Gastric bleeding is bleeding or hemorrhage from stomach. The blood may be apparent in vomiting (hematemesis) or in stool in its altered form (melena). Gastric bleeding is a symptom and not a disease. It occurs from various causes related to stomach or outside the stomach. The amount of bleeding can be very small or in large quantity that can be life threatening.
Massive amount of blood loss in the form of hematemesis can lead to shock. In such situation measures to restore blood volume must be taken. During this period the vital signs such as blood pressure, central venous pressure and urine output are continuously monitored till patient becomes stable for further treatment which may depend on the underlying cause.
What Are The Causes Of Stomach Bleeding?
Stomach hemorrhage can occur due to many reasons. Some of the causes are limited within the stomach while some others may be entirely outside the stomach. Below are given important causes of gastric hemorrhage.
- Mechanical injury inside or outside of stomach can cause bleeding. A penetrating wound, a blunt blow on the stomach area can lead hemorrhage to in the stomach.A rough and sharp object accidentally swallowed or use of stomach tube in unskillful manner can cause injury and bleeding in the stomach. Ingestion of corrosive acid or alkali can also damage the inside of the stomach leading to hemorrhage.
- Gastritis or inflammation of the inner lining of stomach can cause bleeding. It can occur due to several reasons. Certain anti inflammatory drugs can cause gastritis.
- Perforated gastric ulcer can cause massive hematemesis.
- Certain diseases such as cirrhosis of liver, portal vein thrombosis, compression from a large tumor or adhesion can also cause hematemesis.
- Cancer of stomach or polyp will cause massive hemorrhage in the stomach.
Signs And Symptoms Of Gastric Bleeding
Gastric bleeding in itself is a symptom, but it can be accompanied with many other symptoms of the underlying causes. In some cases the bleeding can be very negligible to produce any symptom either through vomiting or passing through stool. However, a small bleeding ulcer or hemorrhage from cancerous growth in stomach can cause small amount of bleeding for days together that may be manifested as dark black stool.
If there is massive bleeding it may be vomited out. The color of blood is dark black or coffee brown. In case of peptic ulcer there is typical periodic abdominal pain which may be aggravated or relieved by meals. Patient usually complains of tenderness below the breastbone.
Heartburn, loss of appetite and vomiting, are common presentation of gastritis. In massive gastric bleeding patient may have low blood pressure, rapid heart rate, perspiration, confusion, dizziness etc.
Treatment Options For Gastric Bleeding
Bleeding from stomach can be massive or minimal depending on the cause. In majority cases of gastric bleeding the prognosis is good with effective treatment. However, rupture of aneurysm or a large blood vessel in the stomach can be fatal.
- Patient should be in recumbent position. He should avoid talking.
- He can suck small pieces of ice but excess amount of fluid should be avoided.
- In case of massive bleeding from stomach patient has to be hospitalized and treated for shock. All the vital parameters such as pulse, blood pressure, respiratory rate, oxygen saturation, urine output has to be monitored round the clock. He may need blood transfusion and intravenous fluids to maintain fluid and blood volume in the body.
- The stomach needs to be cleaned with gastric lavage of ice cold water.
- When there is active bleeding nothing is given by mouth except ice pieces. Once bleeding stops, bland diet can be given.
- Medicines such as proton pump inhibitors; antacids etc are administered to reduce acid secretion in the stomach.
- In some cases such as perforation of gastric ulcer, patient may need surgical intervention.