Gastric bleeding - a formidable complication of peptic ulcer

Bleeding is the most frequent and dangerous complication of peptic ulcer. Most gastric bleeding develops against the background of exacerbation of peptic ulcers, but in some patients it may be the first symptom of an exacerbation of the disease. Latent bleeding always accompanies the development of exacerbation of stomach ulcers. Usually such a symptom of the disease remains unidentified and is not considered a complication.

Diagnostically predominantly only a massive, so-called profuse gastric bleeding with bloody vomiting and melena (tarry stool), which occur almost simultaneously. These symptoms make it possible to assume significant bleeding from the upper parts of the digestive tract. With bloody vomiting, the source of bleeding is more often in the stomach and less often in the wall of the duodenum, but above the duodenal fold. Vomit in this case resemble coffee grounds. However, bleeding from the duodenum and even from the stomach is not always accompanied by the development of bloody vomiting. Only melena is often found. About 90% of bleedings with ulcers localized in the duodenum, manifested only melena, while with gastric ulcer it is often observed bloody vomiting.

Clinical picture

If gastric bleeding develops, its symptoms are determined by the intensity and volume of blood loss. With a mild degree, the volume does not exceed 300-400 ml. Subjective symptoms may not be there at all, or they are limited to mild, rapidly disappearing nausea, and also increased dryness in the mouth, a general weakness. The patient in most cases may not even pay attention to the appearance of these symptoms, if they are not accompanied by vomiting with blood. More permanent symptoms are the urge to drain and black tarry stools. Gastric bleeding, which does not exceed 10% of the circulating blood, the body tolerates easily. This is due to the work of compensatory mechanisms and self-regulation.

With large blood loss or repeated bleeding, there are signs of acute posthemorrhagic anemia. It is manifested by severe weakness, nausea, noise in the ears, palpitation, dizziness, visual disturbances in the form of flickering "stars" or a grid in front of the eyes. The patient develops a sharp pallor, the skin becomes covered with a cold sweat, the pulse accelerates, and the arterial systolic pressure decreases. It must be remembered that these symptoms may appear earlier than bloody vomiting and melena develop. The condition of the patient largely depends not only on the volume of blood loss, but also on the speed of its development. Under the influence of compensatory mechanisms, the volume of circulating blood is restored within several hours, but anemia develops, which causes the severity of blood loss. With a single bleeding anemia is most pronounced at the end of the first day. Absence of positive dynamics in the patient's state during the next two to three days indicates prolonged bleeding or its recurrence.

Gastric bleeding - ways to stop

With the development of bleeding, emergency care is needed. Methods of stopping bleeding may be different. At the pre-hospital stage, the patient is assigned a strictly horizontal position, a cold on the stomach area, parenteral administration of hemostatic drugs. Cardiac and vasoconstrictive drugs are contraindicated. The patient is hospitalized in a surgical hospital where hemostatic therapy is continued and the volume of circulating blood is restored. In severe cases with ineffectiveness of the treatment performed, surgical intervention is indicated. The criterion of ineffectiveness of therapeutic treatment is considered to be continuing bleeding after transfusion of 2 liters of blood or its resumption after a short break.