent of blood loss. However, in the early stages of acute blood loss, the above values ​​may remain unchanged temporarily due to compensatory mechanisms such as blood concentration and blood redistribution. Generally, tissue fluid needs to infiltrate into the blood vessels to replenish blood volume, that is, a decrease in hemoglobin will not occur until 3 to 4 hours later. On average, hemoglobin can be diluted to the maximum extent 32 hours after bleeding. If the patient is not anemic before bleeding, and the hemoglobin drops to below 7g in a short period of time, it means that the amount of bleeding is large, more than 1200ml. The white blood cell count may increase 2 to 5 hours after massive hemorrhage, but usually does not exceed 15×109/L. However, in cases of cirrhosis and hypersplenism, the white blood cell count may not increase.

5. Urea nitrogen

A few hours after massive upper gastrointestinal bleeding, blood urea nitrogen increases, reaches a peak in 1 to 2 days, and returns to normal within 3 to 4 days. If bleeding occurs again, urea nitrogen may increase again. The increase in urea nitrogen is due to the large amount of blood entering the small intestine and the absorption of nitrogenous products. The decrease in blood volume leads to a decrease in renal blood flow and glomerular filtration rate, which not only increases urea nitrogen but also creatinine. If creatinine is below 133 μmol/L (1.5 mg%) and urea nitrogen is >14.28 mmol/L (40 mg%), it indicates upper gastrointestinal bleeding of more than 1000 ml.

I believe that after reading the above introduction, many friends should now have some understanding of the clinical symptoms of gastrointestinal bleeding. In fact, in our lives, when we find that our friends have the above symptoms, as long as we go to the hospital for diagnosis in time and actively receive treatment, our health can be guaranteed.