How does the case of haemorrhage of upper digestive tract deal with?

summary

Upper gastrointestinal bleeding refers to the bleeding of the digestive tract above the flexor's ligament, including esophagus, stomach, duodenum or pancreaticobiliary diseases. The bleeding of jejunal diseases after gastrojejunostomy also belongs to this range. Massive hemorrhage refers to the loss of blood volume more than 1000ml or 20% of circulating blood volume in a few hours. Its main clinical manifestations are hematemesis and (or) melena, often accompanied by acute peripheral circulation failure caused by reduced blood volume. It is a common emergency with a mortality rate of 8% - 13.7%. How to deal with the cases of upper gastrointestinal bleeding?

How does the case of haemorrhage of upper digestive tract deal with?

First, the patients with massive hemorrhage should take the supine position, and raise the lower limbs, head side position, so as to avoid suffocation caused by blood reflux when massive hematemesis, oxygen inhalation and fasting when necessary. A small amount of bleeding can be appropriate into liquid food, patients with liver disease should not use morphine, barbital drugs.

Second: (1) drug therapy: ① commonly used drugs: proton pump inhibitor omeprazole, H2 Receptor Antagonist Cimetidine or ranitidine, norepinephrine, thrombin, etc. ② Pituitrin is commonly used in the treatment of esophageal and gastric variceal bleeding. Patients with hypertension, coronary heart disease or pregnant women should not use. Since 1980s, somatostatin has been used to stop upper gastrointestinal bleeding, but the price is expensive（ 2) Three lumen balloon tube compression hemostasis is suitable for esophageal and gastric variceal bleeding. If the hemostatic effect of drugs is not good, it can be considered to use. The immediate hemostasis effect of this method is obvious, but the complications such as asphyxia and aspiration pneumonia must be prevented.

Third: (3) emergency variceal ligation can be used to stop bleeding of portal hypertension under endoscope; ② Injection of tissue glue or sclerosing agent, such as ethoxysclerol, sodium morrhuate, etc. In the treatment of non portal hypertensive hemorrhage, local injection of epinephrine saline can be used; ② APC electrocoagulation was used for hemostasis; ③ Blood vessel clip (titanium clip) to stop bleeding（ 4) Tips combined with gastric coronary vein embolization can be used in patients with esophageal and gastric variceal bleeding who failed to be treated by pituitrin or three lumen balloon catheter.

matters needing attention

(1) No smoking, drinking, strong tea and coffee（ 2) Drinking milk often can prevent upper gastrointestinal bleeding: gastric acid secretion peak at night. (4) high protein diet: high quality protein should be given priority to, such as milk, eggs, soybeans and their products.