Vomiting blood

Introduction Hematemesis and blood in the stool are common symptoms of neonatal gastrointestinal bleeding. Under normal circumstances, duodenal levator (also known as Treitz ligament) above the gastrointestinal bleeding called upper gastrointestinal bleeding, hematemesis mainly, and lower gastrointestinal bleeding for blood (hematochezia). When the amount of bleeding in the lower digestive tract is higher or the intestinal pressure is higher than the intragastric pressure, the bloody fluid can flow back into the stomach and esophagus, and can also cause hematemesis. Otherwise, when the amount of bleeding in the upper digestive tract exceeds 3 ml, there may be black stools. That is, there is no hematemesis when it is black, and there is often black stool when it is hematemesis.

Cause

Common cause

1. Esophageal disease: rupture of esophageal varices.

2. Gastric and duodenal diseases: peptic ulcer, chronic gastritis and gastric and duodenal mucosal lesions, gastric cancer, etc.

3. Liver and biliary tract diseases: cirrhotic portal hypertension.

4. Pancreatic diseases: acute pancreatitis with abscess or cyst, pancreatic cancer, etc.

5. Blood diseases: leukemia, DIC, etc.

6. Acute infectious diseases: epidemic hemorrhagic fever, leptospirosis, etc.

7. Others: uremia, respiratory failure, liver failure, etc.

an examination

Related inspection

Blood coagulation time blood routine whole blood reduction viscosity serum specific viscosity gastroscope

Laboratory inspection:

1. Regular examination of blood routine, platelet, clotting time, prothrombin time and other general examinations. In general, coagulation disease, abnormal changes in the blood coagulation phase, such as DIC or vitamin K deficiency, such as congenital allogeneic or passive immune thrombocytopenic purpura or various congenital coagulation factor deficiency, coagulation The phase is abnormal.

2. Fecal examination found red blood cells, occult blood test strong positive acute gastroenteritis children may have mucus bloody stools, blood and so on.

3. X-ray inspection

(1). Abdominal plain film: Take the supine, erect or lateral lateral abdominal plain film, which can exclude intestinal obstruction and intestinal perforation, which is especially important for neonatal small intestine torsion necrotic enteritis and meconium peritonitis.

(2). Barium angiography: Dilute barium meal has a certain value in non-acute bleeding period, often with methyl cellulose as a double layer comparison. Oral sputum can also be injected into the small intestine after intubation of the duodenum (with or without methylcellulose). Barium enema often helps in the diagnosis of intussusception.

Differential diagnosis

1. Exclusion of pseudo-heavy hemorrhage and/or blood in the stool including blood transfusion into the mother and neonatal gastrointestinal extra-blood Apt test contributes to this differential diagnosis.

2. Exclusion of systemic coagulopathy is detected before transfusion (or plasma), injection of vitamin K and other anticoagulants, coagulation phase is essential, the most important is to make early diagnosis and treatment of neonatal hemorrhagic disease. At the same time, the infection of the central nervous system is damaged by respiratory distress and heart failure.

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