Drugs that stop ulcer bleeding. How dangerous is an ulcer with bleeding and how is it treated? Treatment of ulcer bleeding

According to statistics, bleeding from a stomach ulcer occurs in 10-15% of patients. It happens when a vessel bursts in the area of ​​damage to the mucous membrane. There are open and hidden bleeding. When hidden, there are no external manifestations. Complications can only be detected using the Gregersen reaction ( gastric juice, urine or feces are treated with special reagents to detect traces of blood).

Open bleeding from a stomach ulcer manifests itself with the following symptoms:

• Vomiting containing blood. Vomit may be brown due to the blood being stained with hydrochloric acid. With massive bleeding, scarlet blood is released.
• The stool is tarry in consistency and dark in color.
• Signs of blood loss.

Depending on the degree of blood loss, there are 3 types of bleeding:

1. Minor blood loss (up to 10%). It manifests itself as mild symptoms: weakness, dry mouth, slight nausea and dizziness, a slight decrease in blood pressure.
2. Average blood loss (up to 20%). The patient develops stage 1 hemorrhagic shock, while the patient is conscious. Main symptoms of bleeding medium degree for stomach ulcers:

• nausea, dizziness;
• trembling of limbs;
• pale skin;
• increased heart rate up to 100 beats per minute;
• slight decrease in pressure.

Massive blood loss (more than 25%). Characterized by the development of decompensated hemorrhagic shock. Massive bleeding with a stomach ulcer manifests itself:

Ask your question to a clinical laboratory diagnostics doctor

Anna Poniaeva. Graduated from Nizhny Novgorod medical academy(2007-2014) and Residency in Clinical Laboratory Diagnostics (2014-2016).

• tachycardia, shortness of breath;
• severe pallor of the skin and dry mucous membranes;
• thread-like pulse (up to 140 beats per minute);
• a sharp drop in blood pressure (below 90/50);
• loss of consciousness.

Causes

Ulcerative bleeding opens for the following reasons:

• Infection. Viruses spread through an open stomach ulcer, affecting blood vessels.
• Injury to the surface of the ulcer during medical procedures (during FGDS).
• Strong physical exercise. The pressure in the vessels increases, they burst, and ulcerative bleeding opens. It can be minor or severe if damaged large vessel.
• Poor diet, alcohol consumption. Spicy, fatty foods and alcohol irritate the already damaged mucous membrane. After eating, bloody vomiting may occur.
• Use of medications. Some medications are prohibited for use for ulcers because they irritate the mucous membrane. After taking such drugs, an exacerbation occurs, the open ulcer begins to bleed.

With closed hemorrhage primary symptoms almost invisible. This type of hemorrhage is divided into the following subtypes:

• spicy;
• chronic;
• symptomatic.

The hemorrhage itself indicates that a pathology such as a stomach ulcer has turned into an aggressive form. Most often, the patient begins to experience severe pain after eating, which is why he may refuse to eat altogether. The body, already exhausted in the fight against peptic ulcer disease, begins to lose its last strength. There is severe weight loss, chronic fatigue, drowsiness.

If left untreated and medical prescriptions ignored, prolonged ulcer bleeding can lead to serious complications, including death. The ulcer itself has a tendency to become malignant (malignant), so there is a high risk of developing cancer. Other consequences of complicated peptic ulcer disease include:

• acute heart failure;
• cerebral edema;
• arterial hypotension;
• liver failure;
• intoxication of the body with decay products of one’s own blood;
• hemorrhagic shock.

If the patient is not provided with medical assistance on time, there is high probability development of multiple organ failure syndrome (MODS), which is essentially the body’s stress response to serious injury and prolonged blood loss. In 80% of cases of MODS development, clinical death occurs.

Like any open bleeding, this complication is dangerous because the body loses blood without being able to replenish it. If losses exceed the permissible norm, the patient may die, so it is necessary to provide assistance to the patient and prescribe treatment as soon as possible.

The patient’s further life activity and his general condition depend on the correctness of the doctors’ actions aimed at eliminating the symptoms of bleeding due to gastric and duodenal ulcers.

Like any other bleeding, this pathology is very dangerous because the body loses a lot of blood without being able to replenish it. If significant blood loss exceeds the permissible norm, the patient may die, so it is important to provide him with first aid and prescribe treatment as soon as possible.

Particularly dangerous is bleeding caused by damage to large vessels, which leads to complications such as:

• cerebral edema;
• heart failure;
• intoxication of the body with toxins and blood decomposition products.

As a result of bleeding, organ failure syndrome can develop, when many organs and systems are affected.

Causes

Most often, ulcerative bleeding is provoked by the progression of the erosive process in the stomach, high capillary permeability or low blood clotting. Most often, an arrosive artery bleeds; a bleeding vein is somewhat less common; several small capillaries may also be damaged.

A. Ulcerative lesions of the digestive tract (55-87%)1. Diseases of the esophagus:

• Gastroesophageal reflux disease

2. Peptic ulcer of the stomach and/or duodenum

3. Acute ulcers of the digestive tract:

• Medication(after long-term use of medications: glucocorticoid hormones, salicylates, non-steroidal anti-inflammatory drugs, reserpine, etc.)
• Stressful (caused by various severe injuries How: mechanical injury, burn shock, myocardial infarction, sepsis, etc. or emotional overstrain, after a traumatic brain injury, neurosurgical operation, etc.).
• Endocrine (Zollinger-Ellison syndrome, decreased function of the parathyroid glands)
• Against the background of diseases of internal organs (liver, pancreas)

4. Ulcers of the gastrointestinal joints after previous operations

5. Erosive hemorrhagic gastritis

6. Colon lesions:

• Nonspecific ulcerative colitis
• Crohn's disease

1. Varicose veins of the esophagus and stomach (usually due to cirrhosis of the liver and increased pressure in the portal system).

2. Gastrointestinal tumors:

• Benign (lipomas, polyps, leiomyomas, neuromas, etc.);
• Malignant (cancer, carcinoid, sarcoma);

3. Mallory–Weiss syndrome

4. Gastrointestinal diverticula

5. Rectal fissures

1. Blood diseases:
   • Hemophilia
   • Ideopathic thrombocytopenic purpura
   • Von Willebrand's disease, etc.
2. Vascular diseases:

• Rondu-Osler disease
• Schonlein–Henoch disease
• Periarteritis nodosa

1. Cardiovascular diseases:

• Heart diseases with the development of heart failure
• Hypertonic disease
• General atherosclerosis

1. Cholelithiasis, trauma, tumors of the liver, gall bladder.

An exacerbation of a stomach ulcer usually occurs when the patient does not experience pain and, so to speak, relaxes, allows himself excesses in nutrition and makes concessions in his daily routine. The patient begins to drink alcoholic beverages, soda, does not monitor the amount of coffee he drinks, and ignores manifestations of stress. Other causes of exacerbation of stomach ulcers:

• too cold and hot food;
• coffee on an empty stomach, or smoking;
• infectious manifestations;

If there are such reasons, there is a possibility that a stomach ulcer will open.

There are enough reasons for bleeding from a stomach ulcer; the most common ones should be listed:

• non-compliance with nutritional recommendations;
• incorrect therapy;
• associated inflammatory processes;
• excessive physical activity;
• alcohol consumption;
• lack of timely treatment of the acute form of the disease.

Light bleeding It is quite difficult to diagnose; in some cases, the patient does not see a doctor for years.

Initially, the patient experiences mild symptoms that can be confused with manifestations of other diseases.

Acute blood loss It is not difficult to identify, but this does not make it any less dangerous.

Acute bleeding may occur suddenly; in such cases, you should immediately consult a doctor. Any home treatment methods will only worsen the patient’s condition.

Ulcerative bleeding occurs for the following reasons:

• Infection. Viruses spread through an open stomach ulcer, affecting blood vessels.
• Injury to the surface of the ulcer during medical procedures (during FGDS).
• Strong physical activity. The pressure in the vessels increases, they burst, and ulcerative bleeding opens. It can be minor or severe if a large vessel is damaged.
• Poor diet, alcohol consumption. Spicy, fatty foods and alcohol irritate the already damaged mucous membrane. After eating, bloody vomiting may occur.
• Use of medications. Some medications are prohibited for use for ulcers because they irritate the mucous membrane. After taking such drugs, an exacerbation occurs, the open ulcer begins to bleed.

Complications from this type of disease can be very diverse, but the most common is bleeding. There are the following types of bleeding:

1. Open.
2. Hidden.

Most often, bleeding is complicated by chronic callous and acute gastric ulcers if the patient has pathology of the cardiovascular system, as well as ulcerative defects that develop during the use of glucocorticosteroids.

The main reasons for the development of this complication are the progression of inflammatory and destructive processes in the defect area, increased capillary permeability, and blood clotting disorders.

Usually, an arrosive artery bleeds, less often a vein or a large number of small vessels localized in the area of ​​the bottom of the ulcer (in this case, hidden diapedetic bleeding develops). The formation of a bleeding ulcer can be facilitated by mechanical or chemical injuries to the mucous membrane, physical or psycho-emotional stress, neurotrophic and thromboembolic lesions of the stomach wall and hypovitaminosis.

The cause of the serious condition of patients is blood loss. If less than 15% of blood volume is lost significant violations there is no systemic hemodynamics, since protective mechanisms are activated: spasm of blood vessels in the skin and abdominal organs, opening of arteriovenous shunts, increased heart rate.

Blood flow in vital organs is maintained, and when blood loss stops, the volume of circulating blood is restored due to natural depots. With a loss of more than 15% of the bcc, a generalized spasm of blood vessels, a significant increase in heart rate and the transition of interstitial fluid into the vascular bed are initially compensatory in nature, and then pathological.

Systemic blood flow is disrupted, microcirculation suffers, including in the heart, brain, kidneys, arterial hypotension develops, and compensation mechanisms are depleted. Possible development of liver and kidney failure, cerebral edema, myocardial infarction and hypovolemic shock.

Forms and degrees

According to the stages, bleeding ulcers are divided into moderate and massive bleeding. With average blood loss of about 16-20%, patients become pale, have cold extremities, diuresis is reduced, and the heartbeat increases even in a calm state.

• Concerns about dizziness and tremors, low body temperature and photophobia;
• There may be blood in the saliva, traces of blood are also observed in the vomit;
• Symptoms of dehydration are observed, patients sweat profusely, and the sweat is cold and sticky.

Such hemorrhage with an ulcer is distinguished by the presence of blood in the vomit and the dark, almost black color of the stool.

A stomach ulcer is a defect in the mucous membrane of the organ, which is formed due to the aggressive effects of hydrochloric acid.

According to statistics, bleeding from a stomach ulcer occurs in 10-15% of patients. It happens when a vessel bursts in the area of ​​damage to the mucous membrane. There are open and hidden bleeding. When hidden, there are no external manifestations. The complication can only be detected using the Gregersen reaction (stomach juice, urine or feces are treated with special reagents to detect traces of blood).

Open bleeding with a stomach ulcer is manifested by the following symptoms:

• Vomiting containing blood. Vomit may be brown due to the blood being stained with hydrochloric acid. With massive bleeding, scarlet blood is released.
• The stool is tarry in consistency and dark in color.
• Signs of blood loss.

Depending on the degree of blood loss, there are 3 types of bleeding:

1. Minor blood loss (up to 10%). It manifests itself as mild symptoms: weakness, dry mouth, slight nausea and dizziness, a slight decrease in blood pressure.
2. Average blood loss (up to 20%). The patient develops stage 1 hemorrhagic shock, while the patient is conscious. The main symptoms of moderate bleeding with a stomach ulcer:

• nausea, dizziness;
• trembling of limbs;
• pale skin;
• increased heart rate up to 100 beats per minute;
• slight decrease in pressure.

• tachycardia, shortness of breath;
• severe pallor of the skin and dry mucous membranes;
• thread-like pulse (up to 140 beats per minute);
• a sharp drop in blood pressure (below 90/50);
• loss of consciousness.

With a stomach ulcer, bleeding can lead to hemorrhagic shock, which can be:

• compensated;
• subcompensated;
• decompensated;
• very heavy.

The pathological condition can be hidden or obvious. Hidden bleeding in the initial stages does not cause deterioration in well-being. An obvious form is observed when a large vessel is affected, and it is accompanied by nausea, vomiting with blood splashes.

In addition, a distinction is made between arterial and venous bleeding. Arterial bleeding is characterized by the spread of erosion to the walls of blood vessels, and venous bleeding can be caused by thrombosis.

Symptoms

The symptoms of a bleeding stomach ulcer are the same as those observed with any internal hemorrhage - weakness, dizziness, pale skin, nausea and vomiting. In this case, the color of the vomit may be a specific shade of “coffee with milk”, as a result of mixing blood with gastric juice.

The main and most striking sign of gastric ulcer bleeding is vomiting with admixtures of blood clots, and the vomit can be scarlet, dark cherry or brown. The bright color of the blood indicates that the open ulcer is bleeding heavily.

Another sign that a stomach ulcer has opened is melena. With melena, the stool takes on a characteristic color and consistency, the feces become thick, shiny and tar-like, usually a symptom of duodenal bleeding. Black stool indicates significant blood loss, up to 800 ml of blood. With more massive hemorrhage, the stool becomes scarlet in color.

General symptoms:

• Causeless weakness, malaise
• Dizziness
• Possible fainting
• Changes in consciousness (confusion, lethargy, agitation, etc.)
• Cold sweat
• Unreasonable thirst
• Pale skin and mucous membranes
• Blue lips, fingertips
• Rapid, weak pulse
• Lower blood pressure

All higher listed symptoms depend on the rate and volume of blood loss. With slow, non-intensive blood loss during the day, the symptoms can be very scarce - slight pallor. Slight increase in heart rate against the background of normal blood pressure. This phenomenon is explained by the fact that the body, through the activation of specific mechanisms, manages to compensate for blood loss.

Moreover, the lack common symptoms blood loss does not exclude the possibility of gastrointestinal bleeding.

External manifestations of gastrointestinal bleeding, main symptoms:

1. A change in the color of stool, from a brown, dense consistency to a black, tarry, liquid-like consistency, the so-called melena. However, if up to 100 ml of blood enters the gastrointestinal tract during the day, no visible changes in feces are observed. To do this, use specific laboratory diagnostics (Gregdersen test for occult blood). It is positive if blood loss exceeds 15 ml/day.

The main and very first symptom indicating a bleeding stomach ulcer is vomiting mixed with blood. The vomit is distinguished by its color (scarlet, dark brown). This manifestation is not immediately observed. The presence of scarlet blood in vomit indicates severe bleeding.

Another sign stomach bleeding considered melena. She is characterized by tarry stools. Its appearance indicates the presence of a duodenal bleeding ulcer. This type of stool appears when there is very heavy bleeding. The chair has its own characteristics. It is black, liquid, shiny. If the bleeding is very heavy, there may be red blood in the stool.

With minor bleeding from a stomach ulcer, there are almost no symptoms. Basically, the person feels satisfactory, nothing interferes with his normal life activities.

Hidden bleeding manifests itself through weakness, dizziness, and pale face. Many people notice dyspeptic disorders a few days before the onset of bleeding and a decrease in all symptoms with the onset of bleeding from the stomach.

However, as blood loss increases, the symptoms of a stomach ulcer become obvious.

Symptoms of an open stomach ulcer

Anemia is the most basic complication that can cause duodenal bleeding and bleeding stomach ulcers. They always reduce hemoglobin levels.

Despite the high level of medicine, cases of death from ulcer bleeding are very common. Most often this occurs in older people with severe blood loss accompanied by other pathologies. Also, deaths can occur due to delayed treatment or failure to provide first aid.

Note! Stomach bleeding is very dangerous phenomenon. It cannot be ignored and treated with folk remedies.

Which doctor should you contact if you have stomach bleeding?

With chronic gastric bleeding, the patient is often unaware that he has this pathological condition. Patients turn to specialized specialists regarding symptoms of the underlying disease:

• for pain and discomfort in the upper abdomen, nausea, indigestion - see a therapist, gastroenterologist;
• If there is increased bleeding or a large number of bruises appear on the body, see a therapist or hematologist.

The specialist prescribes an examination, during which gastric bleeding is detected.

The only symptom that may indicate the presence of chronic bleeding in the stomach is black, tarry stool. In this case, you should immediately contact a surgeon.

In what cases should you call an ambulance?

With intense acute gastric bleeding, the patient's condition deteriorates very quickly. In such cases, you need to call an ambulance:

• Severe weakness, pallor, lethargy, rapid deterioration of condition.
• Loss of consciousness.
• Vomiting "coffee grounds".

If, in case of intense acute gastric bleeding, treatment is not provided in time medical care– the patient may die from heavy blood loss!

The ambulance doctor will quickly examine the patient and perform necessary measures to stabilize his condition and take him to the hospital.

What questions might the doctor ask?

During a conversation and examination of the patient, the doctor faces two tasks: to establish the presence and intensity of gastric bleeding, to make sure that the bleeding comes from the stomach and not from other organs.

The severity of symptoms pathological condition directly depends on the degree of blood loss and the duration of hemorrhage. With a small or hidden hemorrhage, the clinical picture is almost always absent, and the patient’s condition and well-being do not worsen.

In cases of heavy stomach bleeding, signs such as:

• dizziness, which can range from mild to severe;
• increased fatigue;
• pale skin;
• decrease in blood pressure values;
• attacks of nausea and vomiting. The vomit has the color and consistency of coffee grounds;
• change in the shade of stool - they become black;
• reduction in the volume of urine excreted per day;
• increased heart rate and shortness of breath, even at rest, when a person is sitting or lying down;
• increased anxiety and irritability.

With a blood loss of 30–50%, the above symptoms are joined by episodes of loss of consciousness, the release of large amounts of cold and sticky sweat, and a thready pulse. In such cases, it is almost impossible to measure blood pressure. If emergency qualified assistance is not provided, then such a pathology will become irreversible, which is why, in most cases, death occurs.

Consulting a gastroenterologist, with a thorough study of the life history and medical history, analysis of complaints and the presence of specific symptoms, allows the specialist to suspect the development of gastric bleeding even with minor blood loss.

During a physical examination, the condition of the skin is examined, the presence of pain on palpation of the abdomen is determined, and blood pressure, pulse and temperature are measured.

Laboratory tests include:

• general analysis blood - which will show the degree of anemia, changes in composition and ability to clot;
• microscopic studies feces for occult blood, which will objectively make it clear that a person has hemorrhage.

Endoscopy is considered a mandatory instrumental diagnostic technique. This is a diagnostic endoscopic procedure, which is carried out using special equipment, aimed at studying the internal surface of all organs of the gastrointestinal tract. This examination reveals the location of the bleeding site.

Diagnostic measures are aimed not only at establishing correct diagnosis, but also to carry out differential diagnosis of an open gastric ulcer with such disorders as the formation of a malignant neoplasm, the formation of polyps, Mallory-Weiss syndrome.

If symptoms are ignored or therapy is not started in a timely manner, there is a possibility of developing the following consequences of a bleeding ulcer:

• hypovolemic state of shock;
• development of heart failure;
• orthostatic hypotension is a condition in which low blood pressure is observed;
• formation liver failure acute;
• swelling of the brain;
• poisoning by blood decomposition products;
• development of MODS - multiple organ failure syndrome, in which there is a disruption in the functioning of all internal organs and systems.

The typical form of the disease is accompanied by the entry of stomach contents into the free abdominal area.

There are three periods of development:

Period of chemical peritonitis. The duration of the course is from 3 to 6 hours. Depends on the diameter of the hole and the volume of secretions from the stomach. Accompanied by acute pain in the stomach. Severe pain is possible in the peri-umbilical segment and in the right hypochondrium. Subsequently, they cover the entire abdomen. Perforation of the anterior wall of the stomach can manifest itself in pain in the area of ​​the left side of the abdomen and left forearm. Painful sensations are characterized by the duration of manifestation. Vomiting occurs rarely. Arterial pressure decreased, but pulse is usually within normal limits. Breathing becomes shallow and rapid. The skin turns pale, sweating increases. The muscles of the front part of the abdomen are tense, and there is an accumulation of gases in the abdominal cavity.

The period of bacterial peritonitis. It begins 6 hours after perforation. The abdominal muscles relax, breathing becomes deeper and sharp pain disappears. The person feels relieved. During this phase, there is an increase in temperature, an increase in heart rate and a further change in blood pressure. A period of increasing toxicity begins, which leads to an increase in the volume of gases and paralysis of peristalsis. The tongue becomes dry, with a gray coating on the front and side surfaces. The patient's general behavior changes. He experiences euphoria and relief, becomes uncritical of his condition, and does not want to be disturbed. If emergency medical care is not provided during the period of increased intoxication, then the person moves to the third, most severe stage of the disease.

Period of acute intoxication. It begins, as a rule, after 12 hours from the moment of illness. The main manifestation is uncontrollable vomiting, leading to dehydration. Visually you can notice changes in the skin. They become dry. There is a sharp change in body temperature. Increase to 38°-40° gives way to a decrease to 36.6°. The pulse reaches 120 beats per minute. Upper blood pressure drops to 100 mmHg. The general condition of the patient is characterized by lethargy, indifference, slow reaction to external stimuli. The abdomen becomes enlarged due to the accumulation of free gas and liquid. The process of urination is disrupted and eventually stops completely. If a person has reached this phase of the development of peritonitis, then it is almost impossible to save his life.

Perforation is characterized by an attack of sharp, sudden pain. If there is a history of peptic ulcer, gastritis, etc., then the task becomes easier. As a rule, a differential method is used for diagnosis.

Light form

Due to constant hypoxia of the tissues of internal organs, as well as a decrease in the level of hemoglobin in the blood, the following symptoms appear:

• lethargy;
• dizziness;
• slight decrease in performance.

The patient should pay attention to regular headaches and shortness of breath with signs of short-term tachycardia.

Medium form

At this stage, your health begins to rapidly deteriorate, and specific symptoms of the disease appear, which are acute in nature:

• trembling of limbs;
• pale skin;
• photophobia;
• severe tachycardia;
• increased sweating;
• pre-fainting states;
• vomiting clotted blood (the color of coffee grounds);
• darkening of the color of stool.

These symptoms indicate regular and heavy internal bleeding, which is a serious threat to the patient’s life. Immediate hospitalization is required with all necessary diagnostic procedures and subsequent treatment in a hospital setting.

Severe form

A gastric ulcer with massive bleeding is usually accompanied by severe symptoms of hemorrhagic shock; suppression of the functions of all body systems is observed, which leads to irreversible destruction of internal organs. The main symptoms of severe form include:

• increased heart rate;
• dyspnea;
• confusion (aggression, apathy, irritation, panic attack);
• pronounced cyanosis;
• sharp drop blood pressure level;
• sticky and cold sweat;
• thready pulse;
• repeated vomiting;
• loose black stools;
• oligo-anuria syndrome (lack of diuresis).

With timely medical care, there is a chance to save the patient, but according to statistics, the survival rate of patients with extensive blood loss does not exceed 50%.

In general, the manifestations of a bleeding ulcer boil down to the following symptoms:

1. Migraines, cephalgia, dizziness, shortness of breath;
2. Tremor of the limbs, hypothermia, cold feet and hands;
3. Pale skin, palpitations and photophobia;
4. Manifestations of dehydration such as decreased diuresis, etc.;
5. After belching, there may be blood in the saliva, feces become tarry, and admixtures of coagulated or fresh blood are observed in the vomit.

If the blood loss is massive, then multiple organ failure rapidly develops, the symptoms of which include cerebral swelling, a critical decrease in pressure, weakening of cardiac, renal, hepatic activity, shock and intoxication, and unconsciousness.

For diagnosis, you will need to consult a qualified gastroenterologist, who will study in detail the patient’s medical history and complaints. As a result of a general clinical blood test, a decrease in erythrocyte mass and hemoglobin is detected.

The cause of bleeding is damage to the arteries or veins. In such a case, the symptoms will be quite vivid.

The most common manifestations include:

• vomiting blood;
• dark (almost black) stool;
• acute pain;
• photophobia;
• tremor;
• increased body temperature;
• dehydration;
• weakness, possible loss of consciousness.

Bloody vomiting is a characteristic manifestation of a bleeding stomach ulcer. The vomiting process can begin immediately and after some time, the vomit becomes bloody brown in color. Dark-colored stool is formed in the patient when blood loss reaches 200 ml, it is important to note that this is a significant amount of loss. With intense bleeding, the patient's stool becomes scarlet in color.

For an accurate diagnosis it is necessary laboratory research:

1. A blood test shows the presence of hidden bleeding.
2. They analyze the gastric juice, determining its acidity, and examine the stool for the presence of blood.
3. Using fibrogastroscopy, you can detect a defect in the walls of the stomach: this procedure indicated for all patients with suspected bleeding. Often, a biopsy is performed at the time of this study to exclude the possibility of cancer.

For minor blood loss, therapy consists of following a strict diet prescribed by a doctor. Target therapeutic nutrition- reduce the load on the gastrointestinal tract and increase the regenerative abilities of the body.

The patient must completely exclude from the diet:

• spicy;
• roast;
• smoked;
• alcohol.

A gentle diet does not always help; in such cases, surgical intervention is necessary.

After the operation, the patient is shown bed rest, feeding through a tube and full-fledged drug therapy.

Surgical intervention involves the following types of operations:

1. Applying sutures to the bleeding area.
2. Removal of part of the stomach.
3. A puncture through which bleeding vessels are blocked.

Making a diagnosis is not difficult for a gastroenterologist. Stomach ulcer with bleeding is in itself pronounced symptom.

The doctor is based on the patient's complaints. The doctor asks the patient about the symptoms, the duration of bleeding, and the duration of the disease.

Important information is what circumstances preceded the problem, what treatment the patient received. Then the gastroenterologist examines the patient; upon palpation, the patient experiences severe pain in the stomach area.

To clarify the diagnosis, a general blood test is prescribed, which reveals a decrease in hemoglobin and red blood cells. Next, the doctor performs a fibrogastroduodenoscopy. With its help, the condition of the mucous membrane, the size and number of ulcers are studied. It is possible to take a biopsy if there is a suspicion of an oncological process.

Ulcerative bleeding can have both obvious and hidden forms. In the first situation, the cause of the condition is the damaged integrity of the artery, in the second - a small vessel. Venous involvement is much less common.

A bleeding ulcer due to stomach disease has the following symptoms associated with the severity of blood loss:

• dizziness;
• muscle weakness;
• darkening of the eyes;
• hypotension;
• tachycardia;
• pale face;
• vomiting dark masses;
• blood clots in stool;
• oliguria.

A stomach ulcer with duodenal bleeding is characterized by the appearance of tarry stools and the manifestation of an anemic state. In this case, painful sensations may cease against the background of increased leukocytosis. A little later, hyperthermia develops.

In the presence of callous disease, when the ulcer has opened, the bleeding does not stop on its own, since the affected mucous membranes containing scar tissue do not have the ability to regenerate. In such cases, blood is released from the ulcer until surgery is performed.

The acute form of peptic ulcer is characterized by intermittent bleeding, but even in this case, a referral to a specialist is required, since in case of serious blood loss only resuscitation measures can save the patient.

The examination for suspected perforated ulcers is complex and should be carried out as soon as possible. Specialists whose competence is to diagnose pathology are a gastroenterologist and a surgeon. Difficulties in diagnosis are caused by the similarity of symptoms of perforated ulcers and other acute pathologies abdominal cavity, so it is important to differentiate from:

• an attack of appendicitis;
• cholecystitis in the relapse stage;
• an attack of acute renal, hepatic colic;
• dissection of an aneurysm in the peritoneal aorta;
• pancreatitis in the acute phase;
• myocardial infarction;
• thrombosis;
• pneumonia of the lower lungs;
• pleurisy;
• pneumothorax.

If you have a history of gastric and duodenal ulcers, the task is simplified. The main purpose of the examination is to determine the presence of liquid and gases in the peritoneum, to identify ulcerative defects and through perforations. A set of diagnostic measures that are mandatory:

• initial examination with palpation of the abdominal wall;
• a general blood test as an indicator of the intensity of the inflammatory process; when an ulcer is perforated, the readings of ESR, band neutrophils, and leukocytes reach an absolute maximum above normal;
• plain radiography necessary to detect the presence of free gas in the abdominal cavity; the reliability of the method is over 80%;
• CT scan of the peritoneal organs makes it possible to visually establish not only the accumulation of gases, but also the presence of fluid, hypertrophy of the gastric ligaments and the ulcer itself; CT information content is more than 98%;
• endoscopic examination is indicated to clarify the diagnosis, if there are doubts after other diagnostic procedures; endoscopy helps to establish the exact localization of ulcerative defects;
• echography of the peritoneal organs, as an accurate and accessible method, allows us to identify the accumulation of gases, fluids and hypertrophy of the gastric walls;
• esophagogastroduodenoscopy is indicated to confirm the diagnosis in the absence of gas in the peritoneal space and the impossibility of radiography; Endoscopy visualizes the location and size of perforated defects, the presence of hemorrhages, and helps to select the optimal tactics for subsequent treatment;
• laparoscopy is performed for qualitative and quantitative analysis of peritoneal effusion; but has a lot of contraindications - overweight, Availability adhesive process, low blood clotting, large hernia on the anterior wall of the peritoneum, serious condition of the patient;
• An ECG is necessary to assess the functioning of the cardiovascular system and identify dysfunctions in the rhythm.

When a stomach ulcer is complicated by blood loss, then in such cases the manifestations of the disease can appear quite brightly and intensely. If we talk about the hidden state, then in in this case symptoms may be vague. The main symptoms are:

• Vomiting blood.
• Change in stool. This symptom manifests itself due to the fact that blood enters the intestine.
• Feeling of acute blood loss.
• Painful sensations.

In the initial stages, when blood gradually begins to be released from the ulcerative formation, obvious signs may not appear. Typically, pain can appear and increase as the disease progresses.

As a rule, the pain has paroxysmal characteristics. It is precisely these properties of pain that mislead many patients.

Because in moments of lull in signs of illness, patients believe that the danger has passed.

Consequently, precious time is lost and, as a result, the patient’s condition becomes critical. As evidenced by numerous reviews from specialists, if this complication is not detected over a long period of time, it can lead to death.

General signs that may indicate that a stomach ulcer has opened can be divided into obvious and hidden. The indisputable features include:

• Spontaneous pain in the abdominal area. Due to the direct manifestation of this kind of symptomatology, the pain is referred to as “dagger pain syndrome.” When the ulcer has already perforated the lining of the organ, gastric juice does not cease to be released, and the hydrochloric acid it contains plays the role of an irritant.
• Increasing pain between meals.
• Nausea.
• Vomit.
• Paleness of the skin.
• A clear drop in temperature.
• The patient loses the ability to move. When intense pain occurs, the patient is forced into a body position in which the painful sensation is not so intense.

If the first signs of bleeding from a stomach ulcer appear, it is necessary to conduct a diagnosis to accurately determine the presence of a problem. The main diagnostic method is endoscopy, which should be performed as soon as possible. Endoscopic examination is performed under general anesthesia.

In addition, special tests are prescribed to determine the presence of hidden blood in the stool. Laboratory diagnostics are required to determine hemoglobin, the number of red blood cells, platelets, and blood clotting time. In some cases, differential diagnosis may be required to exclude damage to other internal organs.

Anemia

Ulcerative bleeding contributes to a decrease in hemoglobin and is almost always the root cause of life-threatening anemia. Darkening in the eyes, pallor, and increased fatigue are often assessed incorrectly by the patient, while the pathological process in his body is gaining momentum: instead of transporting oxygen and nutrients in inner fabrics and vital organs, intra-abdominal accumulation of blood occurs.

Death

Despite many advances in the field of endoscopy, resuscitation and surgery, the mortality rate from ulcer bleeding is high. This tragic consequence mainly occurs in people with massive blood loss, especially in cases of advanced age or against the background of other pathologies, as well as in cases of delayed provision of medical care.

We must not forget that bleeding from a stomach ulcer is insidious and dangerous: it cannot be ignored, much less tried to be treated with prescriptions traditional medicine neglecting to go to the hospital.

If the patient’s condition allows, then first of all an endoscopic examination is performed (no later than 24 hours from the moment of admission to the surgical or intensive care unit).

The symptoms of this pathological condition are determined by the degree of blood loss and the duration of bleeding. Hidden bleeding ulcers are manifested by general weakness, dizziness, and pale skin. Hemoglobin in acidic environment the stomach is metabolized, acquiring a dark color, and in the case of vomiting, the vomit is typically colored “café au lait.”

In the case of profuse bleeding, the main symptom is bloody vomiting, which can be one-time or repeated. Vomit has a characteristic “coffee grounds” color. In rare cases of massive bleeding from the artery, vomiting of scarlet blood with clots is possible.

A consultation with a gastroenterologist with a detailed study of the disease history, patient complaints and objective data suggests the presence of this pathology even with a small amount of blood loss. During an objective examination of the patient, attention is drawn to pallor of the skin, decreased skin turgor, and possible pain on palpation of the abdomen in the epigastric region.

A general blood test determines a decrease in hemoglobin and red blood cells.

Diagnostic tests

Diagnostic methods Examinations for opening a stomach ulcer are as follows:

• general blood and urine analysis;
• stool occult blood test;
• abdominal x-ray to identify free gas in it during perforation;
• fibrogastroduodenoscopy(FGDS);
• biopsy is performed during FGDS for further histological examination;
• diagnostic tests for the detection of Helicobacter pylor i.

Treatment is carried out with medication; complications may require surgery.

First aid

If you suspect that a patient has started bleeding, you should immediately provide him with first aid. The actions in this case should be similar to those prescribed for any internal hemorrhage.

Place the patient on a flat, hard surface, place a cushion under his feet to ensure a rush of blood to the head and avoid oxygen starvation of the brain. The patient needs complete rest at this time, any physical activity may cause increased bleeding.

The patient should not be given food or water, as it may stimulate the digestive processes. But you can apply a heating pad with ice or a bottle of cold water to his stomach. Every fifteen minutes the cold should be removed for three minutes and then applied again. This way you can achieve vasoconstriction in the affected area and temporarily stop ulcer bleeding.

Do not rinse the victim’s stomach under any circumstances or give any medications. For a bleeding ulcer, treatment should be prescribed by a qualified physician.

Keep the patient conscious until the ambulance arrives. If you notice that he is ready to faint, moisten a piece of cotton wool a small amount ammonia and bring it to the patient’s nose.

Letting ammonia smell directly from the bottle is strictly prohibited.

After the ambulance team arrives, examines the victim and confirms the symptoms of ulcer bleeding, the first aid procedure continues. To begin with, the patient is given two tablespoons of an ice-cold solution of aminocaproic acid, a good hemostatic drug. After some time - a teaspoon of calcium chloride and two crushed diet tablets.

If for one reason or another the patient cannot take these drugs, he may be asked to swallow pieces of ice. True, the effectiveness of this remedy is ambiguous. On the one hand, the cold compresses the blood vessels, but, on the other hand, swallowing movements can further damage the gastric mucosa and increase bleeding.

Do I need to call an ambulance?

Even suspicion of bleeding from the digestive tract is a reason for hospitalization and intensive examination and treatment. Of course, at the first signs of bleeding you should call an ambulance; sometimes every minute counts.

Step by step guide

First of all, if the patient has symptoms of an ulcer, he should be prohibited from moving. It would be better to place the patient in a horizontal position on his back. As part of the assistance before the doctors arrive, it is recommended to place an ice pack on the patient’s stomach. You can give a piece of ice so that the patient swallows it, as cold helps stop bleeding from a stomach ulcer.

It is prohibited until the doctors arrive:

• give the patient food;
• drink liquid;
• move independently.

Doctors who visit a patient determine what to do next if he has a bleeding stomach ulcer. Doctors provide first aid and decide whether to hospitalize the patient. Almost always the patient is admitted to hospital, and in in some cases to the intensive care unit. Already in a hospital setting, further treatment actions are determined:

• medicinal;
• physical.

Dangerous signs of bleeding in the stomach require emergency care. For this purpose, the following algorithm of actions must be performed with the victim:

• ensure complete peace;
• lay on a flat surface;
• exclude feeding or watering;
• apply cold to the stomach;
• refuse gastric lavage and use of medications;
• keep the patient conscious. Ammonia is suitable for this.

If dangerous signs appear, it is necessary to take measures to maximize quick fix bleeding to prevent sad consequences. Since doctors take on the main function of restoring a satisfactory condition, it is only possible to temporarily help the patient. To do this, it is important to do the following:

• provide the patient with complete rest;
• It is advisable to place the patient on a flat surface;
• Do not feed or give liquid under any circumstances;
• for symptoms of bleeding, it is recommended to apply cold to the abdominal area;
• Do not rinse the stomach or give any medications;
• try to keep the patient conscious until the ambulance arrives (to do this, moisten a cotton swab with ammonia).

If the patient begins to bleed, it is necessary to urgently take measures to stop the blood loss.

The appearance of symptoms of gastric bleeding requires immediate medical intervention. An ambulance is called for the patient.

During this period, the following activities must be carried out:

1. Ensure immobility of the patient.
2. Place it on a horizontal hard surface. A bolster, pillow, and blanket are placed under your feet. This position will increase blood flow to the head and prevent loss of consciousness.
3. Avoid water and food completely.
4. Place a cold heating pad on the epigastric area. It is held for 15 minutes. After a three-minute break, the procedure is repeated. Cold reduces bleeding.
5. Prepare cotton swab with ammonia. It will help restore the patient's consciousness.

Ambulance

If a person shows signs of internal bleeding, help is necessary. First of all, you need to call a medical team. The patient should lie on his back and try not to move. If possible, experts advise applying ice to the abdomen to reduce the effects of blood loss. At this time, it is forbidden to drink, eat, take medications, or rinse the stomach.

If possible, the patient should be kept conscious; ammonia is used for this. It is also not recommended to get to the hospital on your own; this can lead to increased bleeding.

It is forbidden to treat an open ulcer at home; this can be extremely dangerous. It is important to know that even if you feel better and stop bleeding, the disease should be treated under the supervision of doctors. It is necessary to call emergency help if bloody vomiting, stool with bloody components, acute pain in the stomach, the development of shortness of breath, tachycardia, a sharp decrease in pressure.

Many people have no idea what to do when an ulcer opens and is accompanied by bleeding. First of all, experts recommend that when such signs of the disease appear, in order to avoid negative consequences, take measures to eliminate blood loss as much as possible.

Since the doctor takes on the main burden of eliminating complications and manifestations of the disease, you can only try to help the patient a little. To do this, you need to do the following manipulations:

1. The patient must first of all be provided with rest.
2. It is also recommended to place the patient on his back.
3. During this period, the patient is prohibited from consuming anything, including water.
4. If there are signs of internal bleeding, the patient should apply cold to the abdominal area.
5. It is forbidden to stuff the patient with medications and perform gastric lavage.
6. Try with all your might to prevent the person from losing consciousness.

Patients whose bleeding is classified as moderate or severe should be mandatory hospitalize. The hospital will carry out the necessary manipulations to replace lost blood.

If by medicinal method It is not possible to stop internal bleeding, then in this case surgery will be used. Direct methods of such intervention depend on the level of severity of the patient and the location of the ulcer crater.

If there are signs of bleeding with a stomach ulcer, then you must call an ambulance, and provide first aid to the patient before it arrives. First of all, you need to stop him from moving. It is best to place the patient in a horizontal position on his back and apply an ice pack to his stomach before the doctors arrive.

You can additionally give a piece of ice to swallow, as the cold helps stop the bleeding. It is strictly forbidden to give food and water to the patient. In the presence of an acute or chronic ulcer with bleeding, the patient is transported only on a stretcher by experienced paramedics.

In almost all cases, the patient is hospitalized in a hospital, and in some cases in the intensive care unit.

Treatment

As such, there are no folk remedies for bleeding stomach ulcers - this is a very dangerous disease and initial treatment should be carried out exclusively in a hospital with the use of medications.

What to do if a stomach ulcer opens? Be sure to get treatment! You should not expect this disease to go away on its own. Usually treatment occurs using classical methods. The choice of treatment method depends on the location of the ulcer. The basic treatment regimen for open peptic ulcer:

Recently, endoscopic therapy in the treatment of ulcers has gained popularity. This is a treatment method in which applications occur, irrigation of the ulcer itself with the help of medications. This method reduces the treatment time for gastric ulcers.

Don't forget the importance dietary nutrition during exacerbations of stomach ulcers. There is an opinion that diets for stomach diseases lead to additional stress for the body and provoke further development of the disease. However, contrary to such statements, it has been proven that dietary nutrition not only does not harm, but also helps speed up the healing process of ulcers.

Nutrition for bleeding peptic ulcers

Proper nutrition after an attack of a bleeding stomach ulcer is the key to successful rehabilitation. In the first two to three days after an attack, a person should completely stop eating and drinking. Thirst is usually quenched with an ice cube, which the patient dissolves in the mouth. After the expiration of the period, the patient is given food and drink in small quantities.

What you can and should eat when an ulcer is bleeding

• low-fat milk;
• cream in small quantities;
• scrambled eggs;
• jelly, but not thick;
• jelly;
• juices, but not sour;
• soufflé made from meat or cottage cheese;
• pureed soups;
• pureed porridge (coating oatmeal is best);
• steamed cutlets or meatballs;
• mashed potatoes;
• herbal decoctions;
• butter with the lowest fat content;
• limited quantities of teas and coffee drinks, only after the acute condition has been relieved.

This kind of balanced diet will allow you to maintain the vital functions of the body with sufficient amounts of fats, proteins and carbohydrates. If the body receives all the vitamins, this will help improve immunity and speed up the healing of ulcers.

Any food for a bleeding ulcer should be in liquid form.

What not to do if you have a stomach ulcer

• alcohol in any form;
• spices;
• roast;
• spicy;
• sweets;
• canned food, even vegetables.

Bleeding peptic ulcer disease is not a sentence in which it is strictly forbidden to eat what you love. It is important to agree on the diet with your doctor and strictly adhere to it. After recovery, the list of foods that you can eat will certainly expand.

Diet after an exacerbation

For uncomplicated ulcers, treatment is aimed at creating favorable conditions to restore the mucous membrane and eliminate the source of infection. For this purpose drugs are prescribed:

• reducing the acidity of stomach contents (antacids);
• those that reduce the production of hydrochloric acid are proton pump inhibitors, type 2 histamine receptor blockers;
• gastroprotectors that protect the mucous membrane from aggressive substances;
• antibacterial, protozoal.

If necessary, vitamins and immune-stimulating medications are prescribed. Traditional methods for open ulcers can only be used after consultation with your doctor.

Surgical treatment indicated for the development of complications: perforation, penetration, bleeding that cannot be stopped endoscopic methods. It is usually possible to stop bleeding into the stomach cavity with the help of FGDS. The vessel is cauterized or coagulated. Perforation requires laparotomy and suturing of the hole. In some cases, the area with the ulcerative defect is excised.

For complications such as malignancy or cicatricial stenosis, extensive surgical interventions are indicated.

In most cases, therapy is carried out using conservative methods. You should not rely on self-medication, as the wrong approach can cause dangerous consequences and relapse of the disease.

A person with a bleeding ulcer is placed in a hospital setting. He will need to remain on bed rest, therapeutic fasting. In addition, the patient is injected with the medicine Vikasol and prescribed droppers with epsilon-aminocaproic acid. This treatment helps stop blood loss. In case of heavy bleeding, a blood transfusion with red blood cells is performed.

If the lower esophagus is affected, it may be necessary to insert a special catheter with a balloon through the mouth, which is inflated to create pressure in the area of ​​the damaged vessel. In some cases, the damaged tissue is affected by special means. Gastric ulcers that are bleeding are often cauterized using an electric current.

Surgical treatment

If conservative methods of treating bleeding in the stomach are ineffective, surgical intervention is prescribed:

• gastric resection - partial or complete removal of the affected part of the organ;
• total gastrectomy - complete removal of the stomach;
• suturing the ulcer using seromuscular sutures;
• suturing the vessels of the bottom of the ulcer that are bleeding;
• excision within non-deformed tissues with further longitudinal suturing of the defect.

In addition to such surgical techniques, others are used, for example, clipping a damaged vessel, using a special biological gel that glues the edges of the wound, and irrigating the ulcer with hemostatic drugs.

A patient with gastric bleeding should be immediately hospitalized.

There are two tactics for treating gastric bleeding:

• without surgical intervention (conservative);
• operation.

Only a doctor can make the right decision. He conducts an examination and examination, establishes the cause and location of the bleeding, and determines the degree of its severity. Based on this, a further course of action is selected.

Treatment without surgery

Event	Description	How is it carried out?
Strict bed rest	Rest helps the bleeding to subside, but during movement it may increase.
Cold in the epigastric region		The most common method is to use an ice pack wrapped in a cloth.
Gastric lavage with ice water	Under the influence of cold, blood vessels constrict, which helps stop bleeding.	Gastric lavage is carried out using a probe - a tube that is inserted into the stomach through the mouth or nose.
Injection of adrenaline or norepinephrine into the stomach through a tube	Adrenaline and norepinephrine are “stress hormones.” They cause vasospasm and stop bleeding.	A tube is inserted into the patient's stomach through which medications can be administered.
Intravenous administration of hemostatic solutions	Special hemostatic solutions contain substances that increase blood clotting.	Medicines are administered intravenously using a drip.
donor blood; blood substitutes; frozen plasma.	Transfusion of blood and blood substitutes is carried out in cases where the patient has lost a lot of blood as a result of gastric bleeding.
Other drugs intended to combat existing disorders in the body

Endoscopic treatment

Sometimes stomach bleeding can be stopped during endoscopy. To do this, special endoscopic instruments are inserted into the stomach through the mouth.

Methods of endoscopic treatment:

• Injection of a bleeding stomach ulcer with solutions of adrenaline and norepinephrine, which cause vasospasm and stop bleeding.
• Electrocoagulation– cauterization of small bleeding areas of the mucous membrane.
• Laser coagulation – cauterization using a laser.
• Stitching with threads or metal clips.
• Application of special medical glue.

These methods are used mainly for minor bleeding.

Surgery for stomach bleeding

• attempts to stop bleeding without surgery are unsuccessful;
• severe bleeding and a significant decrease in blood pressure;
• severe disorders in the patient’s body that can lead to worsening of the condition: cardiac ischemia, impaired blood flow in the brain;
• repeated bleeding after it has already been stopped.

• Suturing the bleeding area.
• Removal of part of the stomach (or the entire organ, depending on the cause of the bleeding).
• Plastic surgery of the junction of the stomach and duodenum.
• Surgery on the vagus nerve, which stimulates the secretion of gastric juice. As a result, the condition of the patient with peptic ulcer improves and the risk of relapse is reduced.
• Endovascular operations. The doctor makes a puncture in the groin area, inserts a probe through the femoral artery, reaches the bleeding lesion and closes its lumen.

In most cases, bleeding gastric ulcers are treated using conservative methods that do not require surgical intervention. Therapy is carried out in a hospital setting with maintaining complete fasting until bleeding stops.

At the initial stage, the following treatment measures are used:

• administration of Vikasol injections;
• droppers of aminocaproic acid.

If the bleeding is of high intensity, then a transfusion of red blood cells is performed, which avoids an excessive increase in the volume of circulating blood.

Sometimes the treatment method corresponds to the location of the bleeding ulcer:

• when it is located in the lower parts of the esophagus, a balloon catheter is inserted into the digestive organ through the oral cavity, which is subsequently inflated to create pressure in the area of ​​the damaged vessel;
• in the case of another localization, the site of bleeding is treated with a special chemical composition that provokes fibrosis and inflammation of the vein.

Recently, endoscopic therapy has been widely used in the treatment of bleeding ulcers, the essence of which is to cauterize the damaged vessel using an electric current. Sometimes a substance is injected into a vein to promote blood clotting.

In the absence of positive therapeutic effect Surgical treatment is prescribed using conservative methods.

Suspicion of an open ulcer is an indication for immediate hospitalization. While waiting for an ambulance, it is necessary to provide first aid to the victim. Rules emergency assistance are as follows:

• providing complete peace to a person and horizontal position bodies on a flat and hard surface;
• complete exclusion of food and liquid;
• applying a cold compress to the projection of the stomach, i.e. top part belly;
• complete refusal to lavage the stomach or consume any medications;
• keeping the patient conscious until specialists arrive.

Upon arrival at the medical facility, strict bed rest and complete fasting are prescribed. The basis of treatment for a bleeding stomach ulcer is to ensure hemostasis - keeping the blood in a liquid state. This can be achieved in several ways:

• conservatively - this involves the use of transfusions of blood and plasma products, intravenous administration of drugs, as well as oral administration aminocaproic acid. Indications for conservative therapy are: a high-risk group of patients, for example, old age or the presence of concomitant pathology, as well as gastric ulcers with bleeding at the initial stage of development;
• operable - in most cases, therapeutic endoscopy is prescribed. Hemostasis is carried out in several ways: thermally - laser and electrocoagulation, injection - administration of drugs such as novocaine, adrenaline and saline, mechanically - stopping bleeding by clipping or ligating bleeding vessels. In addition, hemostatic materials such as biological glue or hemostatic powder can be used. Indications for this method of therapy are severe forms of pathology and the addition of complications.

Extensive medical interventions are carried out extremely rarely, often when the above methods are ineffective. Such operations include complete or partial resection of the stomach, suturing of an open ulcer and suturing of blood vessels.

After such a violation has been eliminated, patients are advised to follow a diet for stomach ulcers, which implies a complete rejection of:

• fatty and fried foods;
• pickles and smoked meats;
• sour varieties of fruits and vegetables, as well as their consumption raw;
• legumes and peas;
• confectionery and bakery products;
• alcoholic and carbonated drinks.

However, a gentle diet does not prohibit the use of:

• dietary varieties of meat, poultry and fish, steamed, boiled or baked;
• vegetable purees;
• mucous first courses and cereals;
• soft-boiled eggs;
• jelly and compotes;
• weak tea without sugar.

Following this diet will help rapid recovery patient.

Perforated ulcers are treated surgically. Preoperative preparation consists of removing gastric contents and restoring blood pressure. Research is also carried out to select further actions.

Evaluated:

Time elapsed since the onset of the disease;

Nature of origin, size and localization of the ulcer;

The severity of peritonitis and the area of ​​its distribution;

Age characteristics patient;

Presence/absence of additional pathologies;

Technical features of the hospital and the level of professionalism of doctors;

There are organ-preserving operations (suturing) and radical ones (resection, excision of ulcers, etc.).

There are two main types of treatment for gastric bleeding: conservative and surgical. The first is used if the patient belongs to a high risk group (old age or presence of other serious illnesses), as well as for mild and medium shape. The conservative method includes a number of the following therapeutic measures:

• transfusion of blood or its individual components (for example, plasma or red blood cells);
• intravenous administration of aminocaproic acid, atropine, fibrinogen, calcium chloride;
• intramuscular injections of vikasol.

In the first three days of hospitalization, complete fasting is prescribed to stop bleeding. Further in the treatment process, doctors recommend adhering to the Meulengracht diet.

Surgery is performed in the following cases:

• extensive blood loss;
• ulcer penetration;
• rapid deterioration of the patient's condition.

Gastric resection

This operation involves partial removal of the affected area of ​​the upper or lower stomach with the possibility of restoring normal functioning of the gastrointestinal tract. If there is a need to completely remove the organ, a total gastrectomy is performed.

Suturing a stomach ulcer

A bleeding stomach ulcer is an indication for hospitalization of the patient. In case of moderate and severe bleeding, it is necessary to call an ambulance and provide the patient with first aid.

First aid

Before the ambulance arrives, the patient should be placed on the bed, with the legs slightly higher than the body to ensure blood flow to the head. Place ice on the stomach area for no longer than 15 minutes.

It is strictly forbidden to give the patient water, food, or medications, so as not to provoke gastric motility and increase bleeding. To prevent the patient from losing consciousness, he must be periodically given ammonia to sniff.

The arriving ambulance doctors also provide emergency care to the patient. To do this, he is given 1 tbsp to drink. l. solutions of aminocaproic acid and calcium chloride.

Further therapy

Algorithm of actions of doctors in the treatment of gastric ulcers with bleeding:

• Urgent stop of bleeding.
• Normalization of blood pressure, heart rate, restoration of blood volume in case of massive bleeding.
• Treatment of the underlying disease.
• Consolidation of the result.

The following methods are used to stop blood loss:

1. Tamponade. It is carried out in case of localization of the ulcer in the lower part of the esophagus. To do this, a balloon catheter is inserted into the patient through the mouth; when inflated with air, it compresses the vessel and the bleeding stops.
2. Endoscopic hemostasis. Recently, this type of therapy has been used as an alternative to major surgery. Endoscopic hemostasis is of the following types:

• Mechanical. A special clip is applied to the damaged vessel.
• Injectable. Sclerotic drugs are used to glue bleeding vessels together.
• Thermal. The vessel is cauterized using a laser, current, liquid nitrogen or radio frequency waves.

Drug therapy

To stop bleeding, hemostatic agents are prescribed.

Other methods

In case of extensive bleeding, perforation of the ulcer, or lack of effect from other types of therapy, surgical intervention is indicated. Perform the following types of operations:

• Partial gastrectomy. The upper or lower part of the damaged organ is removed.
• Suturing the ulcer. The ulcers are closed with sutures made of a special material.
• Suturing of blood vessels. With this method, there is a risk of recurrent bleeding.
• Excision of the ulcer. The affected tissue is removed and sutures are applied.

The patient is hospitalized in surgery department. Here the diagnosis of the disease is carried out. In case of large blood loss or serious condition, the patient is sent to the ward intensive care or intensive care unit.

Urgent measures

Emergency therapy and bleeding control are carried out immediately after the patient is admitted to the hospital. The following activities are carried out:

• Intramuscular injection of Vikasol.
• The substance calcium chloride, aminocaproic acid, is injected into the vein.

The measures help stop bleeding and prevent blood clot formation.

First stage

Internal bleeding is controlled using an inflatable balloon catheter. It is introduced into oral cavity sick. The balloon is inflated with air. It squeezes the vessel. Chemical sclerosis stops bleeding.

Endoscopic therapy

During the procedure, the ulcer is cauterized, which bleeds. To do this, a special substance is injected into the patient’s vein, which increases blood clotting.

The operation is performed in cases where therapeutic measures have not given a positive result.

Mechanical therapy

Extensive bleeding is eliminated in the following ways:

1. Suturing the ulcer and the affected vessel.
2. Clipping. The location of the bleeding is determined using an endoscope. Special clips are placed on the vessel. The method is used for bleeding from varicose veins.
3. Angiographic embolization. Microscopic spirals are inserted into the lumen of the affected vessel.
4. Gastric resection. The operation is performed in cases where previous methods do not have an effect. The ulcerative lesion is excised to the borders of healthy tissue. The stomach is sutured.

Surgery requires a long recovery. The patient is on strict bed rest.

After discharge, the patient is registered at the dispensary. The gastroenterologist monitors the patient's condition. He conducts periodic courses of therapeutic treatment.

People who first encounter a stomach ulcer try to cure it without medical help. Folk recipes help to avoid complications such as acute ulcers with bleeding:

• Cabbage juice take daily. A glass of juice should be drunk three times a day.
• Grind aloe leaves in a meat grinder, add a teaspoon of honey. Leave the composition in a dark place for 3 days. Take 3 times a day before meals.
• Mix 20% alcohol tincture of propolis with 200 ml of water. Take 3 weeks, half an hour before meals.

If a bleeding ulcer is suspected, the patient should be hospitalized immediately. Examination on an outpatient basis is not acceptable. Until the bleeding stops, complete fasting and strict bed rest are prescribed. Dietary nutrition is allowed only after a complete examination and conservative hemostasis.

If a stomach ulcer opens with bleeding, you should immediately consult a doctor for treatment. The main therapy is carried out in the hospital. Immediately after hospitalization, the patient is prescribed medications that help reduce the risk of severe blood loss. For treatment, administration of Vikasol is indicated.

If the bleeding is severe enough, the patient may be given a blood transfusion. Once the required volume has been restored, additional therapy is required to further eliminate symptoms and the risk of subsequent bleeding.

In some cases, endoscopy is used for treatment. This method involves cauterizing the damaged vessel using an electric current. A substance may also be injected into the vein to promote blood clotting and help prevent subsequent bleeding.

Treatment of gastric ulcers with bleeding using conservative therapy involves the use of colloid and crystalloid solutions. To compensate for lost blood, an infusion of the required volume of rheopolyglucin and polyglucin is required.

Also required are agents to improve blood clotting, in particular, such as platelet mass, fibrinogen, plasma, aminocaproic acid. Doctors also prescribe antibacterial agents, in particular, such as Tetracycline, Metranidazole, Clarithromycin.

Then you need to take proton pump blockers (Omeprazole) and histamine receptors (Diazolin). Additionally, antispasmodics are prescribed, for example, “Spazmolgon”, “No-Shpa”.

This treatment lasts for 2 weeks.

In many cases, with a gastric ulcer with bleeding, surgery is the only way to save the patient’s life. The method of surgical intervention largely depends on the severity of the patient’s condition and the location of the ulcer crater. The most popular method of surgery is gastric resection. This type of operation is organ-preserving, as well as quite simple and safe.

In weakened patients, an alternative method of surgical intervention is suturing the defect with vagotomy, as well as subsequent drainage of the wound. It should be noted that all these techniques are not complicated and do not pose any particular risk, since there is no danger of vascular injury during their implementation.

Bleeding from a stomach ulcer is a critical phenomenon: when performing therapeutic tactics Of course, organizational aspects are important, which act as the basis for effective endoscopic hemostasis (round-the-clock duty of competent specialists, availability of modern equipment and medications for hemostasis; adequate pain relief).

Patients whose bleeding is classified as moderate or severe are hospitalized in the intensive care unit, where the amount of lost blood is replaced. Elimination of the phenomenon of hemorrhagic shock will be carried out simultaneously with clarification of the location of ulcerative bleeding, and the operation should be performed in the optimal time.

The decision to replace the amount of circulating blood through infusion of red blood cells or plasma expanders is based on signs of bleeding. In elderly patients with pathological heart function, as well as in cases of massive bleeding, blood transfusion (blood transfusion) is carried out in parallel with blood pressure monitoring.

Important indicators of the success of the measures taken are the hourly measurement of diuresis and venous pressure indicators, which at a level above 16 cm of water. Art. indicate the inability of the heart to cope with the incoming amount of fluid.

In such a situation, the rate of administration of infusion drugs is reduced by prescribing stimulants for the activity of the heart muscle. Conservative therapy carried out by the following pharmacological groups:

1. Colloidal and crystalloid solutions. To compensate for lost blood and normalize water-electrolyte balance, the primary goal is the infusion of a sufficient volume of polyglucin and rheopolyglucin.
2. Means for improving blood clotting properties (fibrinogen, plasma, platelet mass, aminocaproic acid).
3. Long-acting hemostatic drugs (vicasol).

For patients whose ulcer bleeding has been stopped with medication, there is no reason for urgent surgery. Predict the likelihood of resumption of bleeding that was previously stopped in a conservative way, is possible based on the results of endoscopy and laboratory tests.

If unsuccessful drug therapy Surgery is considered the last option to stop blood loss, with the choice of surgical method depending on the severity of the patient and the location of the ulcer crater.

Gastric resection is a topical issue - this is a type of organ-preserving operation, the convenience of which lies in the ease of implementation. In weakened patients, an alternative option is suturing the defect, with vagotomy (dissection of the trunk vagus nerve) or without it, as well as subsequent drainage of the wound.

It should be noted that these methods do not have significant technical difficulties, but require detailed knowledge anatomical location in this area of ​​large blood vessels, to avoid injury to them.

Suspicion of a bleeding gastric ulcer is a direct indication for emergency hospitalization of patients in the surgical department. Examination on an outpatient basis is strictly unacceptable.

All patients are prescribed strict bed rest and complete fasting (after stopping the bleeding - the Meulengracht diet). Conservative hemostasis includes transfusion of blood products, plasma, administration of fibrinogen, aminocaproic acid, calcium chloride, vikasol, atropine, as well as oral administration of aminocaproic acid.

Conservative treatment can be performed in high-risk patients (elderly, severe concomitant pathology), as well as for mild to moderate bleeding.

Indications for surgical treatment are severe bleeding, regardless of the type of ulcer, combination with other complications of peptic ulcer (penetration, pyloroduodenal stenosis), repeated bleeding that does not stop under the influence of conservative methods of hemostasis.

The specific choice of operation is determined by the location of the ulcer and individual characteristics. Resection of the stomach according to Billroth I or II, excision, suturing of the gastric ulcer, suturing of the vessels of the bottom of the ulcerative defect can be performed, possibly combined with vagotomy.

Prognosis and prevention

The prognosis is determined by the amount of blood loss and the timeliness of specialized care. Currently, active surgical treatment tactics (in the absence of contraindications) are considered the only correct one.

In addition to the speed of stopping bleeding, the prognosis depends on the preservation of the patient’s compensatory mechanisms and adequate replenishment of the circulating blood volume. With profuse bleeding, a high mortality rate is recorded.

Prevention of bleeding stomach ulcers involves timely application to a gastroenterologist if there are complaints from the stomach, adequate treatment of peptic ulcer according to current standards, medical examination of patients and regular examination.

Therapy methods

To ensure that a peptic ulcer complicated by bleeding does not have a place in your life, follow the following recommendations:

1. Eliminate alcohol from your diet
2. Stop smoking
3. Minimize caffeine intake
4. Take anti-inflammatory drugs very carefully
5. Stick to your diet
6. Use antacids to reduce stomach acid
7. Use coating agents
8. Get checked regularly.

Gastric ulcer is a dangerous disease that can cause serious complications, one of which is bleeding. By observing preventive measures and taking measures to combat Helicobacter pylori infection, the disease can be avoided.

A patient with a peptic ulcer needs to clearly remember the symptoms of one or another complication of his disease in order to begin treatment on time. Modern medicine has many proven methods to combat them.

At the first signs of this type of bleeding, you should contact a gastroenterologist for a detailed examination and treatment in a hospital setting. Firstly, the patient is immediately prescribed hemostatic drugs, for example, a course of Vikasol injections. If a bleeding stomach ulcer causes severe blood loss, then in this case the patient is given a blood transfusion.

If the injury is located in the lower part of the esophagus, then a balloon catheter is inserted into this area; the catheter inflates inside, squeezing the bleeding area. Also used for treatment is a solution to prevent fibrosis and inflammation.

Sometimes endoscopy is used to treat ulcer bleeding; this procedure involves cauterizing the affected area. electric shock.

If the above treatment methods do not help, then a surgical method is used - gastric resection.

After the operation, the patient remains in the hospital for some time, and for the rest of his life adheres to a strict diet.

Remember, bleeding is an extremely dangerous complication of a stomach ulcer, in order to prevent the development similar situation It is necessary to strictly monitor your health, and at the first signs you should immediately consult a doctor.

Treatment for confirmed perforated ulcer surgical. The main goals of therapy are to preserve the patient’s life, eliminate ulcerative defects, and combat peritonitis.

IN further treatment aimed at eliminating the underlying disease that led to perforation. Surgery for a perforated ulcer is carried out after careful preparation of the patient - cleansing (draining) the gastric cavity of contents, stabilizing blood pressure.

Diet

After the bleeding has stopped, you must follow a special diet for 10-12 days. During this period, meals should be taken every 2-3 hours, the size of one serving should not exceed 150 ml.

Food should be pureed, steamed, boiled or stewed. Rough, fatty, spicy and sour foods should be avoided. The following foods can be included in the diet of a patient with peptic ulcer:

• Milk, low-sour cottage cheese,
• Low-fat varieties of fish and meat,
• Soft-boiled eggs (no more than 2 per day),
• Puree soups,
• Semi-liquid rice, oatmeal, buckwheat porridge.

After a patient with a bleeding stomach ulcer is discharged from the hospital, it is necessary to provide him with adequate nutrition.

Firstly, it is necessary to exclude from the diet all foods that may in one way or another contribute to the resumption of bleeding. These include alcohol, salt, sugar, wheat flour products, and milk. You can drink tea and coffee, but in limited quantities. You should also completely stop smoking and aspirin-based medications - they can cause re-bleeding.

The diet of a convalescent person should include:

• eggs - soft-boiled or in the form of an omelet;
• lean meats or poultry;
• a variety of soups with milk, chicken or vegetable broth;
• semi-liquid porridge with milk or water (semolina, oatmeal, rice) with a spoon of butter;
• a large variety of stewed vegetables - carrots, zucchini, potatoes, beets;
• sweet fruits and berries;
• low-fat dairy products;
• weak sweet tea (can be with milk);
• still mineral water.

Diet therapy is one of the main methods of treatment for peptic ulcer disease. Food should not irritate the mucous membranes, be easily digestible and be nutritious enough to promote fast healing ulcers

You need to eat fractionally, in small portions; during an exacerbation, the number of meals is 5–8 per day. The temperature of the food should be 25–33 degrees.

Be sure to follow a drinking regime of 30 ml/kg per day.

In case of acute ulcers of the stomach and duodenum, you need to be careful about your health and not aggravate the situation. Treatment must be combined with preventive measures.

First of all, you need to give up bad habits. Abuse of alcoholic beverages and cigarettes has a detrimental effect on the condition of stomach and duodenal ulcers.

Patients need:

• kefir, cottage cheese;
• sweet potatoes, apricots, apples, eggs, cheese, carrots;
• ascorbic acid, which is found in cabbage, milk, pork, beef, seafood, yogurt, melon, beans;
• vitamin E, which is found in peanuts, mangoes, kiwis, spinach, and egg yolks.

• Black tea;
• coffee;
• bitter chocolate;
• fried and fatty.

Maintaining a healthy lifestyle, giving up bad habits and being attentive to your health will be the key to eliminating the risk of developing dangerous pathologies. Timely detection of the first symptoms will help to begin treatment at the initial stage of the disease.

Successful treatment is largely determined by proper nutrition. During the first 24 hours, complete abstinence from food and drink is expected.

Thirst can be quenched with a few teaspoons of water or a piece of ice, which dissolves in the mouth. After a couple of days, you can eat food in liquid form.

Acceptable products include lactic acid products, fish or chopped meat, juices.

It is important to avoid rough foods, drinks with gases and foods that can worsen bleeding.

The first rule for recovery and reducing the risk of relapse is strict adherence to the doctor’s instructions. An exception to the rule “if you can’t, but really want to” doesn’t work. During the postoperative period, a strict diet is established. It can last from 3 to 6 months. The diet becomes more complex gradually.

Basic principles of the diet:

The daily number of meals is up to 6 times, in small portions.

All foods taken must be puree or semi-liquid.

Food should be steamed or boiled

Salt should be taken in limited quantities

You should also limit your intake of simple carbohydrates (sugar, chocolate, baked goods) and liquids.

On the 2nd day after the operation, mineral water, fruit jelly, and weak, slightly sweetened tea are allowed.

One of the components effective therapy is a diet that requires the strictest restrictions. A diet for a bleeding stomach ulcer involves an absolute refusal of liquid and food on the first day. If there is severe thirst, the patient is given water (several teaspoons) or ice to suck. Subsequent meals include raw eggs, milk, jelly, and liquid jelly.

Experts have come to the conclusion that if there is an open process with bleeding, prolonged hunger is contraindicated, since the secreted gastric juice worsens the condition of the mucous membrane. The body must receive the required number of calories, mineral salts, vitamins, and proteins. In this case, the food should be liquid.

What diet should you follow in the following days? A little later, you can add a soufflé of cottage cheese, meat, vegetable purees, crushed cereals, steamed cutlets, and butter to your diet. When a patient has an ulcer and bleeding begins, all spicy foods, alcoholic drinks, smoked foods, fried food.

In the postoperative period, it is important for patients to follow a diet, the purpose of which is to protect the stomach from increased load, accelerate the healing process and restore gastrointestinal motility, and prevent recurrence of perforation. A strict diet for a perforated gastric ulcer in the postoperative period can last up to six months. The diet is expanding very slowly.

Principles of dietary nutrition:

• the total number of meals per day is at least 5–6, portions are modest in size (200–250 g);
• the consistency of the dishes is semi-liquid, in the form of a homogeneous puree;
• optimal ways cooking - boiling in water or steaming;
• salt is sharply limited;
• The intake of carbohydrate foods and liquids is subject to restrictions.

The speed of recovery from gastric ulcer largely depends on nutrition. The more accurately the patient follows the doctor’s recommendations in terms of diet, the faster the healing process of the ulcer will occur. Our article will discuss nutritional features during exacerbation of stomach ulcers.

Why do you need a diet for peptic ulcer disease?

In the matter of recovery, diet therapy plays an important role: the diet should be as fortified as possible and involve the patient consuming the following products:

• Zinc: kefir, cottage cheese;
• Retinol: apricots, cheese, carrots, eggs, sweet potatoes;
• Ascorbic acid: melons, beans, non-sour oranges, cabbage, milk, berries, potatoes, yogurt, pork, beef, liver, seafood;
• Vitamin E: spinach and other greens, egg yolk, peanuts, mango and kiwi.

Products and food processing, the consumption of which is strictly prohibited:

• Pepper;
• Coffee;
• Fried and fatty foods;
• Bitter variety of chocolate.