Minor bleeding from the lower digestive tract

Lower gastrointestinal bleeding refers to intestinal segments less than 50 cm from the duodenal suspension ligament, including bleeding caused by jejunum, ileum, colon, and rectal disease. It is customary to exclude bleeding caused by hemorrhoids and anal fissures. Blood is the main type, and only the fecal occult blood or black faeces is present. The large amount of blood is discharged from the blood, and the severe cases are shocked. Clinical manifestations: gastrointestinal bleeding caused by dizziness, palpitations, nausea, thirst, dark or syncope; skin was pale and wet due to vasoconstriction and insufficient blood perfusion; pale after pressing the nail bed, and no recovery after a long time Venous filling is poor, and surface veins are often sagged. The patient feels tired and weak, and may further suffer from mental atrophy, irritability, and even sluggishness and confusion. Hemorrhage of the upper digestive tract was accompanied by vomiting and black stools. Most of the lower gastrointestinal bleeding is acute hemorrhage, which is mostly vomiting; chronic small bleeding is positive with fecal occult blood. (1) Factors that cause bleeding and affect hemostasis 1. Mechanical damage such as damage to the esophagus by foreign bodies, abrasion of flexion veins by pharmaceutical tablets, and severe vomiting due to cardia mucosa tear. 2, the role of gastric acid or other chemical factors, such as the intake of acid-base caustics, acid-base drugs. 3. Decreased mucosal protection and repair function Aspirin, non-steroidal anti-inflammatory drugs, steroid hormones, infection, stress, etc. can damage the protection and repair function of the digestive tract mucosa. 4, blood vessel destruction inflammation, ulcers, malignant tumors, etc. can damage arteriovenous blood vessels, causing bleeding. 5. Local or systemic coagulation disorders. The acidic environment of gastric juice is not conducive to platelet aggregation and clot formation. Anticoagulant drugs, systemic bleeding disorders or coagulopathy disorders can easily cause bleeding in the digestive tract and other parts of the body. (II) Pathophysiological changes after hemorrhage 1. Reduced circulating blood volume The elderly have arteriosclerosis of heart, brain, kidney and other important organs. Less severe reduction of circulating blood volume can cause obvious ischemic manifestations of these important organs. It even aggravates the original underlying disease, causing abnormal or even failure of one or more important organs, and a large amount of bleeding is more likely to cause peripheral failure and multiple organ failure. 2. Absorption of blood protein decomposition products by nitrogen-containing decomposition products can cause azotemia. In the past, it was thought that the absorption of blood decomposition products could cause "absorption of heat." It is now believed that the fever after gastrointestinal bleeding is related to the dysfunction of the thermoregulatory central nervous system caused by the decrease in circulatory blood volume. 3. Compensation and repair of the body (1) Circulatory system: The heart rate increases and the peripheral circulation resistance increases to maintain blood flow perfusion of important organs. (2) Endocrine system: increased secretion of aldosterone and posterior pituitary, reducing water loss to maintain blood volume. (3) Hematopoietic system: Bone marrow is hematopoietic, reticulocytes increase, and the amount of red blood cells and hemoglobin gradually recovers.

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