Notes by dr Claudio Italiano
We all know about patients with hemorrhage that have gone to hospital urgently (while
I am writing to you I am following a patient who has come to us with 5 g / dl of
hemoglobin, strongly anemic) or to be directly sometimes affected by the
emission of blood from the digestive tract. Normally it can be a simple case of
inflammation of the hemorrhoidal plexus (hemorrhoids), with the emission of
bright red blood that wets the toilet, or, we hope never, to emit real
discharges of diarrhea black putrid, such as pitch , technically called melena.
Finally, it may happen that you have taken NSAIDs for pain (see neuropathic pain)
and that you have had an intense burning in the "mouth of the soul" (epigastrium)
with the emission of coffee vomiting (see haematemesis), that is, a fetid
vomiting brown-reddish as if you had vomited coffee. We try to understand why
and try to understand what the digestive tract hemorrhages are and how they
divide.
They are divided into:
EGDS: dramatic bleeding from bleeding esophageal varices
EGDS: II-grade esophagitis: note the erosive red stripes along the esophageal
tube
EGDS, varices F1, after reclamation with ligature
Hemorrhages of the upper tract:
Duodenal ulcer
Esophagitis
Gastric ulcer
Acute hemorrhagic gastritis
varices of the gastric fundus
esophageal varices
hernia jatale, esophagitis and esophageal ulcer
s. of Mallory Weiss
stomach cancer
cancer of the esophagus
hemobilia
telangiectasia
angiodysplasias
blood swallowed by the pharynx
The patient presents haemathèsi, which means emission of brown blood vomit,
as if it were coffee grounds, for hemoglobin reduced to hematina by the HCL (hydrochloric
acid) contained in the stomach. In addition you can have diarrhea stools, of
black color, like pitch, called melena. These diarrheal discharges are made up
of putrid stools, very malodorous, due to the cathartic action of the blood,
which works like a purge. The stools are black, shiny and adhesive for the
action that the blood undergoes in the digestive tract by enzymes and bacteria.
However, not always dark stools must alarm us. For example, can a patient take
drugs such as a banal antacid, colloidal bismuth, licorice, iron per os, for the
treatment of anemia? These substances can color the feces black!). Clinical
signs: if the patient has had mild hemorrhage, ie if the blood loss is less than
500 ml, the objective signs are poor; if the loss, instead, was 1000-1500 ml,
then the patient will be tachycardia (arrhythmias), with an increase of 20 beats
/ minute and a pressure drop of 10 mmHg from the declive position to the
orthostatic position; furthermore, we will have leucocytosis and hyperazotemia
due to an orientative protein load of 200 g of proteins lost with blood in the
digestive tract.
The active bleeding from the digestive tract, Forrest classifies it:
Ia = gushing hemorrhage;
Ib = oozing haemorrhage;
II a = lesion with a vascular stump;
II b = lesion with a coagulum;
II c = lesion covered by blood;
III = injury without hemorrhage.
In the case of a negative diagnostic result, an arteriographic or scintigraphic
study is carried out; in the first case the upper and lower mesenteric artery is
cannulated (see arteriography of the celiac tripod); the use of blood clots and
gel foam can be used to embolize the vessels and vasopressin directly 0.1-0.5
minute units can be infused into the catheter to reduce the splacnic flow.
However, the scintigraphic technique is far more sensitive and can detect losses
of 0.5 1 ml / minute.
Compare also these specific links:
>> emorragie_del tratto inferiore