Gastric hemorrhage

　　The causes of upper gastrointestinal bleeding usually include bleeding from ulcers and mucosal erosion in the esophagus, stomach, and duodenum, accounting for 55% to 74%; bleeding from esophageal varices, accounting for 5% to 14%; Mallory-Weiss syndrome, accounting for 2% to 7%; vascular lesions, accounting for 2% to 3%; tumors, accounting for 2% to 5%. The specific diseases that cause gastric bleeding are as follows:

　　1. Gastric and duodenal diseases: gastric ulcer, duodenal ulcer, acute gastric mucosal erosion, stress ulcer, chronic gastritis, gastric cancer, gastric polyps, gastric smooth muscle sarcoma, gastric smooth muscle tumor, gastric mucosal prolapse, postoperative anastomotic ulcer, intussusception, gastric granuloma lesions, duodenal diverticula.

　　2. Esophageal diseases: esophageal varices, esophageal gastroesophageal junction mucosal tear syndrome, esophageal hiatus hernia, esophagitis, esophageal ulcer, esophageal cancer, benign esophageal tumors, esophageal diverticula.

　　3. Vascular lesions: aortic aneurysm, splenic artery aneurysm, intramural small artery aneurysm of the stomach, hemangioma, arteriovenous malformation under the gastric mucosa, hereditary hemorrhagic telangiectasia.

　　4. Liver, gallbladder, and pancreas diseases: liver cirrhosis with portal hypertension, liver cancer with portal hypertension, portal vein thrombosis, portal vein obstruction syndrome, biliary bleeding, ampullary cancer, pancreatic cancer invading the duodenum, acute pancreatitis.

　　5. Other systemic diseases and conditions: epidemic hemorrhagic fever, leptospirosis, pulmonary heart disease, emphysema with infection, coagulation mechanism disorder, leukemia, purpura, hemophilia, disseminated intravascular coagulation, lymphoma, uremia, amyloidosis, sarcoidosis.

　　1.FeverThe fever in patients with gastric bleeding usually does not exceed 38.5°C and can last for 3-5 days.

　　2.Vomiting blood and black stoolsThe symptoms of gastric bleeding are mainly vomiting blood and bloody stools. After bleeding, due to the stimulation of blood, nausea and vomiting can lead to vomiting blood. Before bloody stools, there is a sense of defecation, and after defecation, the patient may experience darkening of the eyes, palpitations, and even fainting, pale complexion, thirst, weak pulse, and a decrease in blood pressure. All patients have black stools resembling tar. Generally speaking, when the amount of bleeding is large, there are both black stools and vomiting blood; when the amount of bleeding is small, there are often only black stools. If the bleeding site is in the duodenum, vomiting blood is less common.

　　3.Other systemic accompanying symptomsIf the patient's bleeding is slow and the amount is small, there are generally no obvious systemic symptoms, and anemia may appear only after a long time of bleeding. If the bleeding amount is large and fast, symptoms such as dizziness, blurred vision, fatigue, abdominal pain, diarrhea, tachycardia, pale complexion, and cold sweat may occur.

　　The clinical manifestations of gastrointestinal bleeding depend on the nature, location, amount, and speed of bleeding, as well as the patient's age, renal and cardiac function, and other systemic conditions.

　　1. If it is ulcer bleeding, there is often a history of upper abdominal pain before bleeding; if it is variceal bleeding from esophageal-gastric varices, there is a history of liver cirrhosis and clinical manifestations of liver cirrhosis.

　　2. Vomiting and black stools: Any vomiting caused by blood stimulation after bleeding.

　　3. General symptoms caused by bleeding: If the bleeding is slow and the amount is small, there are generally no obvious systemic symptoms, but anemia may appear after a long time of bleeding. If a large amount of blood is lost quickly, symptoms such as palpitations, cold sweat, and pale complexion may occur, even leading to a decrease in blood pressure and acute hemorrhagic manifestations.

　　4. Vomiting blood may occur. If blood is vomited immediately after bleeding, it appears bright red; if blood stays in the stomach for a period of time and is vomited after being acted upon by stomach acid, it appears as a brownish coffee-ground color. In addition to vomiting, more blood is excreted from the intestines. Since hemoglobin is acted upon by intestinal sulfides to form black ferric sulfide, the excreted blood is usually tarry black stools. Only when a large amount of blood is lost and it passes through the intestines quickly, the excreted blood appears dark red, or occasionally bright red. Generally speaking, when a large amount of blood is lost, there are both black stools and vomiting blood; when a small amount of blood is lost, black stools are often present alone. If the bleeding site is in the duodenum, vomiting blood is less common.

　　1. Treatment of the primary disease should be actively treated under the guidance of a doctor, such as peptic ulcer and liver cirrhosis.

　　2. Life should be regular. Meals should be at regular intervals with moderation, avoid overeating, and avoid alcohol, smoking, strong tea, and coffee.

　　3. Pay attention to the use of medication, try to use as few or no stomach-irritating drugs as possible. If necessary, such as when it is necessary to take them, H2 receptor antagonists or alkaline antacids, gastric mucosal protective agents, proton pump inhibitors, etc. should be taken together.

　　4. Regular physical examinations should be conducted to detect early lesions, receive timely treatment, and go to the hospital for examination as soon as possible when symptoms of anemia such as dizziness appear.

　　5. Patients with frequent recurrence of ulcer disease, slow healing of ulcers, and complications (such as upper gastrointestinal bleeding, ulcer perforation, pyloric obstruction) should persist in maintaining treatment.

　　6．For those with symptoms of ulcer recurrence, endoscopic examination should be performed on principle to determine whether there is recurrence and whether it is still a benign ulcer. Be vigilant about the possibility of malignant transformation in a few benign gastric ulcers under the chronic stimulation of repeated destruction and regeneration.

　　7．Maintain good emotions, do not be pessimistic, the stomach is one of the organs most affected by emotions.

　　8．Strengthening physical exercise is the key to treatment, such as jogging, practicing Tai Chi, etc.

　　(1) Barium X-ray examination: It is only suitable for patients whose bleeding has stopped and whose condition is stable. Its positive rate for the diagnosis of the etiology of acute gastrointestinal bleeding is not high.

　　(2) Endoscopic examination: Ulcer bleeding can be detected by emergency or early gastric endoscopy.

　　(3) Angiography

　　(4) Radioisotope Imaging: In recent years, the method of using radioisotope imaging to detect the site of active bleeding has been applied. The method is to perform an abdominal scan after intravenous injection of 99mTc colloid, to detect the evidence of tracer extravasation from the blood vessels, which can be used for initial orientation.

　　(5) X-ray examination: It can understand the bleeding site and the nature of the lesion.

　　(6) Gastroscopy: It can make a rapid and accurate diagnosis of the bleeding site and etiology and is listed as the first examination method.

　　(7) Selective arteriography: It is an additional examination for cases where the above diagnoses have not been confirmed, and it has diagnostic value for vascular malformations.

　　(8) Radionuclide imaging: Detecting the leakage of labeled substances from the blood vessels can detect active bleeding lesions.

　　(9) Capsule endoscopy: It has certain value in locating bleeding caused by lesions at the distal and proximal jejunum of the duodenum.

　　1. Start with liquid rice gruel and lotus root starch, which all increase acid production;

　　2. Eat a light diet, avoid spicy, fried, roasted, fried, strong alcohol, and other indigestible and irritant foods, eat more fruits, vegetables, and fibrous foods, and drink more water;

　　3. Have meals at regular intervals and in appropriate amounts, and avoid overeating and overdrinking;

　　4. Avoid intake of irritant foods such as cigarettes, alcohol, caffeine (coffee, strong tea, cola, cocoa), chili, pepper, etc., and food should not be too sweet, salty, cold, or hot;

　　5. Drink milk in moderation and avoid sour or sweet foods;

　　6. Mainly use cooking methods that are easy to digest (such as steaming, boiling, stewing) and so on;

　　7. Hot food may cause abdominal distension and dilate the blood vessels of the gastric mucosa, which is not conducive to hemostasis;

　　8. Adding a little salt is harmless when food is tasteless.

　　1. Bed rest

　　Observe the color and skin of the limbs, whether they are cold and damp or warm; record blood pressure, pulse, blood loss, and urine output per hour; maintain venous access and measure central venous pressure. Keep the patient's respiratory tract unobstructed and avoid asphyxiation when vomiting blood. Patients with massive bleeding should fast, while those with slight bleeding can consume a small amount of liquid food.

　　2. Increase blood volume

　　When hemoglobin is below 9g/dl and systolic blood pressure is below 12kPa (90mmHg), sufficient amounts of whole blood should be administered immediately. Patients with portal hypertension due to liver cirrhosis should be cautious of the possibility of rebleeding triggered by blood transfusion. It is necessary to avoid acute pulmonary edema or recurrence of bleeding caused by excessive blood transfusion or fluid infusion.