intestinal bleeding



Overview

Definition

Intestinal bleeding is bleeding caused by lesions in the intestinal tract distal to the pylorus including the duodenum, jejunum, ileum, cecum, appendix, colon, and rectum.

Staging or Classification

Classification according to the site of bleeding

Duodenal bleeding: bleeding site occurs in the duodenum.

Small bowel bleeding: bleeding in the jejunum and ileum between the beginning of the ligament of Trietz and the ileocaecal valve.

Bleeding in the large intestine: bleeding in the colon and rectum distal to the ileocecal valve.

Classification according to anatomy

Duodenal bleeding from the gastric pylorus to the ligament of Trietz is classified as upper gastrointestinal bleeding.

Bleeding in the jejunum, ileum, colon, and rectum between the beginning of the ligament of Trietz and the anus is called lower gastrointestinal bleeding [1-6].

Morbidity

Lower gastrointestinal bleeding is clinically common and accounts for 20% to 30% of all gastrointestinal bleeding.

Bleeding from the small intestine is a relatively rare condition, accounting for about 5% to 10% of GI bleeding.

Bleeding from the colon and rectum farther than the ileum accounts for about 20% of GI bleeding [1-3].

Etiology

Causes of the disease

The etiology of intestinal bleeding is complex and varied, with duodenal ulcers, colorectal malignancies, and intestinal polyps being the most common clinical causes. Inflammatory diseases and colonic diverticula are the next most common. The etiology of different age groups is also different, the most common is intestinal polyps in children, young people are mostly seen in duodenal ulcers, middle-aged and elderly colorectal cancer is the most common.

Duodenal ulcer

Gastroduodenal ulcer bleeding accounts for 50% of gastrointestinal bleeding cases, of which 75% are duodenal bulb ulcer bleeding [4]. Ulcer bleeding is mostly due to rupture of peripheral blood vessels by corrosion, and it is usually not easy to stop on its own. Even if the bleeding is temporarily stopped, it is very easy to reoccur with active bleeding.

Bleeding duodenal ulcers are usually located in the posterior wall of the bulb, and the ulcers may erode the gastroduodenal artery or the superior pancreaticoduodenal artery and its branches.

Intestinal malignant tumor

Including colorectal cancer, small bowel cancer, or malignant tumor of other organs infiltrating and metastasizing to the intestines, malignant lymphoma and sarcoma of the intestines, and intestinal carcinoid tumors.

Intestinal polyps

Including colorectal and small bowel adenomas, inflammatory polyps, familial adenomatous polyposis, Gardner syndrome, Turcot syndrome, juvenile polyposis, and Peutz-Jeghers syndrome.

Inflammatory bowel disease

These include ulcerative colitis and Crohn’s disease, intestinal tuberculosis, intestinal amebiasis, acute necrotizing enterocolitis, radiation enteritis, ischemic enteritis, and drug-induced enteritis.

Intestinal diverticula

Including Meckel’s diverticulum, small bowel diverticulum, colonic diverticulum and colonic diverticulosis.

Vascular disease

Including mesenteric vascular embolism and thrombosis, colonic varices, small bowel and colonic vascular malformations, intestinal hemangiomas, and hereditary hemorrhagic capillary dilatation.

Trauma and medical bleeding

Including abdominal trauma involving intestinal or mesenteric vessels, anastomotic bleeding after intestinal anastomosis, bleeding in the intestinal lumen after enteroscopy or therapeutic procedures.

Systemic diseases

Including sepsis, typhoid fever, epidemic hemorrhagic fever, leptospirosis, anaphylactic purpura, leukemia, aplastic anemia, multiple myeloma, hemophilia, schistosomiasis, hookworm disease, vitamin K or vitamin C deficiencies, as well as the use of special medications (non-steroidal anti-inflammatory drugs and anti-coagulants).

Others

These include extra- or intra-abdominal hernia or other causes of strangulated bowel obstruction, isolated ulcerative syndrome of the rectum, small bowel and colonic Dieulafoy’s disease, colonic pneumatosis, portal hypertensive enteropathy, and endometriosis [4-7].

Symptoms

Main symptoms

The clinical manifestations of intestinal hemorrhage depend on the volume, rate, site and nature of bleeding, and are related to the patient’s age and the compensatory capacity of circulatory function.

Vomiting blood

Vomiting of blood is often present in cases of large duodenal hemorrhage and may be absent in cases of small hemorrhage.

If the bleeding rate is slow, the vomited blood is mostly brown or coffee-colored; if the short-term bleeding is large and the blood is not mixed with gastric acid sufficiently, the blood will be bright red or have blood clots.

Black stool

Bleeding from the high small intestine or bleeding that stays in the intestine for too long, the feces show a black, tarry or jam-like color with a special fishy smell. Even bleeding from the right half of the colon can be tarry if the blood stays in the intestinal lumen for a long time.

Blood in stool

Most of the bleeding is from the colon or small intestine, and the bleeding volume is >1000ml, there may be blood in stool, and the stool is dark red blood, or even fresh blood.

The larger the bleeding volume, the lower the bleeding site, the faster the bleeding, and the shorter the time it stays in the intestines, the brighter the “red” color of the stool.

Hemorrhagic shock

Acute massive intestinal bleeding leads to peripheral circulatory failure and shock due to rapid reduction of circulating blood volume. The manifestations are dizziness, panic, fatigue, sudden fainting, cold sensation in limbs, rapid heart rate, low blood pressure, etc., and severe cases are in shock.

Anemia

Hemorrhagic anemia may occur after acute massive hemorrhage, but in the early stage of hemorrhage, hemoglobin concentration, red blood cell count and hematocrit may have no obvious changes.

It is characterized by dizziness, panic, weakness, rapid heart rate and low blood pressure.

Fever and azotemia

After massive gastrointestinal bleeding, some patients develop low-grade fever within 24 hours, which decreases to normal after 3 to 5 days.

As a large number of digestion products of blood protein are absorbed in the intestine, the concentration of urea nitrogen in the blood can be temporarily increased, which is called intestinal origin azotemia. Generally, blood urea nitrogen begins to rise a few hours after bleeding, peaks in about 24 to 48 hours, and falls to normal after 3 to 4 days [3-6].

Other symptoms

Crohn’s disease, intestinal tuberculosis, intussusception, colorectal cancer, etc. are often accompanied by symptoms of incomplete intestinal obstruction, often with varying degrees of abdominal pain.

Consultation

Department of Medicine

Gastroenterology

If you have a small amount of black stool, blood in stool, or physical examination shows iron deficiency anemia or positive fecal occult blood, you should consult the Department of Gastroenterology.

General Surgery

If the diagnosis of intestinal bleeding is clear and surgery is needed, patients should go to the General Surgery Department.

Emergency Department

If there is a large amount of blood in the stool within a short period of time, or if there is dizziness, panic, fainting when getting up suddenly, coldness in the limbs, low blood pressure, or shock, you should go to the Emergency Department immediately or call 120 to the Emergency Department.

Preparation for medical treatment

Preparation for medical consultation: registration, preparation of information, common problems

Tips for seeking medical treatment

It is better not to eat and keep an empty stomach before going to the doctor. If you have emergency bleeding, you should go to the doctor immediately.

If you have vomited blood or have black stools, we suggest that you take a picture of them for the doctor’s convenience; if you are not sure of the nature of the discharge, you can keep a portion of it in a clean, sealed container for testing at the doctor’s office.

Preparation Checklist

Symptom list

Pay special attention to the time of onset of symptoms, special manifestations, etc.

Are there any black stools? Are the black stools well formed?

Is there blood in the stool? What is the amount? What color is it? Is there any blood clot?

Are there symptoms of abdominal pain?

Are there any symptoms of dizziness, weakness, palpitations, etc.?

List of medical history

Is there a history of inflammatory bowel disease such as ulcerative colitis or Crohn’s disease?

Is there a history of intestinal tumors?

Any medications such as aspirin, clopidogrel, etc.?

Has intestinal endoscopy been performed? What are the results of the examination?

Checklist

Test results in the last six months, which can be brought to the doctor’s office

Laboratory tests: routine blood test, routine stool test, kidney function, coagulation function, etc.

Endoscopic examination: gastroscopy, colonoscopy, capsule endoscopy, small bowel examination.

Imaging tests: barium meal imaging of the whole digestive tract, CT small bowel imaging, CT angiography, magnetic resonance small bowel imaging, selective mesenteric artery digital subtraction angiography, nuclear imaging.

Medication List

Medication use in the last 3 months, if available in a box or package, carry it with you to the doctor’s office

Growth inhibitors and their analogs: octreotide, lanreotide, etc.

Proton pump inhibitors (PPI): omeprazole, lansoprazole, pantoprazole, rabeprazole, etc.

Iron and bismuth: ferrous succinate, ferrous sulfate, bismuth potassium citrate, etc.

Diagnosis

Diagnosis is based on

medical history

The patient may have a history of inflammatory bowel disease, intestinal tumors, duodenal ulcers, intestinal polyps, diverticula, intestinal anastomosis, sepsis, typhoid fever, epidemic hemorrhagic fever, anaphylactic purpura, leukemia, and aplastic anemia.

Medication history of taking aspirin, clopidogrel, warfarin and other drugs.

Clinical manifestations

Symptoms

Patients may have clinical manifestations such as vomiting blood, black feces, bloody stools and hemorrhagic shock.

Physical signs

Patients with short-term massive bleeding peripheral circulatory failure may have pale face, cold and clammy extremities, increased heart rate, decreased blood pressure and other manifestations. Some patients may have abdominal pressure and pain.

Laboratory Tests

Blood test

Routine blood tests can be used to determine whether the patient is anemic and whether there is a complication of infection.

Acute hemorrhage patients have orthoclonal orthochromatic anemia, and after hemorrhage, the bone marrow has obvious compensatory hyperplasia, which may temporarily appear macrocytic anemia, while chronic blood loss is microcytic hypochromatic anemia [4-6].

Stool routine and occult blood

The presence of intestinal bleeding can be clarified by fecal occult blood. Fecal occult blood test is positive when gastrointestinal bleeding is >5 ml per day.

Do not mix urine when retaining the stool specimen, do not be contaminated by other things, and send the specimen for examination as soon as possible after retaining it. Do not consume food containing animal blood, lean meat and dark green vegetables three days before the test, these may cause a false-positive reaction of the test result.

Kidney Function

Renal function tests are used to see if azotemia is present.

Generally, blood urea nitrogen begins to rise a few hours after bleeding, peaks in about 24 to 48 hours, mostly not exceeding 14.3 mmol/L, and falls to normal 3 to 4 days after bleeding stops [4].

Coagulation function

The examination will help to know whether the patient has coagulation dysfunction or not.

Endoscopy

Gastroscopy

Gastroscopy can be used to clarify the presence of bleeding caused by duodenal lesions and also to differentiate from esophageal and gastric bleeding.

Gastroscopy can directly observe esophageal, gastric and duodenal lesions, and directly perform pathologic biopsy and cytology on suspected lesions to further clarify the diagnosis.

Small bowel examination

Small bowel disease is the main means of examination, through the oral and transanal route, can directly observe the lesions in the small bowel lumen, tissue biopsy and endoscopic hemostasis treatment.

Capsule endoscopy

Capsule endoscopy has the advantage of being safe and less invasive, and is mainly used for the diagnosis of small bowel diseases, with a detection rate of approximately 38% to 83% for suspected small bowel bleeding [1].

The optimal timing for elective capsule endoscopy is 3 days after bleeding stops and should not exceed a maximum of 2 weeks.

Capsule endoscopy should be avoided in cases of gastrointestinal bleeding caused by gastrointestinal obstruction, small bowel stenosis or fistula formation, small bowel diverticula, double small bowel malformation, and when the amount of gastrointestinal bleeding is relatively large or accompanied by dysphagia or when the patient’s condition is not suitable for surgery.

Colonoscopy

Colonoscopy can identify the cause and location of colorectal bleeding and can be performed under direct endoscopic vision to stop bleeding.

In patients at high risk for colorectal bleeding or those with active bleeding, emergency colonoscopy within 24 hours of admission to the hospital can provide early identification of the cause of bleeding and endoscopic hemostasis.

For patients with stable colorectal bleeding, colonoscopy can be completed after the bleeding stops and the bowel is prepared.

Precautions for endoscopy

Transoral endoscopy can be moderate bowel cleansing and fasting for 6 to 12 hours before the operation, wearing movable dentures, should be removed before endoscopy.

Transanal endoscopy patients should change to a liquid diet 1 to 2 days before the operation, and then take bowel cleansing medication with at least 3L of water 6 to 8 hours before the examination in order to clean the intestinal tract.

For patients with active bleeding or who may need endoscopic hemostasis, it is recommended to take compound polyethylene glycol solution for bowel preparation. Adequate bowel preparation facilitates the detection of lesions, which can be replaced by enema or other methods in case of emergency.

Imaging

Barium meal imaging of the whole digestive tract

The total detection rate of whole digestive tract barium meal imaging for small intestinal bleeding is 10% to 25% [1], and it has high diagnostic value for the etiology of tumor, diverticulum, inflammatory lesions, intestinal lumen stenosis and dilatation, and so on.

Eat less indigestible food 1 day before the examination and fast after dinner. The barium swallowed will not be absorbed and is not harmful to the body; it will be excreted in the stool.

Pregnant women within three months are not allowed to have this test. Barium meal test is usually not done during gastrointestinal bleeding and should be done after the bleeding stops.

Small bowel imaging

Small bowel imaging includes CT small bowel imaging (CTE), CT angiography (CTA), and magnetic resonance small bowel imaging (MRE).

CTE is able to show both internal and external lesions in the intestinal lumen. For neoplastic small bowel bleeding, enhanced CTE can clearly show the size and morphology of the tumor lesion, the extent of intraluminal and extraluminal invasion, and the blood supply to the tumor.

CTA has high diagnostic value for acute small bowel bleeding and is suitable for patients with active bleeding (bleeding rate ≥0.3 ml/min).MRE has high diagnostic value for early diagnosis of small bowel Crohn’s disease.

Eat soft food with little residue and easy to digest 1~2 days before the imaging, and start fasting and abstaining from food and water on the night of the day before the examination.

There should be no clothes and ornaments with metal on the body during the examination, remove watches and dentures, and do not carry a cell phone.

Selective mesenteric artery digital subtraction angiography (DSA)

DSA has qualitative and localization effect on small bowel out, contrast spillage is a direct sign of bleeding site, abnormal blood vessels are an indirect sign of small bowel bleeding, and the localization diagnosis rate of gastrointestinal hemorrhage is 44% to 68% [1]. It has high diagnostic and therapeutic value in active bleeding.

DSA can show diseases such as vascular dysplasia, hemangiomas, arteriovenous malformations, and blood-rich tumors during non-bleeding periods or when bleeding is slowing down.

DSA has a certain diagnostic value for both overt and covert small bowel bleeding, and can be used to treat bleeding lesions with drug injection and embolization.

DSA is an invasive operation with the possibility of complications (renal failure, thromboembolism and ischemic enteropathy, etc.), and should be used with caution in patients with allergy to contrast media, severe coagulation disorders, severe hypertension and cardiac insufficiency, as well as the risk of radiation exposure.

Keep quiet and keep your body still during the examination.

Do not have clothes and ornaments with metal on your body during the examination, take off your watch, dentures, and do not carry a cell phone.

After the examination, closely observe the puncture site for blood seepage, swelling, pain and ulceration.

Nuclear imaging (ECT)

ECT is mainly used for initial screening and approximate localization of bleeding lesions. It has the irreplaceable role of other methods for trace chronic bleeding, and is suitable for chronic recurrent bleeding with the bleeding volume between 0.1 and 0.5 ml/min.

ECT can be considered for patients with suspected diverticular hemorrhage and suspected small bowel hemorrhage.

ECT is not suitable for patients with hemorrhage.

Patients should not walk around freely after injecting drugs. Lying down is required during the examination, and those who cannot lie down should be explained in advance, and clothing should be kept clean, otherwise it will cause errors.

Pathological histologic examination

Intestinal tissue should be taken for pathological histological examination during endoscopy, which can clarify the cause of intestinal bleeding, such as intestinal tumor.

Differential diagnosis

Esophageal and gastric bleeding

Similarity: there are clinical manifestations such as black stool, vomiting blood and anemia.

Differences: differential diagnosis can be made by gastroscopy.

Anal fissure bleeding

Similarity: clinical manifestations of blood in stool.

Difference: anal fissure with perianal pain, burning or cutting pain during defecation, radiating to buttocks, perineum, sacrococcygeal area or inner thighs; blood in stool is mainly dripping or wiped on the paper after defecation, and the color of blood is bright red.

Hemorrhoidal bleeding

Similarity: clinical manifestation of blood in stool.

Differences: blood in bowel movement, dripping blood, bleeding stops on its own after bowel movement, with or without the clinical symptom of hemorrhoidal prolapse.

Treatment

Treatment purpose: stop bleeding as soon as possible, remove the cause of the disease, and achieve the purpose of cure.

Treatment principle: The treatment principle of intestinal bleeding is to quickly assess the condition, stabilize hemodynamics, locate and qualitatively diagnose, and treat as needed. Treatment measures include supportive therapy, drug therapy, endoscopic therapy, interventional therapy and surgical therapy.

General treatment

Bed rest, close monitoring of patients’ vital signs, central venous pressure measurement when necessary.

Observe the situation of vomiting blood and black stool.

Regularly review hemoglobin concentration, red blood cell count, hematocrit and blood urea nitrogen.

Elderly patients should be placed on cardiac monitoring as appropriate.

Fasting is recommended for patients with large amount of bleeding, while those with small amount of bleeding can be put on a liquid diet appropriately.

Symptomatic supportive treatment

For patients with acute hemorrhage, anti-shock treatment should be carried out first.

According to the patient’s vital signs, the degree of circulatory volume loss, bleeding rate, age and complications, appropriate hemostasis, rehydration, blood transfusion and other treatments should be given to maintain the stability of vital signs.

Emergency blood transfusion is required for patients with hemoglobin less than 70g/L or active hemorrhage; hemoglobin should be maintained at 90g/L or above for patients with massive hemorrhage, comorbid cardiovascular underlying diseases, or those for whom hemostatic treatment is not predicted to be possible in the short term.

If the patient’s blood pressure is still low and life-threatening while replenishing blood volume, appropriate amount of intravenous dopamine, mesylate and other vasoactive drugs can be injected to maintain the systolic blood pressure above 90mmHg temporarily.

In hemorrhagic shock, blood volume should be replenished as soon as possible, and vasoconstrictors should not be used prematurely.

Most patients with chronic or intermittent bleeding have varying degrees of iron deficiency anemia, which requires oral or intravenous iron supplementation therapy [1-7].

Pharmacologic treatment

Pharmacologic therapy may be considered in small bowel bleeding lesions of unknown location or diffuse lesions that are not amenable to endoscopic treatment, surgical treatment, or angiographic embolization and treatment that is ineffective.

Colorectal bleeding can be applied to growth inhibitors, posterior pituitary hormone, hemostatic drugs and so on.

Proton pump inhibitors (PPIs) may be applied in duodenal bleeding.

Growth inhibitors and their analogs

Growth inhibitors and their analogs include octreotide and lanreotide.

Growth inhibitors and their analogs achieve bleeding by reducing visceral blood flow, increasing vascular resistance and improving platelet aggregation [8-10].

Octreotide.

Common adverse reactions to octreotide are pins and needles or burning sensation at the injection site, loss of appetite, nausea, vomiting, cramping abdominal pain, flatulence, loose stools, diarrhea, hyperglycemia or hypoglycemia.

Allergy is prohibited, diabetic patients should pay attention to monitoring blood glucose during use, pregnant and lactating women should be cautious.

Lanreotide

Common adverse reactions to Lanreotide are hypoglycemia, headache, dizziness, arthralgia, nausea, vomiting, abdominal distension, dyspepsia, alopecia, malaise, pain at the injection site.

Allergy and children and adolescents are contraindicated; Lanreotide can induce gallstones, gallbladder ultrasonography should be performed every 6 months; pregnant women, lactating women and diabetic patients should be used with caution [9].

Thalidomide

Thalidomide, a glutamic acid derivative, is effective against small intestinal bleeding caused by vasodilatation, which may be related to its inhibition of the antiangiogenic effect of epidermal growth factor.

The main adverse effects of thalidomide are constipation, fatigue, vertigo and peripheral edema, and others include peripheral neuropathy and deep vein thrombosis. Thalidomide has serious teratogenicity to the fetus, and is contraindicated in women during pregnancy and in children; use with caution in the elderly.

Posterior pituitary lobe

Posterior pituitary injection has a strong contraction effect on smooth muscle, especially on blood vessels.

After using the drug, if there is pallor, sweating, palpitation, chest tightness, abdominal pain, anaphylactic shock, etc., the drug should be stopped immediately. It should not be applied to patients suffering from myocarditis, vascular sclerosis, narrow pelvis, twin fetuses, excessive amniotic fluid, excessive uterine distension, etc.; it should be used with caution in patients with hypertension or coronary artery disease.

Hemagglutinin for Injection

Hemocoagulase for injection only has the function of hemostasis and does not affect the number of thromboplastin in blood.

The incidence of adverse reactions to hemocoagulase is low, and anaphylactic reactions are occasionally seen. It is contraindicated in individuals with a history of thrombosis.

Proton Pump Inhibitors (PPI)

PPIs include omeprazole, lansoprazole, pantoprazole, and rabeprazole.

By inhibiting gastric acid secretion and increasing duodenal pH, they exert hemostatic effects and are indicated for intestinal bleeding caused by duodenal ulcers and other causes.

Common adverse reactions to PPI are diarrhea, headache, nausea, abdominal pain, gastrointestinal flatulence and constipation. PPI is contraindicated in allergic persons, severe renal insufficiency and infants and young children; pregnant and lactating women should use with caution.

Other drugs

Hemostatic drugs also include vitamin K1, tranexamic acid and other drugs.

Endoscopic treatment

For small bleeding spots, microwave, laser, high-frequency electrocoagulation and other methods can be taken to stop bleeding.

For larger bleeding, local spraying of 1:20 norepinephrine or 5%-10% Menzies solution can be used to stop bleeding.

For the above methods are ineffective or large bleeding areas, titanium clips can also be used to stop bleeding. At present, endoscopy can not only carry out effective ligation and excision of polyps with tips, but also carry out submucosal dissection for broad-based polyps or early cancers to achieve the purpose of hemostasis.

Interventional therapy

Interventional therapy is suitable for cases where conventional medical hemostatic treatment and endoscopic treatment cannot effectively stop bleeding.

Local perfusion or embolization of posterior pituitary hormone can be used.

The efficacy of local infusion of posterior pituitary hormone ranges from 59% to 90%, but once the local infusion is stopped, half of the patients will re-bleed, and caution is needed in patients with serious complications such as cardiac arrhythmia and intestinal ischemia.

Materials commonly used for embolization therapy include absorbent gelatin sponge and metal coils, etc., and the effective rate of treatment is 80% to 100%, and the percentage of rebleeding is 14% to 29%, while this group of patients can still receive secondary embolization [4].

Interventional hemostasis is only a temporary means of hemostasis and does not provide complete treatment of the cause of lower gastrointestinal bleeding, but only saves the patient’s life in order to provide the opportunity for second-stage treatment, therefore, most patients should also be considered for treatment of their primary pathology after interventional hemostasis.

Surgical treatment

Intestinal malignant tumors, hemorrhage that is ineffective after conservative treatment, intestinal perforation, intestinal obstruction that is ineffective after internal conservative treatment and unexplained recurrent bleeding from the small intestine, and recurrent intractable diverticular hemorrhage, etc. require surgical treatment.

The aim of surgical treatment is to find the bleeding site as soon as possible and stop bleeding rapidly.

Acute massive bleeding combined with intestinal obstruction, intussusception, intestinal perforation, peritonitis; the emergence of hemorrhagic shock, hemodynamic instability, can not be corrected after regular medical treatment; repeated repeated unexplained bleeding caused by anemia, recurrence of bleeding need to be emergency surgical treatment.

After surgical treatment, patients should be fasted with water, observed for changes in vital signs, and encouraged to get out of bed early after anesthesia awakening. After exhaustion, patients should be fed a fluid diet with no or little residue, which is easy to digest, and gradually transitioned to semi-fluid, soft, and normal diet as the condition improves [4, 9].

Prognosis

Cure

Intestinal hemorrhage without active treatment may trigger short-term massive bleeding, and patients suffer from hemorrhagic shock or even death.

If early detection and active formal treatment, the removal of the cause of the disease can basically be cured, and some cases may appear again bleeding.

The prognosis is poor for patients with inflammatory bowel disease, intestinal tumors and other primary diseases, malignant tumors of the blood system, and combined with hemorrhagic shock.

Harmfulness

Patients with intestinal hemorrhage can be life-threatening if they experience short-term massive bleeding.

Patients with repeated intestinal bleeding or occult bleeding may develop chronic iron-deficiency anemia, which affects the quality of life.

Patients with intestinal bleeding may require repeated endoscopy multiple times, causing discomfort and fear.

Daily

Daily Management

Dietary management

Patients with intestinal bleeding should abstain from water intake during the acute phase.

Daily attention should be paid to a light and varied diet to ensure balanced nutrition, and consume more diets containing high quality proteins that are easy to digest.

Patients with iron deficiency anemia can consume more foods and fruits with high iron content, such as pig liver, pig blood, spinach, red dates, peaches, cherries and grapes.

Quit smoking and drinking.

Exercise management

Patients with intestinal hemorrhage should rest in bed and reduce activities during the acute stage.

During the recovery period, the amount of exercise can be increased gradually, and appropriate exercise should be chosen so as not to feel fatigue.

Psychological support

Maintain optimism in daily life, face the condition positively, establish confidence in overcoming the disease, and try to avoid the psychological state of depression, anxiety and fear.

Disease monitoring

Observe the stool condition to assess the efficacy of treatment.

Regularly monitor the fecal occult blood test to know whether there is hidden bleeding.

Patients with symptoms of peripheral circulatory failure should have their vital signs monitored for disease recovery.

Perform endoscopy as needed to see if bleeding has stopped.

Follow-up

Importance of follow-up: Regular follow-up can help to understand the recovery of the disease, and any abnormalities can be treated in time.

Follow-up time: The patient should be followed up in time if there is any change in his condition, and the hospitalized patient should be followed up regularly according to the doctor’s instructions after discharge.

Tests to be done during follow-up: endoscopy, stool routine, blood routine.

Prevention

Actively treat the primary disease to reduce the chance of intestinal bleeding.

Avoid taking non-steroidal anti-inflammatory drugs, antiplatelet drugs and anticoagulants as much as possible. If you have to take them, regular monitoring of stool routine should be performed so that intestinal bleeding can be detected in a timely manner, and the drugs can be stopped or symptomatic treatment can be given in a timely manner.

Regular endoscopy should be performed above the age of 40 to detect intestinal tumors and polyps as early as possible and treat them as early as possible.