Gastrointestinal bleeding is a peptic ulcer bleeding by ulcers that puncture blood vessels in the wall of the stomach. Therefore, the application of a rapid treatment regimen for gastrointestinal bleeding is essential. This treatment regimen is issued by the Ministry of Health and is considered to be the general standard applicable to patients suffering from gastrointestinal bleeding disease.
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General information about gastrointestinal bleeding disease
Gastrointestinal bleeding is when blood leaves the lumen of the blood vessel and flows into the digestive tract. This phenomenon can be found in any segment of the digestive tract such as the esophagus, stomach, intestines or anus.
This can be a result of diseases related to the digestive system that are not under control. Depending on the severity of the damage to the gastrointestinal mucosa, bleeding can range from mild to severe or even shocking.
Gastrointestinal bleeding is characterized by blood vomiting and bloody stools. Based on the location of bleeding in the digestive tract, this condition will be divided into 2 types:
- Upper gastrointestinal bleeding: This condition will occur from the esophagus extending to the D4 position on the Triez ligament and the boundary that separates the duodenum from the jejunum.
- Lower gastrointestinal bleeding: This condition activates from the Triez ligament extending to the anus.
Gastrointestinal bleeding is a serious medical emergency that requires prompt intervention, otherwise it may cause the following complications:
- Lack of blood to the brain causes brain depression.
- Myocardial infarction in patients with cardiovascular disease.
- Prolonged bleeding leads to blood loss and is potentially fatal.
Latest treatment regimen for gastrointestinal bleeding according to the Ministry of Health
In order to come up with the right treatment regimen, the patient will first be appointed by a doctor for a physical examination and perform diagnosis to determine the severity. Depending on the severity or mildness, there will be the most suitable treatment regimen.
1. Diagnosis of gastrointestinal bleeding
Currently there are many methods of diagnosis, namely:
1.1. Implementing the quadrants
- Typical: Symptoms include blood vomiting, black stools, bleeding signs of acute blood loss.
- Atypical: Patient presents with acute blood loss only and does not notice typical symptoms. At that time, the doctor will place a gastrostomy tube to check, examine the rectum to find signs of black stools and combine with gastro duodenal endoscopy if there is suspicion of upper digestive tract.
1.2. Differential diagnosis
For severe bleeding will be identified in the following cases:
- Unstable flow of blood: Postural hypotension and blood loss shock accompanied by manifestations such as hypotension, cold skin, consciousness disorder, low urination.
- The amount of lost blood is about over 500ml or the patient must transfuse more than 5 units of blood / 24 hours.
- Patients with fresh bleeding immediately after insertion of a gastric tube or defecation with red water in the stool.
- The HP ratio below 20%, HC below 2 million / L and Hb below 7g / dL.
- Combined health problems: Heart failure, coronary heart disease or patients over 60 years old.
1.3. Assess risk of recurrent bleeding and severity
- Symptoms that bleeding is continuing or recurring: Blood pressure fluctuates, becomes stuck or falls off, or the pulse shows signs of increasing.
- Gastrointestinal endoscopy: Evaluate results based on the Forrest rating or Rockall scale.
1.4. Diagnose the cause
- Based on: Clinical examination, medical history and gastrointestinal endoscopy.
- If the patient’s condition has been stabilized, an endoscopy of the esophagus and duodenum will be performed as soon as possible with the aim of diagnosing the cause and intervening in hemostasis treatment.
- The main causes of gastrointestinal bleeding: gastro duodenal ulcers, esophageal varices rupture and gastro duodenal inflammation.
- Other causes: Crohn’s disease, Mallory Weiss syndrome, benign tumors in the gastrointestinal tract, vascular malformations, …
2. Treatment regimen for gastrointestinal bleeding
Treatment regimen for gastrointestinal bleeding must include a combination of resuscitation measures, hemostasis and treatment of the cause.
2.1. Resuscitation measures
This includes basic first aid actions such as:
- Put the patient in a low head position, attention should be paid to preventing the risk of choking lungs.
- Nasal oxygen breathing from 2 – 6l / min.
- Endotracheal intubation in the event of risk of reflux into the lungs or respiratory failure, confusion.
- Carry out insertion of 2 intravenous lines that are firm and large enough. Central venous catheter is placed and central venous pressure is measured in case of heart failure.
- Insert a catheter to monitor the amount of urine.
- Insert a gastrostomy tube and proceed to wash the blood in the stomach.
- Take blood for tests and electrocardiograms.
Volume recovery and shock resistance
- Priority should be given to compensating for the loss of fluid and to restore the hemodynamic state.
- Infusion: Most patients will receive an infusion of about 1-2 liters of isotonic saline to help adjust the lost volume.
- After isotonic saline infusion with a total dose of 50ml / kg, but the patient is still in shock, then continue to infuse more colloidal solution.
- Based on the level of blood loss and cardiovascular status of the patient to actively adjust the number and speed of infusion.
- The purpose of the measure: Help the patient get rid of shock (warm skin again, maximum blood pressure over 90, urine over 30ml / hour, no stimulation).
- Note: In case of patients suffering from gastrointestinal bleeding due to varicose esophageal varices, blood pressure should not be raised too high because it will increase the risk of bleeding recurring due to increased pressure on the portal vein.
- Need to closely monitor pulse, blood pressure and lung listening, especially in patients with cardiovascular disease.
Blood transfusion
- Used in patients with severe or progressive bleeding for the purpose of stabilized hemodynamic and hematocrit above 25%. For the elderly with coronary artery disease or respiratory failure, the hematocrit must be above 30%.
- In the case of a blood clotting disorder caused by thrombosis or fresh plasma with signs of freezing.
2.2. Treatment of hemostasis according to the cause
Gastroscopy is a method that plays an important role in the treatment of hemostasis of a specific cause. It then needs to be initiated as soon as possible until the patient’s condition is gradually stabilized.
Specific causes:
- Acute gastroduodenitis: Cut out the stimulants and use omeprazole intravenous bolus 80 mg and then intravenously 8 mg / hour. If the bleeding continues, it is possible
- Gastroduodenal ulcers: Endoscopic intervention combined with drugs that inhibit the secretion of gastric juice omeprazole intravenously 80 mg. Continue intravenous infusion approximately 8 mg / hour. In case of severe, persistent bleeding but failed endoscopy, surgery should be considered early, combining intravenous somatostatin infusion with similar doses.
- Oesophageal varicose rupture: Endoscopic intervention is combined with drug use to reduce portal pressure. Indications for the use of one of the following drugs: somatostatin (intravenous bolus injection 0.25mg, then intravenous infusion 6mg / 24 hours), terlipressin (1mg x 4 times / 24 hours), terlipressin (1mg x 4 times / 24 hours).
For patients with heavy bleeding that cannot endoscopy to determine the cause or can not distinguish the cause of bleeding, it is necessary to coordinate treatment:
- Infusion and blood to resist shock.
- Intravenous infusion combined with gastric juice secretion inhibitors (omeprazole intravenous bolus injection 80 mg and then intravenous infusion 8 mg / hour) and use of drugs to reduce portal pressure (somatostatin intravenous bolus 0 , 25mg, then intravenous infusion 6mg / 24 hours or terlipressin 1mg x 4 times / 24 hours).
Advice for people with gastrointestinal bleeding
Gastrointestinal bleeding is a serious medical condition that has negative effects on health. Therefore, when abnormal signs related to gastrointestinal bleeding appear, the patient should actively go to the hospital to be diagnosed and treated by a doctor.
In addition, stopping some Western drugs can worsen bleeding, most commonly:
- Blood thinners: Warafin is the most typical. This medication can disrupt the natural process of blood clotting, increase your risk of bleeding, or worsen gastrointestinal bleeding.
- Aspirin: This medication can disrupt platelet circulation, making bleeding worse. Therefore, the drug should be used until symptoms of gastrointestinal bleeding have been completely cured.
- Ibuprofen and other NSAIDs: The cause of gastrointestinal bleeding in many patients may be related to this group of drugs. Therefore, if you regularly take these drugs, you should consider stopping them immediately or talking to your doctor about this.
Care and prevention of gastrointestinal bleeding
As has been mentioned, gastrointestinal bleeding is a dangerous condition. In addition to treatment according to the regimen of the Ministry of Health, patients also need to take care and preventive measures at home to support the shorter treatment process.
1. Home care
Practicing home care methods will help repair damage quickly through the following:
- Use a warm compress on your abdomen to help relieve pain caused by symptoms of illness or surgery.
- Take plenty of time to relax in a quiet space. Should lie in a supine position, keep your back straight on a flat bed and pay attention not to rest your head.
- Eat light, easy-to-digest foods like porridge, soup, stewed soup, and drink milk. Eat only a small amount of food and avoid overly hungry or full stomach.
- Always keep the spirit to relax comfortably by listening to music, reading the newspaper, talking with relatives. Avoid pressure, stress or thinking a lot.
- Absolutely do not exercise or move a lot.
2. Prevent the risk of recurrence
To avoid recurrent gastrointestinal bleeding, patients need to take measures to prevent the disease as follows:
- Include high-fiber foods with fresh fruits and vegetables in your daily diet.
- Increase the amount of water for the body from 2 – 2.5 liters to help the digestive system work better.
- Absolutely do not use beverages containing stimulants such as alcohol, coffee, and tea. At the same time, limit the tolerance of fast foods, fatty foods, processed foods, …
- Maintain the habit of eating on time and having enough meals Food can be divided into 5-6 meals to reduce pressure on the digestive organs.
- Maintain a healthy lifestyle by getting enough sleep, getting a good balance between work and rest. At the same time, exercise regular exercise every day to improve the body’s resistance.
The above article has summarized the latest treatment regimen of gastrointestinal bleeding according to the Ministry of Health together with effective care and prevention measures that you can refer to. In order to avoid having dangerous complications, patients should proactively seek out a doctor to visit and develop an effective treatment regimen.
