Examination.
1, routine laboratory tests
Including blood, urine and stool routine, fecal occult blood (stool occult blood), liver and kidney function, coagulation function, etc.
2.Endoscopic examination
According to the original disease and bleeding site, choose gastroscopy (esophagoscopy), duodenoscopy, small intestine microscopy, capsule endoscopy, colonoscopy to clarify the cause and bleeding site.
3.Barium x-ray examination
It is only suitable for the diagnosis of the cause of chronic bleeding and the site of bleeding is not clear; or for patients whose acute massive bleeding has stopped and the condition is stable.
4.Angiography
Through digital silhouette technique, contrast agent is injected into the blood vessel to observe the site of contrast agent spillage.
5.Radionuclide imaging
In recent years, radionuclide imaging is applied to discover the site of active bleeding. The method is to make abdominal scan after intravenous injection of 99mTc colloid to detect the marker, and the bleeding site can be initially determined from the evidence of vascular spillage.
6.Other
According to the need of primary disease, CT, MRI, CT simulation of small intestine and colonography can be chosen to assist in diagnosis.
Treatment
Depending on the primary disease, the amount and speed of bleeding, the principles of treatment vary.
1.Upper gastrointestinal bleeding
2.Middle and lower gastrointestinal bleeding
(1) Symptomatic treatment for chronic and small bleeding is mainly for the primary disease (cause). In acute massive bleeding, bed rest and fasting should be applied; closely observe the change of condition, maintain intravenous access and measure central venous pressure. Keep the patient’s airway unobstructed to avoid asphyxia when vomiting blood. And take appropriate treatment for the primary disease.
(2) When replenishing blood volume for acute massive bleeding, intravenous fluids should be given rapidly to maintain blood volume and prevent blood pressure from dropping; blood transfusion should be considered when hemoglobin is lower than 6g/dl and systolic blood pressure is lower than 12kPa (90mmHg). It is important to avoid transfusion and excessive amount of fluids that may cause acute pulmonary edema or induce re-bleeding.
(3) Endoscopic treatment colonoscopy and small intestine microscopy has limited hemostatic effect and is not suitable for acute hemorrhage, especially for diffuse intestinal lesions. Specific methods include: argon ion coagulation hemostasis (APC), electrocoagulation hemostasis (including unipolar or multipolar electrocoagulation), cryostasis, thermal probe hemostasis, and hemostasis of bleeding lesions by spraying epinephrine, thrombin, lithotripsy and other drugs. Hemostasis methods such as APC and electrocoagulation should not be used for bleeding due to diverticula, which may lead to intestinal perforation.
(4) Minimally invasive interventional treatment can be performed via catheter for hemostasis after selective angiography shows the bleeding site. Hemostasis can be achieved in most cases, although in some of them bleeding occurs again during hospitalization, during which the patient’s general condition is improved and good conditions are created for elective surgical treatment. It is worth pointing out that gastrointestinal bleeding due to intestinal ischemic disease is contraindicated when it occurs. In general, embolization is not advocated to stop bleeding in cases of lower GI bleeding after arterial placement because embolization of the proximal vessels is likely to cause ischemic necrosis of the intestinal tube, especially the colon.
(5) In cases where the cause of bleeding and the site of bleeding are not clear, it is not recommended to blindly perform dissection.
(i) active hemorrhage with hemodynamic instability that does not allow arteriography or other examinations.
(ii) No site of bleeding is found on the above tests, but bleeding continues.
③Repeated similar severe bleeding. Intraoperative exploration should be thorough and careful, and intraoperative endoscopy should be introduced through the anus and/or transenterostomy if necessary. The endoscopist will assist in guiding the scope and rotate the intestinal tube to flatten the mucosal folds, so that the endoscopist can obtain a clear view and facilitate the detection of small and hidden bleeding lesions. At the same time, the surgeon can sometimes detect the lesion from the plasma membrane surface through endoscopic fluoroscopy.
Prevention.
1.Actively treat the primary disease.
2, according to the different primary diseases (etiology), take appropriate preventive measures.