"Blood battle" to the end: first aid and treatment of upper gastrointestinal bleeding

Author: Zhang Huijun, The Fifth Medical Center, PLA General Hospital

Han Bin The Fifth Medical Center of PLA General Hospital

Reviewer: Lu Zheng, deputy chief physician, Fifth Medical Center, PLA General Hospital

Upper gastrointestinal bleeding refers to bleeding caused by lesions of the esophagus, stomach, duodenum, or pancreas and gallbladder, and is one of the most common clinical emergencies. When facing an emergency situation of upper gastrointestinal bleeding, the difficulty of first aid lies in its sudden onset and rapid progression, which often requires everyone to make accurate judgments and implement effective treatment in the shortest possible time. Today, we will explain in depth the first aid and treatment of upper gastrointestinal bleeding to help everyone quickly and correctly deal with related emergencies in the future.

1. How should we treat upper gastrointestinal bleeding in hospitalized and outpatient patients?

1. In-hospital treatment

(1) Lie down on the spot, stay calm, and do not eat or drink anything. Tilt your head to one side to prevent accidental aspiration and suffocation.

(2) Keep vomitus and excrement and call medical personnel.

(3) Do not walk or move on your own. Wait for medical staff to arrive and cooperate with their treatment.

2. Out-of-hospital treatment

(1) Rest on the spot, stay calm, and don't be nervous to avoid aggravating the bleeding; tilt the patient's head to one side to prevent aspiration and suffocation.

(2) Dial the emergency number "120" to buy time for emergency treatment, avoid being shaken, and seek medical treatment nearby.

(3) Stop eating or drinking immediately. You can rinse your mouth with warm water, but do not apply hot compresses to the abdomen to prevent gastrointestinal vasodilation and aggravate bleeding.

2. How to estimate the amount of bleeding?

Hematemesis, black stools and blood in the stool are helpful in judging the amount of bleeding and provide a basis for formulating treatment plans. See the figure below for judging the amount of bleeding based on black stools and/or hematemesis.

Figure 1 Copyright image, no permission to reprint

It should be noted that when the patient's family estimates the amount of bleeding at home, they can use the capacity of a small bowl commonly used at home (about 250 ml) or an ordinary disposable paper cup (about 250 ml) or an egg (1 egg is about 50 g). Do not make estimates arbitrarily to avoid being misled by the doctor's questions about the medical history after seeing the doctor.

3. If the patient has an infectious disease, how should his vomit and excrement be handled?

1. For patients with infectious diseases, their family members should take personal protection measures. It is recommended that they wear disposable gloves or latex gloves to avoid contact of broken skin and mucous membranes with vomit and excrement to prevent cross infection.

2. For families with the conditions, 1:5000 chlorine-containing disinfectant should be used to completely cover vomitus and excrement, and then poured into the toilet or sewage disposal system after 30 minutes. The mops and rags used to handle vomitus and excrement must also be treated with disinfectant of the same concentration.

4. What are the hemostatic measures that can be taken for esophageal and gastric varicose vein bleeding?

Rupture of esophageal and gastric varicose veins is one of the most common causes of upper gastrointestinal bleeding in clinical practice. The treatment process of rupture of esophageal and gastric varicose veins is shown in the figure below.

Figure 2 Copyright image, no permission to reprint

5. Can patients with cirrhosis who suddenly vomit blood undergo emergency gastroscopy? Will it aggravate the bleeding?

1. Emergency gastroscopy can also be performed for vomiting blood: If the patient vomits fresh blood (excluding hemoptysis), emergency gastroscopy should be performed in time if conditions permit, to find the bleeding point, stop the bleeding in time, and save the patient's life.

Figure 3 Copyright image, no permission to reprint

2. Emergency gastroscopy will not aggravate bleeding: When esophageal and gastric varices rupture in patients with cirrhosis and columnar blood spurts out under endoscopy, the blood loss is more than 100 ml per minute. Timely emergency gastroscopy examination and treatment will not aggravate bleeding. On the contrary, timely hemostasis will prevent the patient from hemorrhagic shock and thus save the patient's life.

6. What are the methods for endoscopic treatment of esophageal and gastric varices?

There are three commonly used methods for endoscopic treatment of esophageal and gastric varices: band ligation, sclerotherapy, and tissue adhesive embolization.

1. Band ligation

Figure 4 Copyright image, no permission to reprint

(1) Definition and principle: Endoscopic varicose vein ligation is a safe, effective and simple method for hemostasis and prevention of esophageal varicose vein bleeding, which uses multiple linked rubber bands to ligate the varicose esophageal veins and mucosa, causing ischemia and necrosis of the varicose veins.

(2) Indications: Applicable to patients with acute esophageal variceal bleeding, acute bleeding after surgical treatment or other methods, and patients with a history of esophageal variceal bleeding. Applicable to LDRf classification D1.0-D2.0 varicose veins (varicose vein diameter <2 cm). If the diameter of the varicose vein is >2 cm, the risk of recurrent massive bleeding after endoscopic band ligation increases.

2. Sclerotherapy

Figure 5 Copyright image, no permission to reprint

(1) Definition and principle: Endoscopic esophageal varicose vein sclerotherapy is a method of endoscopically injecting a sclerotherapy agent to produce chemical inflammation in the varicose veins, causing adhesion of the damaged surfaces of the vascular endothelium, thrombosis to occlude the lumen, coagulation and necrosis of the mucosa around the vein, and tissue fibrosis.

(2) Indications: Applicable to patients with acute esophageal variceal bleeding, acute recurrent bleeding after surgical or other treatments, and patients with a history of esophageal variceal bleeding. For patients with esophageal variceal bleeding who are not suitable for endoscopic esophageal variceal ligation, endoscopic esophageal variceal sclerotherapy can be considered.

3. Tissue adhesive embolization

Figure 6 Copyrighted images are not authorized for reproduction

(1) Definition and principle: Tissue adhesive is a water-like substance that can solidify quickly. It polymerizes and hardens immediately after contact with blood. It can effectively occlude blood vessels and control varicose vein bleeding. It can also make varicose veins disappear, thereby reducing the risk of rebleeding.

(2) Indications: Suitable for gastric varices. It can be used for all gastrointestinal varicose bleeding in emergency. It is suitable for esophageal varices in small doses.