A nasal bleeding is called bleeding from the inside of the nasal cavity or from the nasopharynx. It can appear in two places of the nasal department: in the front sections of the nose (this place is called Kiselbach) and in the lower nasal shell of the front sections of the nose.

There is also rear bleeding, which occurs in the rear sections of the nose and nasopharynx (bottom nose sink or its arch). More often such a state is observed in children under 10 years and people over 50 years old.

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Odnoklassniki.

IN international Classification Diseases (ICD-10) has its own code, which is referred to as follows: R04.0 Nasal bleeding.

If such a problem appears, it is necessary to know how to render emergency help With nasal bleeding, the patient to maximize it to help him. The algorithm of first aid aid for nasal bleeding will be like this:

1. Before providing 1 assistance in nasal bleeding, as far as the patient is as serious. It is necessary to immediately evaluate this phenomenon, is it possible to cope with blood loss independently or have to expect help from doctors.
2. Then it is necessary to initially calm down and calm the victim. Ask a person to start deeply breathing, it will reduce the emotional cargo, it will reduce the heart rate, it may be possible to prevent blood pressure jump. Since all these circumstances are able to aggravate the situation.
3. Proponial assistance in nasal bleeding is done in this way: to take a person more convenient. It is important that the head of the victim leaned forward, so the blood fluid will flow without obstacles.
4. The nostril from which bleeding is observed must be pressed to the partition and so keeps in a few minutes. After these actions in the area of \u200b\u200bthe damaged vessel, a thrombus is formed.
5. In the nasal moves it will be necessary to drip any vasoconstrictor drops, from a series of naphtizin, galasoline, and the like. In each nasal department of 6-8 drops.
6. Then, several (8-10) droplets in both nasal holes are dripped 3% hydrogen peroxide.
7. To the area of \u200b\u200bthe nose you need to apply wet towel Or another cold subject. Such compress is maintained for 15-20 minutes, after that a pause is 3-4 minutes. The action is repeated up to 2-3 times.
8. Another way of providing first aid with nasal bleeding is the immersion of brushes into cool water, and the stop in warmth. Due to this, the narrowing of the walls of the vessels occurs, and the blood fluid will soon stop flowing.

In the period of nasal bleeding, the first medical care is extremely important, the further state of a person will depend on this. If the state was stopped, it is not necessary to drink hot drinks in the near future and there are hot dishes, as well as intensively play sports. It is advisable to see a doctor if this has not been done.

The reasons for the nasal blood pressure isetled, external circumstances, local and general factors can contribute to that. It is worth considering the most common reasons affecting the occurrence of blood from the nose.

The external causes of blood discharge from the nose:

1. Poor moisture indoors, which causes dry dryness, especially in winter, when the heating system is enabled.
2. Overheating of the body.
3. Atmospheric changes or barometric differences, this can occur when lifting up or when immersed to depth.
4. The effects of toxic or poisoning substances on the body, when working in harmful enterprises.
5. Reception of certain types of medical preparations.
6. Inhalation of drugs, especially cocaine.

Local causes of nasal bleeding:

1. Nasal damage.
2. ENT disease.
3. If the watches of the nasal partition is observed, there are vascular disorders, the layer of the mucous membrane in the nasal cavity is changed.
4. Tumor process in the nose - adenoids or polyps. Pretty rarely are malignant growths, such as sarcoma or carcinoma.
5. Penetration of the foreign object in the nasal passage, or different insects, etc.

Head position when nasal bleeding occurs

Causes of frequent nasal bleeding in adults general:

1. The fragility of the vessels due to changes in their wall, as a result of diseases such as vasculitis, vascular atherosclerosis, various infections, lack of vitamins.
2. Violations of the hormonal plan.
3. Hypertension. Contribute to this state such diseases as atherosclerosis, heart violations, chronic pyelonephritis, adrenal diseases, etc.
4. Blood pathology. it bad coatability, anemic condition, leukemia, low level platelet.
5. Cirrhosis of the liver.

The reason should be revealed by a comprehensive body examination, the blood test and coagulogram is submitted.

Why only from one nostril?

Bleeding from one nostrils in adults also arises as a result of various reasons, they can be local and common.

Local factors affecting the emergence of bleeding from one nostrils:

• injury internal nasal structure;
• the need for a long time is under the scorching sunshine;
• inflammation developed in the nose;
• all sorts of tumors, such as polyps, angioma, papillomas and granulomas, sometimes sarcoma, which relate to cancer neoplasms.

General reasons:

• hypertension;
• ARVI, flu and other colds;
• hemorrhagic diathesis, hemophilia;
• due to specific working conditions, for example, such a phenomenon is often at pilots, divers, high-tip climbers, etc.;
• diseases of the spleen or liver.

If blood is very much from the nose

It happens that blood goes so hard that it is difficult to stop, usually it happens as a result of damage to the vascular wall.

• abundant bleeding from the nose threatens significant blood loss, and it can even end with a fatal outcome;
• approximately 20% of the population suffering from this pathology needs emergency medical care;
• the most non-hazardous bleeding is the front, it occurs in 90-95% of people;
• arterial hypertension refers to the most frequent reasons for blood flowing from the nose;
• in 85% of cases, this symptom occurs against the background of common pathological reasons, and only in 15% of cases, blood from the nose is developing due to violations in the work of the authority itself.

What does this mean: signs and symptoms

The forefront of bleeding is characterized by the fact that the blood is formed in the front of the nose.

At the background, the deeper departments of the structure of the nose are involved. Sometimes blood from the nose does not flow, as it flows into the throat. As a result, the following symptoms arise:

1. Nausea.
2. Vomiting with blood impurities.
3. Hemochka.
4. Chair is tarmed, that is, black, this is due to the fact that the blood, under the influence of digestive enzymes, acquires a resin shade.

Symptoms of this state will depend on the volume of blood loss.

If blood loss is not so significant (up to a few milliliters), the general well-being of a person does not change. The exceptions make up a constant person, or people who are afraid of blood, they can develop snowstanding condition or hysteria.

If the bleeding is long, then with time such signs arise:

• general weakness;
• before the eyes appear flies;
• feeling thirst;
• dizziness;
• frequent heartbeat;
• pale skin cover and mucous membranes;
• developing shortness of breath.

If the blood loss indicator has already been 20%, then the development of hemorrhagic shock, which is manifested as follows:

• inhibition of consciousness;
• frequent heart blows;
• it is tested by a threaded pulse;
• blood pressure jumps that subsequently lead to its decrease;
• reducing the amount of urine or it is completely absent.

Blood from the nose in pregnant women can be observed both at the beginning and at the end of the baby tooling, only here the reasons for this circumstance can be different. In the first trimester, this condition may be due to physiological changes in the body of a woman. There is a relationship with an increased progesterone - hormone, which is responsible for the preservation and normal development of pregnancy.

Because of the actions of progesterone in the entire system of a pregnant woman, blood flow is enhanced. Sometimes small capillaries do not stand such pressure and burst, for this reason, nasal bleeding can develop.

After 20 weeks of pregnancy, it is possible to develop such a complication as gestosis in which the pressure on the artery increases, which leads to the appearance of blood from the nose. Other factors affecting the frequent isolation of blood from the nose are characterized by a shortage of vitamins and nutritional trace elements, injuries, the drying of the mucous membranes of the nose, weak blood coagulation.

The children's body is extremely susceptible to bleeding from the nose, the reasons for the following:

1. Blow on the nose or mechanical effect on the body mucous membrane. The child often fuss his fingers into the nose or trying to chant in the nostrils any small item.
2. Defects of an anatomical nose structure.
3. Infections of bacterial or viral plan.
4. Weakening immune system, avitaminosis.
5. Thermal or chemical burns.
6. Overheat.
7. Various pathologies, often it is hemophilia, liver and spleen anomalies, a tumor process in the nasal cavity.
8. Dry indoor.

In the transitional age, the child's body undergoes changes, both anatomical and physiological plan. The appearance of blood from the nose is often not associated with diseases. After completing the adolescence and puberty, everything will come to a normal state.

Regular bleeding from the child's nose should not leave his parents indifferent, be sure to consult a doctor.

Causes of nose bleeding in the adolescence:

• getting injury or nose injury as a result of fighting, games or accident;
• various growths, for example, cystic education, polyps and adenoids;
• the nasal partition can be twisted from birth or have acquired character;
• the weakening of the capillary walls due to the increased load of the physical plan, overheating, supercooling, etc.

Useful video

A few words about the features of the blood supply to the nose cavity:

Conclusion

1. All listed reasons must establish a doctor after diagnostic measures.
2. If necessary, therapy will be assigned, which will relieve a person from frequent bleeding from the nose.
3. Do not forget that the reasons for bleeding from the nose set and not all of them are harmless, sometimes such a state can serve as a symptom of dangerous pathologies.

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One of the heavy complications of various diseases - gastrointestinal bleeding, it is the expiration of blood into the lumen of the stomach or intestine from the vessels passing under the mucous membrane. Pathology is dangerous in that it is not always possible to immediately recognize, blood loss is often severe, and can lead to a fatal outcome.

It is necessary to know at what ailments it may arise this complication, as manifests itself to suspect it in time and take the necessary measures.

According to the international classification of diseases of the ICD-10, gastrointestinal bleeding has a general code K92, with the exception of bleeding in newborns with the P54 code.

All causes that lead to gastrointestinal bleeding can be divided into 2 groups:

• associated with the pathology of digestive organs;
• non-illness digestive system.

The 1st group includes:

In case of ulcers and erosion, when the defect is located near the large vessels, their wall is destroyed under the influence of hydrochloric acid and enzymes.

The reason may be a long use of aspirin and its analogues, hormonal agents.

The 2nd group is the pathology of other bodies:

• blood coagulation impairment (hemophilia, thrombocytopenia, anticoagulant, DVS syndrome);
• diseases blood vessels (capillaryotoxicosis, vasculitis, atherosclerosis);
• diseases of the circulatory system (hypertension, heart failure);
• severe intoxication;
• renal and liver failure;
• card and brain injury;
• stressful situation.

Ethiology with low coatability, pathology of vessels, intoxication, lack of liver and kidney is not associated with the rupture of vessels, but with an increase in their permeability. With hypertension, atherosclerosis in the elderly, the arteries gap can occur, and in the heart venous wagging Overflow and break veins. Heavy brain injuries and stress can be accompanied by the formation of sharp deep ulcers in the stomach, intestines.

Classification

The existing classification is based on the peculiarities of gastrointestinal bleeding, while the location of the source, the clinical course, intensity, the degree of blood loss is taken into account.

According to anatomical sign

Allocate 2 bleeding groups:

1. From the top department of the digestive tract, which includes the esophagus, stomach, a 12-risk intestine. From the lower section - skinny, ileum, colon (colon, sigmoid, straight).
2. From the lower department - skinny, iliac, colon (colon, sigmoid, straight).

By clinical flow

Distinguish 3 types of bleeding:

1. Acute - With a sudden beginning and pronounced symptoms, characterized for ulcers, varicose veins of the esophagus, mellore-wais syndrome.
2. Chronic - with periodic insignificant blood loss, characteristic of polyps, diverticulus, crown disease, inflammatory process.
3. Recurrent - The resulting re-may have different reasons.

By intensity

Distinguish 2 types of bleeding:

Severity of gastrointestinal bleeding

Depending on the magnitude of the blood loss and the patient's condition, 4 degrees of gravity are distinguished:

1. Easy: loss of blood not more than 5% of the total general state Satisfactory, pressure within the normal range, small tachycardia - up to 100 ° C. per minute, hemoglobin 100 and more g / l.
2. Average: Blood loss 6-15%, condition middle severityThe pressure is reduced to 80 mm Hg. Art., hemoglobin 90-80 g / l.
3. Heavy: Blood volume deficiency 16-30%, condition is severe, pressure 70-60 mm RT. Art., hemoglobin is reduced to 50g / l;
4. Extremely heavy: Blood deficiency more than 30%, pressure below 60 mm RT. Art., pulse threaded, can be determined only on carotid arteries, patient in a state of hemorrhagic shock, coma, unconscious, on the verge of agony.

Symptoms

Clinical manifestations are accompanied by obvious bleeding, when blood loss is tangible for the body. Developed by syndrome consisting of local and general signs of gastrointestinal bleeding.

Local symptoms are: nausea, vomiting with blood, blood presence in feces. The nature of vomiting may be different. If the blood flowed into the stomach, it is exposed to gastric juice and acquires a brown color, has a view of a coffee ground. When the source of bleeding in the esophagus, the blood is fresh, with clots, with varicose veins of esophageal veins, it is often vomiting with the blood "fountain".

Blood in feces can also have a different look. When the source is located in the upper part of the tract, the blood is exposed to gastric juice and digestive enzymes, hemoglobin turns into a salty-sized hemathin, which has a gray-black color. Cal in these cases has a kind of tar and a malware.

From the lower divisions of the intestine, blood in feces will have a form of clots, bloody impurities in the form of strips, or stand out in a fresh form if the object is located in the rectum. It may be scarlet or dark, depending on which blood vessels or veins. It is characterized by a symptom of reduction or disappearance of abdominal pain, if it was before bleeding (for example, with ulcers, gastritis).

Common symptoms of bleeding are:

• pallor skin;
• general weakness, dizziness, fainting condition;
• reduced blood pressure, pulse;
• in severe cases - cold sticky sweat,
• inhibition, loss of consciousness.

Diagnostic methods

When inspection, the overall condition of the patient, the color of the skin, pulse, pressure, the presence and character of the vomit, chair, and the character of the vomit. If the patient does not remember, they make a finger study of the rectum. The palpation of the belly is carried out with caution, so as not to cause extra injury.

The diagnosis is based mainly on additional methods Studies to determine the source and severity of pathology. These methods include:

Differential diagnosis is aimed at identifying the nature and causes of gastrointestinal bleeding, take into account the data of the anamnesis, inspection and additional studies. The set of results makes it possible to distinguish bleeding associated with diseases of the digestive system, from those caused by diseases of the vessels, blood system, circulating disorders, intoxications, infections, medication reception.

Urgent Care

If on the basis of anamnesis and clinical manifestations there is reason to suspect bleeding, you need to immediately call ambulance And proceed to such urgent action:

• put the patient on a flat surface, unbutton the belt, gate, ensure fresh air access;
• to put a cold on the abdomen area, it may be ice in a plastic package, a bubble or a heated water;
• rotate the head in case of vomiting so that there is no asphyxia;
• measure the pulse, pressure and before the "ambulance" arrive to control them every 10-15 minutes;
• if the pulse disappeared, proceed to closed massage Hearts and artificial respiration.

Actions that cannot be performed:

• leave a patient one, because it can sharply fall the pressure, stop cardiac activity when resuscitation measures will be required;
• allow the patient to rise, provide him to the toilet in bed - Vessel for urine, ship;
• rog the stomach, give drink, food, medicines.

Patients with bleeding are hospitalized in a variable order to the surgical department of the hospital.

Treatment of gastrointestinal bleeding

Medical tactics in gastrointestinal bleeding depends on their character and severity, it can be conservative or surgical.

Conservative treatment

If bleeding is not heavy, does not progress, prescribe medication therapy: hemostatic drugs, anti-diamemine products - iron preparations, vitamin B12, foliic acid, overflow blood components - platelet, erythrocyte mass, replenish the volume of circulating blood.

Conduct treatment of the underlying disease: peptic disease, vascular pathology, disorders of the coagulation system and organ functions.

Surgery

The ineffectiveness of conservative measures and heavy bleeding is indicated to operational treatment. It can be performed by endoscopic method or laparoscopic. When endoscopy through a probe, depending on the situation, coagulation, ligation (flashing) of the vessel, impose vascular clips or acrylic glue is introduced.

In case of ineffectiveness of such a procedure, surgical intervention in vital indications - by the method of laparotomy (traditional cut) or laparoscopy (through the probe). Eliminate a bleeding area by firmware, resection, polypa removal, diverticulus, tumors.

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Features of bleeding in children

In infants, the most frequent causes of blood appearance in the digestive tract are congenital pathology: hemorrhagic disease, anomalies (doubling of the stomach and intestines), Diesel's disease and Randu-Osler syndrome (vessels anomalies), internal angioma, Peteza-Jershs syndrome (intestinal polyposis), Diaphragm hernia, meckel diverticulus.

As a result strong vomiting May occur syndrome Mellory Weis. At an older age, the cause is sharp erosion and ulcers, portal hypertension, intestinal obstruction, inflammatory process, ingress of foreign bodies.

A feature of bleeding in children is often the absence of severe symptoms, up to loss of 15% of the circulating blood, and then the sudden loss of consciousness occurs. Therefore, it is necessary to be extremely attentive to the child, always inspect the chair. The principles of diagnosis and treatment in children are the same as in adults, but the leading method is surgical, since most reasons are rude anatomical changes in a congenital character.

The consequences of gastrointestinal bleeding

Acute blood loss can lead to the development of severe complications:

• acute anemia;
• acute insufficiency internal organs (heart, kidneys, liver);
• hemorrhagic shock;
• comatous state, death.

The consequence of small but multiple blood loss is chronic anemia, Hypoxia internal organs with the development of dystrophic changes in the heart, liver, kidneys, disruption of the function of the central nervous system.

Prediction and prevention

With hidden small bleeding, the forecast is favorable, but relatively. Not established reason and not a treated disease can lead to an increase in blood loss. Massive and profuse bleeding have an unfavorable forecast, their mortality is about 80%, while the overall mortality in this pathology varies within 5-23%.

Prevention is attentive to health, regular visits to the doctor and passage of preventive inspections. In the presence of chronic diseases, especially peptic, liver pathology, intestines, vessels, blood systems must be observed by a doctor, periodically undergo a survey and controversial treatment.

Bleeding - The expiration of blood from the blood vessel with impaired integrity or permeability of its wall.

Code for the international classification of diseases of the ICD-10:

• H92.2.
• I85.0.
• K62.5.
• P50.3.
• P50.4.
• T79.2.

Classification. By etiology .. Traumatic - bleeding as a result of mechanical damage to the wall of the blood vessel .. Non-imaginary - bleeding as a result of pathological changes in vessels (arrosion, bundle wall), for example, atherosclerosis, syphilis, malignant neoplasms, purulent inflammation, blood dilapidation disorders .. postoperative bleeding There are in patients with impairment of blood flowability (long jaundice, echinococcosis of the liver, internal combustion), when scolding or teething a ligature superimposed on a vessel. At the point of blood expiration .. The external - the expiration of the blood into the external environment through damaged skin and mucous membranes .. Internal - bleeding into the lumen of the hollow organ or body cavity: ... in the gastrointestinal gastrointestinal bleeding ... bladder - Hematuria ... in the uterus - hematometer ... in the trachea and bronchi - light bleeding ... hemorrhage and hematomas. By the time of occurrence .. Primary - bleeding, arising at the time of injury .. secondary - bleeding, arising after a while after injury and caused by the injection of wounds, violations of blood consumption, etc. . By the source of bleeding .. Blood bleeding - the blood is bright - red, pulsates, flows the jet. Bleeding from large arteries (aorta, sleepy, femoral, shoulder) can quickly lead to a heart stop .. Venous bleeding - blood dark red, flows slow jet. Bleeding from large veins (femoral, subclavian, jugular) is life-threatening due to significant blood loss and possible development of an air embolism .. Capillary bleeding is bleeding the entire surface of the wound, as a rule, stops independently. Danger represent capillary bleeding in patients with violations of blood flowing (for example, hemophilia) .. parenchymal bleeding - occurs when damaged the fabric of parenchymal organs (liver, kidney, spleen, etc.). The walls of the blood vessels of these organs are fixed and do not fall, therefore bleeding itself rarely and leads to a large blood loss.

Symptoms (signs)

Clinical picture. General symptoms - the pallor of the skin and mucous membranes, dizziness, weakness, yawning, thirst, tachycardia, decreased blood pressure. In the case of the development of hemorrhagic shock - loss of consciousness, cold sweat. With long bleeding - a decrease in Hb and HT (blood breeding). Outdoor bleeding is diagnosed easily due to the presence of the wound. Often, during injuries there are simultaneous damage and arteries and veins, as a result of which it is impossible to unequivocally characterize the bleeding as arterial or venous. Damage to the main vessels represent the greatest danger. Internal bleeding .. when bleeding in abdominal cavity - dulling the percussion sound in the detached places of the abdominal cavity .. when bleeding into the pleural cavity - dulling of the percussion sound, the movement of the mediastinum in the opposite direction, the weakening of breathing on the side of the lesion, with a radiographic study - hydrotorax .. during bleeding in the pericardia cavity - the expansion of the heart boundaries, Weakening of the tones .. Even a small inner blood loss in a closed space can be life-threatening due to the compression of the blood of vital organs (brain, heart).

Treatment

TREATMENT

Temporary bleeding is aimed at preventing massive blood loss and allows you to win time for the final stop of bleeding .. The imposition of the gulling bandage is shown to stop small outer bleeding: venous, capillary, from the arteries of small-scale caliber, bleeding from wounds located on the body (for example, on the jagbon region ), forearm, shin, scalp. The wound is imposed with a sterile gauze napkin, from above - a non-pronounced bandage or a rebound material, and then apply a tight circular bandage .. The finger pressed arteries during the dice stops the bleeding almost instantly. The disadvantage is a small duration (10-15 minutes) due to the fatigue of the hands providing first assistance, but during this time other methods of stopping bleeding can be applied, for example, put the harness ... The total carotid artery is pressed against the transverse process with the VI ... Connect artery - in the test jam to the I edge ... shoulder artery - to shoulder bone In the inner edge of the two-headed muscles on the inner surface of the shoulder ... The femoral artery is to the pubic bone in the middle of the distance between the pubic and the upper front of the iliac bone. Pressure is produced big fingers Both hands or fist ... The popliteal artery is pressed against the rear surface of the tibia in the field of the patented holes. The imposition of the harness is shown during bleeding from the femoral or shoulder arteries. Venenous bleeding stop the tight bandage and the sublime position of the limb. Instead of a standard hemostatic harness, various braid means and cloth spins can be used ... The harness is applied to a proximal wound ... Criterion for adequateness of the imposition of a harness - a stop of bleeding. Continuing bleeding may indicate incomplete criticism of the artery and bleeding from one-time damaged veins ... Hartems must be applied through a lining, you can not apply on the skin ... The maximum period is 2 hours, after which you need to remove the harness, spending the finger pressed artery immediately above the wound . After a short time, the harness is replaced again, and the proximal than the previous level. When you embed a harness, you should fix the overlay time (time is recorded directly on the skin or under the harness leave a piece of time with a time entry) .. The maximum flexion of the limbs in the joint with additional compression of the vessel due to the laying over the artery of the roller (bandage) leads to cessation of bleeding ... The forearm is maximally flexed in the elbow joint and fixed with the help of bandage to the shoulder ... When bleeding from wounds of the top of the shoulder and the plug-in area, the upper limbs are settled behind the back with a bending in the elbow joint and fix the bandage or both hands start back with bending in the elbow joints and attract each other with a bandage ... Low limb Flex in the knee and hip joints and fix it .. Pressing the vessel in the wound with your fingers and the imposition of the clamp on the bleeding vessel is used mainly during surgical interventions.

Final cessation of bleeding .. Tinging the vessel in the wound or throughout .. flashing soft fabrics and bandage to them together with a vessel located in them .. Electro-mapping of a vessel .. overlay vascular seam or vessel prosthetics .. wound tamponade .. pressed to wound parenchymal tampon , moistened with hot (50-70 ° C) sterile 0.9% p-rum sodium chloride by 3-5 min. exposure to low temperature .. For parenchymal bleeding - processing of laser scatteled beam, plasma flow .. Chemical method - the use of vasoconstructuring Funds (1-2 ml of 0.1% P - RA Epinephrine) or means to increase blood consumption (for example, 10 ml of 10% R - calcium chloride calcium) .. Biological methods ... Tamponade Wounds with muscle or gland ... Application Thrombin, sponges with fibrin, hemostatic sponge ... Transfusion of drugs and blood components.

The sublime position of the limb and ensuring rest.

MKB-10. H92.2 Bleeding from ear. I85.0 varicose veins of the esophagus with bleeding. K62.5 Bleeding from rear Passage and rectum. P10 Out of intracranial fabrics and bleeding due to generic injury. P26 Light bleeding arising in the perinatal period. P38 Ommophalit Newborn with small bleeding or without it. P50.3 Bleeding at the fetus of another single twin. P50.4 Bleeding in the fetus in the bloodstream of the mother. P51 Bedding from the umbilical cord in the newborn. R04 Bleeding from respiratory tract. T79.2 Traumatic secondary or recurrent bleeding.

In Russia, the International Classification of Diseases of the 10th Review (ICD-10) adopted as a single regulatory document for accounting for incidence, reasons for people's appeals to medical institutions of all departments, causes of death.

The ICD-10 has been introduced into the practice of health throughout the territory of the Russian Federation in 1999 by order of the Ministry of Health of Russia from 27.05.97. №170

A new revision (ICD-11) is planned to be planned in 2017 2018.

With changes and additions to WHO.

Processing and transferring changes © MKB-10.com

Coding of gastrointestinal bleeding in the ICD

The diagnoses of any medical facilities are subject to a single international statistical classification of diseases and problems associated with health, officially evident WHO.

K92.2 - on the ICD 10 of the gastrointestinal bleeding code of unspecified.

These figures are exhibited on the title page of the history of the disease and are processed by statistical authorities. Thus, data on morbidity and mortality due to various nosological units are structured. Also as part of the ICD there is a division of all pathological diseases by classes. In particular, gastrointestinal bleeding belongs to the XI class - "Diseases of the digestive organs (by 00-K 93)" and to the section "Other diseases of the digestive organs (by 90-k93)".

Gastrointestinal bleeding

Gastrointestinal bleeding is a serious pathology associated with damage to blood vessels in the cavity gastrointestinal tract and leakage of blood. In such cases, blood loss can be significant, sometimes it leads to a shock state and can create a serious threat to the patient's life. Intestinal bleeding in the ICD 10 has the code the same as the gastrointestinal intestinal - to 92.2.

In any case, this state is extremely dangerous and requires urgent medical care. Etheological reasons leading to the HCRD:

• ulcerative disease of the stomach or duodenum in the aggravation stage;
• gastroesophageal reflux disease (corrosive vessel walls with aggressive gastric juice);
• chronic or acute hemorrhagic erosive gastritis;
• nonspecific ulcerative colitis, Crohn's disease;
• chronic inflammation of the esophagus;
• long-term intake of non-steroidal anti-inflammatory drugs, glucocorticosteroids, acetylsalicylic acid;
• acute stress and occurrence of ulcers in the gastrointestinal tract under the influence of ischemia and stressful neurotransmitters, hormones;
• hypersection of gastrin as a result of Zolinger Ellison syndrome;
• with a strong indomitable vomiting, the occurrence of breaks in the esophagus, which can bleed;
• enterocolites and colitis of bacterial origin;
• benign and malignant neoplasms in the gastrointestinal tract;
• portal hypertension.

To find the cause of the bleeding, it is necessary to deal with the department that is amazed. If there is a labeled blood from oral cavity It is damaged by the esophagus if black, it is bleeding from the stomach. Blood unchanged from the anal hole indicates the defeat of the lower departments of the intestine, if with an admixture of mucus, feces, with clots - from the upper departments. In any case, regardless of the etiology of bleeding, the HCC code on the ICD 10 - K92.2 is set.

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Code of ICD 10 gastrointestinal bleeding

Any diagnosis is strictly obeying the unified classification of all diseases and pathologies. Such a classification is officially adopted by WHO. Code of gastrointestinal bleeding - K92.2. These figures are marked on the title page of the disease history, are processed by the relevant statistical authorities. This is how structuring is found, fixing information about pathologies and mortality, given a variety of causes, nosological units. In the ICD there is a separation of all diseases in accordance with classes. Bleeding refers to diseases of the digestive organs, as well as other data pathologies.

Etiology and features of the treatment of the disease on the ICD 10

Gastrointestinal bleeding is considered serious diseaserelated to damage to the vessels located in the region of the gastrointestinal tract, as well as the subsequent flow of blood from them. With such diseases, the tenth convocation adopted a special abbreviation, namely to 92.2. The international classification indicates that with abundant blood loss, shock can develop, which forms a serious danger and threat of life. The stomach and intestines can suffer at the same time, so there will be emergency medical care.

The main causes of bleeding:

• hypertension portal;
• aggravation of the ulcer of the stomach and the intestine of duodenum;
• gastritis;
• inflammatory process in the esophagus;
• crohn's disease;
• nonspecific ulcerative colitis;
• bacterial enterocolitis, colitis;
• prolonged use of anti-inflammatory non-steroidal drugs;
• non-corrosive vomiting, esophageal rupture;
• hypersecretion of gastrin;
• tomestication in the area of \u200b\u200bthe gastrointestinal tract.

Before proceeding with treatment, it is important to identify the causes of such bleeding, to determine the affected gust department. In the case of scarlet blood coming from the oral cavity, the esophagus is damaged, if the blood of black color is observed - the stomach. Blood from the anal hole signals the defeat of the lower departments in the intestine when there is a feces or mucus, we are talking about the defeat of the upper departments.

Treatment can be conservative and operational. Tactics conservative therapy It is based on the character of the disease itself, in which bleeding acts as a complication. The principle of this treatment is based on the severity of the state. If the severity is low, the patient is prescribed calcium preparations and vitamins, the injection of vicasol, as well as a gentle diet. With moderate gravity, blood transfusion is prescribed, endoscopy with a mechanical or chemical effect on the ground of bleeding.

In case of severe severity, a totality is undertaken resuscitation action, urgent operation. Postoperative recovery takes place in the stationary department. To normalize the functioning of hemostasis, take the following drugs: Thrombin, Vikasol, Somatostatin, omeprazole, acid aminocapron and gastrocepin.

Gastrointestinal bleeding is a dangerous state that threatens human life. In this situation, it is necessary to seek medical care without delay and not engage in self-medication.

The first urgent measures in gastric bleeding

They should be distinguished from stripe bleeding arising in the gastrointestinal bodies (as a result of stupid trauma of the abdomen, penetrating the wounds of the abdominal cavity, intestinal breaks), but accompanied by the outpouring blood in the abdominal cavity.

Gastrointestinal bleeding in the medical literature can be referred to in the bleeding of the gastrointestinal tract, gastrointestinal bleeding syndrome, bleeding of the gastrointestinal tract.

Not being an independent disease, gastrointestinal bleeding is a very serious complication of acute or chronic diseases of the gastrointestinal organs, most often in 70% of cases - emerging in patients suffering ulcerative disease duodenal and gastric.

Gastrointestinal bleeding syndrome can develop in any gastrointestinal tract:

The prevalence of bleeding of the gastrointestinal tract is such that they are given the fifth position in the overall structure of gastroenterological pathologies. The first places respectively occupy: acute appendicitis, cholecystitis, pancreatitis and disadvantaged hernia.

Most often from them suffer from male patients in an eating. Among patients entering surgical departments Due to urgent states, 9% of cases falls on the share of HCR.

Symptoms of gastrointestinal bleeding

The clinical picture of the HCR depends on the location of the source of bleeding and the degree of hemorrhage. Its pathognomic signs are presented by the presence:

• Hemattemesis - vomiting with fresh blood, indicating that the source of bleeding (varicose veins or arteries) is localized in the upper gastrointestinal department. Vomiting, resembling a coffee grip, due to the effects of gastric juice on hemoglobin, leading to the formation of a salty hematine, painted in brown, testifies to stopped or slowing down bleeding. Profuses of gastrointestinal bleeding are accompanied by vomiting of dark red or scarlet. The resumption of bloody vomiting occurring in one or two hours is a sign of continuing bleeding. If vomiting develops after four to five (and more) hours, bleeding is repeated.
• Blood chair, most often indicating the localization of hemorrhage in the lower gastrointestinal departments (blood is excreted from the rectum), but there are cases when this symptom occurs during massive bleeding from the upper sections of the gastrointestinal tract, provoking the accelerated blood transit through the intestinal lumen.
• The tar-shaped - black - stool (molenet), usually accompanying hemorrhages that occur in the upper gastrointestinal departments, although there are no cases of occurrence of this manifestation during sublicane and thick-binding bleeding. In these cases, there may be veins or bunches of blood scarlet, indicating the localization of the bleeding source in the colon or rectum. Isolating from 100 to 200 ml of blood (with hemorrhages from the upper sections of the tract) can provoke the occurrence of melen, which can be maintained for several days after blood loss.

In some patients, a black chair without the slightest signs of hidden blood may occur as a result of the reception of activated carbon and preparations containing bismuth ("de nol") or iron ("Ferrum", "sorbifer Durules"), which give the bowel content of black color.

Sometimes such an effect gives the use of some products: blood sausages, pomegranates, prunes, blue-rowed rowan berries, blueberries, black currant. In this case, the differentiation of this feature with melen is necessary.

Heavy degree bleeding is accompanied by symptomatics of shock, manifested:

• the appearance of tachycardia;
• tahipne - rapid surface respiration, not accompanied by a violation of respiratory rhythm.
• the pallor of the skin;
• increased sweating;
• confusion of consciousness;
• a sharp decrease in urine release (oliguria).

Overall symptoms at the HCR can be represented:

• dizziness;
• fainting;
• feeling ailment;
• unfortunate weakness and thirst;
• release of cold sweat;
• a change in consciousness (excitation, confusion, intensity);
• the pallor of the skin and mucous membranes;
• lips sinusiness;
• on the basis of fingertips;
• decrease in blood pressure;
• weakness and rapidity of the pulse.

Degree of severity general symptomatics Determined by the volume and speed of blood loss. Scooty low-intensity bleeding, observed during the day, can manifest themselves:

• light beast of skin;
• insignificant greeting heartbeat ( arterial pressure, as a rule, remains normal).

The poverty of clinical manifestations is explained by the activation of protective mechanisms. human organismcompensating for blood loss. At the same time, the complete absence of general symptoms is not a guarantee of the lack of bleeding of the gastrointestinal tract.

To identify hidden chronic hemorrhages, developing in any department of the gastrointestinal tract, a laboratory blood study is needed (a sign of bleeding is the presence of anemia) and wheelchair (the so-called Gregersen sample on hidden blood). With blood loss, exceeding 15 ml per day, the result turns out to be positive.

The clinical picture of the HCC is always accompanied by symptomatics of the main disease provoked a complication complicing that:

• belching;
• difficult swallowing;
• ascites (clusters of fluid in the abdominal cavity);
• nausea;
• manifestations of intoxication.

Forms

In the international classification of diseases of the tenth version (ICD-10), unspecified gastrointestinal bleeding are attributed to the XI class covering the disease of the digestive organs (section "Other diseases of the digestive organs") under code 92.2.

The main one is considered to be the classification of the HCR, which takes into account their localization in a specific digestive department. If the source of hemorrhage is the top departments of the gastrointestinal tract (the frequency of such pathologies is from 80 to 90% of cases), bleeding happens:

• esophageal (5% of cases);
• gastric (up to 50%);
• duodenal - from the duodenum (30%).

For diseases of the lower departments of the tract (no more than 20% of cases) bleeding can be:

The guideline that allows you to distinguish between the tract on the upper and lower departments, is a bunch that supports the duodenum (the so-called tape bundle).

There are still many classifications of gastrointestinal bleeding syndrome.

1. Depending on the etiopathogenetic mechanism of the occurrence of HCRs, there are ulcers and non-informed.
2. The duration of pathological hemorrhages - hemorrhages - allows them to divide them into sharp (profuse and small) and chronic. Profuse bleeding, accompanied by bright clinical symptoms, lead to a difficult state for several hours. Small bleeding are characterized by a gradual occurrence of signs of growing iron deficiency anemia. Chronic hemorrhages are usually accompanied by a long-lasting preserving anemia with a repeated character.
3. According to the degree of severity of clinical symptoms, the HCRs can be explicit and hidden.
4. Depending on the number of hemorrhage episodes, there are recurrent or one-time.

There is another classification, dividing the LCD to a degree depending on the size of blood loss:

• In the gastrointestinal bleeding of a mild, the patient who is in complete consciousness and experiencing a light dizziness is in a satisfactory condition; Its diuresis (urine release) corresponds to the norm. The heart rate (heart rate) is 80 shots per minute, systolic pressure - at the level of 110 mm Hg. Art. The shortage of circulating blood (BCC) does not exceed 20%.
• GCC of the average degree leads to a decrease in systolic pressure up to 100 mm RT. Art. and pulse increases up to 100 ° C. / min. Consciousness continues to be maintained, but skin covers become pale and covered with cold later, and diuresis is characterized by a moderate decrease. The level of BCC deficiency is from 20 to 30%.
• For the presence of the HRCC, severely indicates a weak filling and voltage of the cardiac pulse and its frequency, which is more than 100 ° C. / min. Systolic blood pressure is less than 100 mm RT. Art. The patient is slowed down, not allowed, very pale, it has either Anuria (complete cessation of urine production), or Oliguria (a sharp decrease in the volume of urine allocated by the kidneys). The BCC deficiency is equal to or exceeds 30%. Gastrointestinal bleeding, accompanied by massive loss of blood, is customary to be called profuse.

The reasons

In medical sources, more than a hundred diseases are described in detail, capable of proving the occurrence of gastrointestinal bleeding of varying severity, conditionally attributable to one of the four groups.

HCRs are divided into pathology due to:

• lesions of the gastrointestinal tract;
• blood diseases;
• damage to blood vessels;
• the presence of portal hypertension.

Bleeding caused by the lesion of the gastrointestinal organs arise when:

Circulation System Diseases may provoke blood circulation syndrome:

• leukemia (acute and chronic);
• hemophilia;
• hypoprothrombinemia - a disease characterized by a deficit of promcrin (coagulation factor) in the blood;
• avitaminosis of vitamin K is a condition due to violation of blood coagulation processes;
• idiopathic thrombocytopenic purpura;
• hemorrhagic diathesis - hematological syndromes arising from violations of one of the hemostasses of hemostasis: plasma, platelet or vascular.

Bleeding GTS, due to damage to vessels, can develop as a result:

• systemic red lupus;
• varicose veins of the stomach and esophagus;
• thrombosis of mesenterior (mesenteric) vessels;
• sclerodermia (connective tissue pathology, accompanied by fibrous-sclerotic changes in the internal organs, the articulated muscular apparatus, vessels and skin);
• avitaminosis C;
• rheumatism (inflammatory infectious-allergic systemic lesion of connective tissues localized mainly in vessels and heart muscle);
• randu-Osler's disease (hereditary disease characterized by a persistent expansion of fine skin vessels leading to the occurrence of vascular meshes or sprockets);
• nodule periatery (diseases leading to inflammatory-necrotic damage to the walls of visceral and peripheral arteries);
• septic endocarditis ( infectious inflammation internal shell cardiac muscle);
• atherosclerosis (systemic lesion of medium and large arteries).

Gastrointestinal bleeding, developing on the background of portal hypertension, may occur in patients suffering:

• cirrhosis of the liver;
• drombosis of hepatic veins;
• chronic hepatitis;
• constricttery pericarditis (fibrous thickening of the pericardic structures and the occurrence of gradually declining granulation tissue forming a dense scar that prevents full-fledged ventricular filling);
• squeezing the carrier veins by scars or tumors.

In addition to the above paragraphs, gastrointestinal bleeding may result from:

• alcohol intoxication;
• an attack of severe vomiting;
• reception of corticosteroid drugs, aspirin or nonsteroidal anti-inflammatory funds;
• contact with some chemicals;
• impact of strong stress;
• significant physical tension.

The mechanism of the occurrence of the HCR passes one of two scenarios. The impetus to its development can be:

• Disorders of the integrity of blood vessels that occurred as a result of their erosion, gap varicose nodes or aneurysm, sclerotic changes, fragility or high permeability of capillaries, thrombosis, broken walls, embolism.
• Pathology of blood coagulation system.

Diagnostics

At the initial stage of the diagnosis of gastrointestinal bleeding, produced:

• Careful collection of anamnesis.
• Assessment of the nature of caliber and vomitive masses.
• Physical examination of the patient. Very important information for setting a preliminary diagnosis can give coloring of skin. So, hematomas, telegangectasia (vascular meshes and sprockets) and petechia (multiple point hemorrhages) on the patient's skin can be manifestations of hemorrhagic diathesis, and the jaggility of the skin may indicate varicose extension esophageal veins or the pathology of the hepatobiliary system. Palpation of the abdomen - so as not to provoke the GCC gain - should be carried out with extreme caution. During the inspection of the rectum, the specialist can detect hemorrhoidal nodes or a crack of the anal channel capable of being sources of blood loss.

Of great importance in the diagnosis of pathology has a complex of laboratory research:

• The data of the general blood testing with the HCR indicates a sharp decrease in the hemoglobin level and a decrease in the number of red blood cells.
• When bleeding due to pathologies of the coagulation system of blood, the patient has a blood test for platelets.
• No less important data of the coagulogram (analysis, reflecting the quality and speed of blood coagulation process). After a heavy blood loss, blood clotting increases significantly.
• Hepatic functional samples are performed to determine the level of albumin, bilirubin and a number of enzymes: ACT (aspartataminotransferase), Alt (AlanineNotransferase) and alkaline phosphatase.
• It is possible to identify bleeding using the results of a biochemical analysis of blood characterized by an increase in the level of urea on the background normal values Creatinine.
• Analysis of the hidden mass on the hidden blood helps to identify hidden bleeding, accompanied by a minor loss of blood, which is not able to change their color.

Radiological techniques are widely used in the Diagnosis of HCRs:

• X-ray-contrast examination of the esophagus consisting of two stages. In the first of them, the specialist performs an overview x-ray of internal organs. On the second - after taking the sour cream-like barium suspension, they perform a series of targeted radiographs in two projections (oblique and side).
• Radiography of the stomach. For contrasting the main organ of digestion, all the same barium suspension is used. Aiming and reproducible radiography is carried out with different positions of the patient's body.
• Irrigoscopy - X-ray-contrast study of the colon by tight (through the enema) filling it with a susceptible barium sulfate.
• Colecography - X-ray-contrast study of the branches of the abdominal part of the aorta. By performing puncture femoral arteryThe doctor sets the catheter in the lumen of the horn of the aorta. After the administration of the radiopatrum is carried out by a series of snapshots - angiograms.

The most accurate information is given endoscopic diagnostic methods:

• Fibrogastroduodenoscopy (FGDS) is an instrumental technique that allows you to carry out a visual inspection of the upper sections of the gastrointestinal tract with a managed probe - fibroenndoscope. In addition to inspection, the FGDS procedure (conducted either on an empty stomach, under local anesthesia, or under general anesthesia) allows you to remove the polyps, extract foreign bodies And stop bleeding.
• Ezophagoscopy is an endoscopic procedure used to examine the esophageal tube by introducing an optical instrument - an esophagoscope - through the mouth. It is performed both with diagnostic and with therapeutic goals.
• Colonoscopy is a diagnostic technique intended for inspecting the lumen of a thick bowel with an optical flexible apparatus - fibrocolonoscope. The introduction of the probe (through the rectum) is combined with air supply to help replete colors. Colonoscopy allows a wide range of diagnostic and therapeutic manipulations (up to Uz-scanning and recording received information on digital media).
• Gastroscopy is an instrumental technique, carried out by means of a fibroesophagogastroscope and allowing to assess the condition of the stomach and esophagus. Due to the high elasticity of esopagogastroscopes, the risk of injury to the underlying organs is significantly reduced. Unlike X-ray methods, gastroscopy is able to identify all sorts of surface pathologies, and through the use of ultrasound and Doppler sensors, it allows us to evaluate the state of regional lymph nodes and the walls of the hollow organs.

In order to confirm the presence of HCR and determine the place of its accurate localization, resort to a variety of radioisotope studies:

• static bowel scintigraphy;
• scintigraphy gastrointestinal tract with laundered erythrocytes;
• multispiral computed tomography (MSCT) of the abdominal organs;
• dynamic scintigraphy of the esophagus and stomach.

First emergency assistance

In the occurrence of acute gastrointestinal bleeding, it is necessary to have a patient first prefigure:

• The first step is to challenge ambulance.
• The patient immediately laid into bed so that his legs be raised above the body level. Any manifestations of physical activity from his side are completely unacceptable.
• In the room where the patient is lying, it is necessary to open the window or window (for fresh air).
• Do not give a patient with no drugs, food and water (it will only provoke bleeding). He can swallow little pieces of ice.
• In the presence of pronounced bleeding, the patient sometimes give ice aminocaproic acid (no more than 50 ml), 2-3 of the ditinone tablet (instead of water, powder "washed" with pieces of ice) or one or two teaspoons of a 10% calcium chloride solution.
• At the abdomen of the patient, you must put a package with ice, which is to avoid frostbies of the skin - it follows from time to time (every 15 minutes) to shoot. After a three-minute pause, ice is returned to the previous place. Over the absence of ice, you can use ice water heating.
• Next to the patient - up to the arrival of ambulance - should someone be.

How to stop bleeding at home by folk remedies?

• With the HCRK, the patient needs to create a relaxed atmosphere. Setting it into bed and putting an ice mark on the stomach, you can give him a few pieces of ice: their swallowing accelerates cessation of bleeding.
• To stop the bleeding, sometimes enough to drink 250 ml tea from the shepherd bag.
• Good hemostatic properties have infusion from the suma, the root of the serpentine mountaineer, the leaves of the raspberry and the greenery of Virgin, the root of wild alum. The bay of a teaspoon of one of the above-mentioned herbs with steep boiling water (enough 200 ml), withstand infusion for half an hour. Drink after polling.
• Taking dry yarrow (a couple of tea spoons), poured it 200 ml boiled water And insist within an hour. After filtration take four times a day (by ¼ cup) before meals.

Treatment

All therapeutic measures (they can wear and conservative, and operational character) begin only by making sure the availability of the HCR and after finding its source.

The total tactics of conservative treatment is determined by the nature of the main disease, the complication of which and became gastrointestinal bleeding.

The principles of conservative therapy depends on the severity of its condition. Patients with a low degree of gravity are prescribed:

• vikasol injections;
• vitamins and calcium preparations;
• a gentle diet, which provides for the use of dietary food, not traumating the tissue of the mucous membranes.

With the bleeding of moderate severity:

• sometimes blood transfusion;
• perform therapeutic endoscopic procedures, during which they carry out a mechanical or chemical impact on the source of bleeding.

In relation to patients in extremely serious condition:

• carry out a number of resuscitation activities and an urgent surgical operation;
• postoperative rehabilitation is carried out under a hospital.

Medications

To normalize the hemostasis system use:

Surgery

In the overwhelming majority of cases, operational therapy is a planned and carried out after a course of conservative treatment.

The exceptions are cases of life-degrading states that require an emergency surgical surgery.

• When bleeding, the source of which are varicose-enhanced veins of the esophagus, resort to its endoscopic stop by the method of ligation (overlapping elastic ligating rings) or conspiration (installation of vascular clips) bleeding vessels. To perform this minimally invasive manipulation, an operating gastroduodenoscope is used to the instrument channel of which special tools are introduced: a clip or a ligator. By summing up the work end of one of these tools to a bleeding vessel, impose a ligating ring or clip on it.
• Depending on the testimony in some cases, a colonoscopy with slipping or electrocoagulation of bleeding vessels is used.
• Some patients (for example, with a bleeding stomach ulcer), a surgical stop of the HCR is needed. In such cases, the operation of economical resection of the stomach or flashing a bleeding area is performed.
• With bleeding caused by nonspecific ulcerative colitis, the operation of the subtotal resection of the colon is shown, followed by the imposition of Sigmmites or Ilestostas.

Diet

• A patient with profuse gastrointestinal bleeding is allowed to take food no earlier than a day after its termination.
• All food should be slightly warm and having a liquid or semi-liquid consistency. The patient will come up with rubbed soup, liquid porridge, vegetable puree, light yogurts, kisins, mousses and jelly.
• In normalizing the state of the diet, the patient diverse is diverse with the gradual introduction of boiled vegetables, meat souffle, steam fish, eggs, cooked scholars, baked apples, omelets. The patient's table must necessarily have frozen butter, cream and milk.
• Patients whose state managed to stabilize (as a rule, it is observed to the outcome of 5-6 days), it is recommended to take food every two hours, and its daily volume should be no more than 400 ml.

When using animal fats, blood clotting increases significantly, which helps to accelerate the formation of blood clots in patients suffering from ulcerative disease.

How to raise hemoglobin?

Frequent blood loss provoke the occurrence of iron deficiency anemia - hematological syndrome, characterized by a violation of hemoglobin production due to the lack of iron and manifested by anemia and siderpoint (perversion of taste, accompanied by addiction to chalk, raw meat, test, etc.).

The following products must be on their desk:

• All types of liver (pork, beef, bird).
• Seafood (crustaceans and mollusks) and fish.
• Eggs (quail and chicken).
• The greens of turnips, spinach, celery and parsley.
• Nuts (walnuts, peanuts, pistachios, almonds) and plant seeds (sesame, sunflower).
• All types of cabbage (broccoli, color, Brussels, Chinese).
• Potatoes.
• Cereals (buckwheat, millet, oats).
• Corn.
• Persimmon.
• Watermelon.
• Wheat bran.
• Bread (rye and coarse grinding).

Patients with low (100 g / l and below) level of hemoglobin must be prescribed medicia treatment. Course duration - a few weeks. The only criterion for its effectiveness is normal indicators Laboratory blood test.

The most popular are drugs:

In order to prevent overdose, the patient must strictly comply with all prescriptions of the doctor and know that the use of tea and coffee slows down the absorption of iron preparations into blood, and the use of juices (thanks to vitamin C) - accelerates.

Complications

Gastrointestinal bleeding is fraught with development:

• hemorrhagic shock arising due to massive blood loss;
• acute renal failure;
• acute anemia;
• the syndrome of polyorganic insufficiency (a dangerous state characterized by simultaneous failure of the functions of several systems of the human body at once).

Attempts by self-treatment and late hospitalization of the patient can end with a fatal outcome.

Prevention

Specific measures for the prevention of HCR does not exist. To prevent the occurrence of gastrointestinal bleeding, it is necessary:

• To engage in the prevention of diseases, the complication of which they are.
• To regularly visit the gastroenterologist's office (this will allow you to identify pathology in the earliest stages).
• Timat the diseases capable of provoking the development of gastrointestinal bleeding syndrome. The development of the tactics of treatment and the appointment of drugs should be engaged in a qualified specialist.
• Elderly patients every year perform analysis on hidden blood.

Code of ICD: K92.2

Gastrointestinal Bleeding Uncomfortable

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Internal bleeding - loss of blood, in which blood does not expire, but in one of the cavities of the human body. The reason may be injured or chronic illness. The massive character of blood loss, later the treatment of patients for help and diagnostic difficulties in identifying this pathology increases the seriousness of the problem and turn internal bleeding into a serious threat to the life of patients.

Specialized medical care.

Patients are hospitalized in the hospital. The choice of separation is carried out taking into account the source of internal bleeding. Treatment of traumatic hemotoraxia is carried out by traumatologists, non-agricultural hemotorax and pulmonary bleeding - thoracic surgeons, intracranial hematomas - neurosurgeons, uterine bleeding - gynecologists. With stupid injury of belly and gastrointestinal bleeding, hospitalization is carried out in the separation of general surgery.
The main tasks in this case are urgent stopping of internal bleeding, reimbursement of blood loss and improving microcirculation. From the very beginning of treatment for the prevention of an empty heart syndrome (reflex stop of the heart due to a decrease in the volume of the BCC), the reduction of the circulating fluid volume and the prevention of the hypovolemic shock is carried out inkjet transfusion of a 5% solution of glucose, saline solution, blood, plasma and blood substitutes.
Sometimes the stop of internal bleeding is made by tamponade or caculate the bleeding area. However, in most cases, urgent surgical intervention under anesthesia is required. In the signs of hemorrhagic shock or the threat of its occurrence at all stages (preparation for the operation, operational intervention, the period after surgery) transfusion measures are manufactured.
In case of pulmonary bleeding, the bronchi tamponade is made. With an average and small hemotorecase, pleural puncture is performed, with a large hemotorax - thoracotomy with a wound of a wound or a suspension of a vessel, with a blood loss in the abdominal cavity - emergency laparotomy with the stove of the wound wound, spleen or other damaged organ, intracranial hematoma - Treep trepanation.
With the stomach ulcer, resection of the stomach is produced, with a duodenal ulcer - the firmware of the vessel in combination with the wagotomy. With mellore-waise syndrome (bleeding of the esophagus crack), an endoscopic bleeding stop is performed in combination with a cold, assignment of antacids, aminocaproic acid and blood coagulation stimulants. If conservative treatment is ineffective, the operation is shown (fracting cracks).
Internal bleeding Due to ectopic pregnancy, an indication for emergency surgery. With dysfunctional uterine bleeding The uterus cavity is produced, with massive bleeding due to abortion, generic injury and after childbirth, surgical intervention is performed.
Infusion therapy is carried out under the control of blood pressure, heart Emission, Central venous pressure and hourly diurea. The volume of infusion is determined taking into account the severity of blood loss. Hemodynamic hemodynamic treatment is used: dextran, refooliglukin, solutions of salts and sugars, as well as blood preparations (albumin, freshly frozen plasma, erythrocyte weight).
If the blood pressure fails, despite the infusion therapy, dopamine, norepinerenaline or adrenaline is introduced after stopping bleeding. For the treatment of hemorrhagic shock, pentoxifillalin, dipyridamol, heparin and steroid drugs are used. After eliminating the threat to life, the acid-alkaline balance is corrected.