1. Can acute lower gastrointestinal bleeding be prevented?
The prevention of acute lower gastrointestinal bleeding is mainly done in the following aspects.
(1) Pay attention to dietary management
Eat a light, easy-to-digest diet, rich in nutrients and less residue diet, regular meals, quit smoking and alcohol, avoid spicy and irritating, dry and rough and indigestible food, such as abdominal discomfort, avoid raw, cold and hard food as far as possible, semi-liquid food as the main food, appropriate to reduce the amount of food, up to 8 to 9 percent full, and then eat normally when the symptoms are relieved.
(2) Adapt to the task environment
Pay attention to adjusting yourself to the working and living environment. Pay attention to keeping the abdomen warm.
(3) Ensure the quality of sleep
Adequate rest should be emphasized to reduce mental and physical load.
(4) Active adjustment of mental and psychological state
(1) Strengthen mental training to improve the ability to endure hardship and frustration.
(2) Establishing harmonious interpersonal relationships, eliminating psychological stress and creating a relaxed mental environment.
③Cultivate hobbies and interests, learn to entertain oneself and maintain mental health.
(5) Rational application of certain preventive and curative drugs
Such as taking non-steroidal anti-inflammatory drugs, antipyretic and analgesic drugs, cold and flu medicine, should be stopped as far as possible, such as abdominal discomfort, should promptly find a doctor according to the symptoms of reasonable drug, trying to quickly relieve the symptoms, not to make the disease, to achieve the purpose of prevention. Choose blood-activating drugs carefully.
(6) Standardize diagnosis and treatment, timely consultation and treatment according to the diagnosis and treatment norms.
2.What is acute lower gastrointestinal bleeding?
Lower gastrointestinal bleeding refers to bleeding from the intestinal segment below the duodenal suspensory ligament (Treize ligament), including bleeding caused by jejunum, ileum, colon and rectal lesions, customarily excluding bleeding caused by hemorrhoids and anal fissure. Lower gastrointestinal bleeding that cannot be found after gastroscopy or colonoscopy is also called unexplained gastrointestinal bleeding.
3.What are the symptoms and manifestations of acute lower gastrointestinal bleeding or physical discomfort?
The main manifestation of lower gastrointestinal bleeding is blood in the stool. Generally speaking, the lower the location of the lesion, the larger the bleeding volume and the faster the bleeding speed, the brighter the color of the blood in the stool; conversely, the higher the location of the lesion, the smaller the bleeding volume, the slower the speed and the longer the time spent in the intestine, the blacker the stool may be. A high amount of blood, low fecal quality, and uniform mixing of blood and feces indicates a high location of GI bleeding. Small intestinal bleeding below the flexural ligament of the jejunum is mostly dark red blood. Lesions in the anorectum are mostly bright red blood in the stool, mostly not mixed with feces but attached to the surface of the stool, or dripping blood after the stool. In case of acute hemorrhage, patients may experience dizziness, weakness, thirst, false sweating, panic, nausea, pallor and other symptoms of circulatory disorders.
4.What factors can cause acute lower gastrointestinal bleeding?
There are many causes of lower gastrointestinal bleeding, mainly divided into.
I. Primary diseases of the intestinal tract.
(1) tumors and polyps.
Malignant tumors include carcinoma, carcinoid tumor, malignant lymphoma, etc.; benign tumors include smooth muscle tumor, lipoma, hemangioma, etc.. These tumors are most common with cancer, mostly in the large intestine.
(2) Polyps are mostly found in the large intestine, mainly adenomatous polyps, as well as juvenile polyps and juvenile polyposis, all of which can cause bleeding.
(2) Inflammatory lesions.
① Infectious enteritis: intestinal tuberculosis, enteric typhoid, bacillary dysentery and other bacterial enteritis, etc.; parasitic infections include ameba, schistosomiasis, enteritis caused by Giardia lamblia, and haemorrhage in the lower gastrointestinal tract caused by a large number of hookworm or flagellate infections have also been reported in China.
② Non-specific enteritis: ulcerative colitis, Crohn’s disease, colonic non-specific isolated ulcers, etc.
(③ antibiotic-associated enteritis, necrotizing small bowel, ischemic enteritis, radiation enteritis, etc.
(3) Vascular lesions: such as hemangioma, capillary dilatation, vascular malformation, varicose veins (note that bleeding varicose veins in rare sites caused by portal hypertension can be located in the rectum, colon and end ileum), etc.
(4) Structural lesions of the intestinal wall: such as diverticula, intestinal duplication malformation, intestinal pneumatosis, intestinal overlap, etc. In Chinese, most of the diverticula are in the right side of the colon, but they are not common, while bleeding from Michael’s diverticulum (Meckel’s) of the small intestine is not uncommon.
(5) Anal lesions: hemorrhoids and anal fissures.
Second, systemic diseases involving the intestine
(1) Leukemia and bleeding disorders; rheumatic diseases such as systemic lupus erythematosus, polyarteritis nodosa, Behcet’s disease, etc.; malignant histiocytosis; uremic enterocolitis.
②Infiltration of malignant tumors or rupture of abscesses in adjacent organs of the abdominal cavity invading the intestinal cavity can cause bleeding.
According to statistics, the most common causes of lower gastrointestinal bleeding are colorectal cancer and colorectal polyps, followed by inflammatory intestinal lesions, among which enteric typhoid fever, intestinal tuberculosis, ulcerative colitis, Crohn’s disease and necrotizing small bowel inflammation can sometimes cause massive bleeding.
5.Why does acute lower gastrointestinal bleeding occur?
①Patients with colorectal cancer, or intestinal polyps, inflammatory lesions and intestinal diverticula, can have lower gastrointestinal bleeding as the first symptom.
(ii) Taking non-steroidal anti-inflammatory drugs (NSAIDs): 2% to 4% of patients taking traditional NSAIDs can have significant gastrointestinal complications.
(iii) Dieulafoy’s disease: one of the rare causes of severe GI bleeding, characterized by insidious bleeding sites and arterial bleeding, rapid bleeding, large and easily recurrent bleeding, often leading to shock and endangering patients’ lives. Its bleeding accounts for 0.3% to 6.8% of GI bleeding, of which 2% is located in the jejunum and 10% in the large intestine.
④ vascular malformation dilatation: it accounts for 3% to 6% of lower gastrointestinal bleeding
⑤ Michael’s diverticulum: a diverticulum at the end of the ileum, which mainly presents as recurrent haemorrhage in dark or bright red blood stools. The probability of bleeding from diverticula is 3 to 5 per cent
(6) Mesenteric ischemia: It can be divided into primary and secondary mesenteric vascular ischemia. The clinical manifestations of acute intestinal ischemia are sudden onset of abdominal pain, diarrhea, and bloody stools.
(vii) Intestinal ulcers due to fecal masses: patients tend to have constipation, mostly located in the rectum and sigmoid colon, and may bleed suddenly in long-term stable cases.
(viii) Radioactive enteritis: it is often seen months to years after radiotherapy for pelvic tumors such as prostate, ovarian and cervical cancer, and can lead to severe bleeding.
6.How to diagnose acute lower gastrointestinal bleeding? How to self-judge whether there is acute lower gastrointestinal bleeding?
Most lower gastrointestinal bleeding has obvious blood in the stool. Combined with clinical and necessary laboratory tests, the diagnosis is usually not difficult to confirm through colonoscopy of the whole colon and, if necessary, with barium x-ray small intestine imaging.
7.With which diseases are acute lower gastrointestinal bleeding easily confused or which diseases need to be differentiated?
①Acute massive upper gastrointestinal bleeding: some patients with upper gastrointestinal bleeding have a large amount of bleeding and fast bleeding, and may also pass dark red stools or even bright red stools through the anus, which should be distinguished from lower gastrointestinal bleeding.
(ii) Biliary tract bleeding: patients often have typical biliary colic and jaundice.
(iii) Hematologic disorders: patients often have bleeding from other parts of the body.
④ Hemorrhoids and anal fissures: fresh blood often drips after defecation and does not mix with feces.