Features of managing patients with gastrointestinal bleeding in resuscitation and intensive care units

Abstract

Emergency hospital doctors very often encounter cases of gastrointestinal bleeding. Known causes of such bleeding are peptic ulcers of the stomach and duodenum and esophageal varices in portal hypertension. But there are cases of gastrointestinal bleeding, when the diagnosis is not easy to establish, treatment is carried out symptomatically and fatal dangers for the patient are often underestimated. Bleeding is often massive and difficult to assess in terms of volume as blood is in the gastrointestinal tract and only changes in hemodynamics and blood tests can serve as indirect indicators of blood loss. Carrying out intensive care and resuscitation measures simultaneously with endoscopic and surgical methods to stop bleeding determine a high risk and dramatic situation. On the background of hypocoagulation syndromes associated with the use of anticoagulants and antiplatelet agents, the course of these syndromes is significantly complicated. A major contribution to the adverse outcome of the disease is brought by severe concomitant diseases and old age. Intensive care for this category of patients requires an individual approach, taking into account the underlying disease and the cause of bleeding, as well as comorbidities. Endoscopic methods of vascular coagulation are the main ways for diagnosing and stopping bleeding, but in extreme cases urgent surgical intervention is necessary. Patients require treatment in multidisciplinary clinics, where there is an expanded diagnostic service, endoscopic service, departments of abdominal and thoracic surgery, transfusion and resuscitation departments and intensive care with extended options for replacement therapy of vital organs. The article provides a review of the causes, diagnosis and methods of intensive treatment of upper gastrointestinal bleeding from esophagus and stomach in MalloryWeiss and Boerhaave syndromes.