Bleeding from the small intestine: what it is, causes, symptoms and diagnosis, treatment, prevention, possible complications.

Bleeding from the small intestine develops in any part of the digestive tube. More often in the duodenum against the background of peptic ulcer disease. The clinical picture depends on the localization of the source of blood flow, its intensity.

What is intestinal bleeding

Intestinal bleeding is the effusion of blood into the lumen of the small intestine. This is a fundamental difference from bleeding from the gastrointestinal tract, when blood enters the abdominal cavity. Pathology accounts for up to 10% of all hemorrhages of the digestive tract. About 76% of patients are young or middle-aged people. Risk group - men over 40 years old, patients of gastroenterologists.

In most cases, bleeding from the small intestine, symptoms are blurred and chronic. The condition is detected by chance when diagnosing other diseases or during medical examination.

Less often, the clinical picture is vivid, associated with a complication of the underlying gastrointestinal disease. An acutely developed symptom poses a direct threat to a person's life.

You can independently suspect a pathology in the small intestine by the following signs:

• dark colored feces;
• vomit in the form of "coffee grounds";
• constant pallor;
• loss of strength.

Causes

There are more than 200 reasons for the leakage of blood from different parts of the small intestine. Hemorrhage occurs as a result of mechanical or organic damage to the wall of the intestine itself and blood vessels of various sizes.

In every 10th case, it is not possible to find out the reason. Provocative factors - impaired hemostasis, coagulability, changes in the platelet component.

The most common causes of small bowel bleeding are:

• erosive duodenitis - inflammation and ulceration of the duodenum;
• duodenal ulcer;
• benign and malignant tumors;
• vascular malformation (angiodysplasia) - defects in the structure and functionality of the arteries and veins of the small intestine;
• Meckel diverticulum - congenital anomaly, when the yolk duct (the strand connecting the intestine of the embryo and the yolk sac for intrauterine nutrition) does not dissolve before the baby is born;
• Crohn's disease - chronic recurrent inflammation of the walls of all parts of the gastrointestinal tract with the formation of edema, ulcers, abscesses, fistulas;
• aorto-intestinal fistula - a slowly developing complication after reconstruction of the abdominal aorta;
• specific pathology - tuberculous colitis, intestinal syphilis;
• foreign body, mechanical injury, injury;
• helminthiasis;
• marathon races by professional athletes.

Symptoms

The clinical manifestations of hemorrhage from the small intestine directly depend on the progression of the pathology, the rate of blood loss. If the duodenum is damaged, blood is pumped into the stomach, provoking "coffee grounds" vomiting (oxidation of blood by the action of gastric juice).

With profuse bleeding, a large volume of blood irritates the walls of the digestive tube, softens the stool, and disrupts the motor-evacuation function. The result is melena, a fetid, liquid, black stool.

Nonspecific symptoms of hemorrhage of the small intestine of varying intensity:

• general weakness;
• pallor of the skin;
• rapid heartbeat, breathing, pulse;
• lowering blood pressure;
• excessive sweating;
• tinnitus, flies in front of the eyes;
• confusion, fainting.

Other signs of intestinal bleeding are associated with an underlying medical condition. Often, the condition is accompanied by epigastric or abdominal pain, nausea, belching. It is difficult for a person to swallow food.

The risk of developing ascites (accumulation of fluid in the abdominal cavity) increases. With latent forms of bleeding, only signs of increasing anemia are noted (a decrease in hemoglobin or erythrocytes).

On examination, psychological tension, anxiety, and a sense of fear are noted. If the blood loss is significant, dry mouth appears, the person experiences an unquenchable thirst.

The severity of blood loss in case of damage to the small intestine:

• 1st degree - latent chronic bleeding, anemia is insignificant, the general condition is not worsened;
• 2nd degree - acute short-term bleeding, pressure and pulse are stable, hemoglobin content is not more than 100 g / l;
• 3rd degree - acute blood loss, slight decrease in blood pressure, heart palpitations, hemoglobin <100 g / l, shock index> 1 (ratio of heart rate in 1 minute to systolic pressure);
• 4th degree - heavy massive bleeding, pulse 120 beats per minute, systolic blood pressure below 80 mm Hg. Art., hemoglobin <80 g / l, erythrocyte volume <30% (norm 36-48%, depending on gender), decreased daily urine output, shock index 1.5.

Diagnostics

The patient is examined by a gastroenterologist and an abdominal surgeon. Collect anamnesis, assess the nature of vomit and feces. During an external examination, attention is paid to the condition of the mucous membranes, skin, the presence of such elements:

• hematomas - local accumulation of blood in soft tissues;
• petechiae - grouped dotted spots of a rounded shape, red, brown, purple;
• telangiectasias - pronounced spider veins;
• yellowness of the skin - the liver is involved in the pathological process.

Palpation and percussion are performed with extreme caution so as not to provoke increased bleeding. Laboratory tests - a blood test for the number of erythrocytes, hemoglobin, platelets, urea, creatinine, liver function tests.

Instrumental research:

• celiacography - X-ray of the celiac trunk and its branches;
• gastroscopy - endoscopic examination of the upper part of the small intestine in real time;
• angiography of mesenteric vessels - detection of affected intestinal vessels;
• static scintigraphy - the introduction of radioactive isotopes-markers into the body to obtain a clear flat image on a color monitor;
• multispiral CT - the use of two-dimensional detectors and X-rays for accurate visualization of internal organs.

How to treat small intestine bleeding

If intestinal bleeding is suspected, the patient is urgently hospitalized. Therapeutic tactics depend on the causes, localization, and intensity of hemorrhage.

Providing emergency care and stopping bleeding from the small intestine in acute massive blood loss:

• infusion therapy - catheterization of the subclavian vein for the rapid introduction of solutions in order to replenish the circulating blood volume, change the central venous pressure;
• emergency endoscopy for cutting off a bleeding ulcer or vessel coagulation;
• continuous catheterization of the bladder to monitor kidney function;
• oxygen therapy;
• hemostatic therapy - the use of drugs to stop bleeding;
• autotransfusion by bandaging the legs - prevents oxygen starvation of the brain, cardiac arrest;
• a cleansing enema to remove blood residues and clots from the intestines.

With moderate bleeding, treatment is aimed at eliminating the cause (therapy of the underlying disease) - proton pump blockers, H2 receptors, antacids. Shows strict bed rest, hunger, an ice pack on the stomach.

If bleeding cannot be established, an emergency operation is performed. With successful relief of blood loss, patients with a perforated ulcer are prepared for elective surgery. The risk of death remains high. The prognosis of bleeding from the small intestine depends on the severity, age, and the presence of concomitant diseases.

Tell us in the comments if you have experienced bleeding from the small intestine. Bookmark the article, share it on social networks.

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Sources:

• https://cyberleninka.ru/article/n/zheludochno-kishechnoe-krovotechenie-sovremennye-aspekty-diagnostiki-obzor-literatury
• https://health-ua.com/article/16720-taktika-vracha-pri-krovotecheniyah-iz-zheludochnokishechnogo-trakta
• https://gkb-luki.tmbreg.ru/news/580-zheludochno-kishechnye-krovotecheniya
• https://thepresentation.ru/medetsina/sindrom-zheludochno-kishechnogo-krovotecheniya
• http://www.myshared.ru/slide/435842/
• https://www.krasotaimedicina.ru/diseases/zabolevanija_gastroenterologia/intestinal-bleeding