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Pulmonary hemorrhage (hemoptysis).

Pulmonary hemorrhage is a very frequent and most threatening complication of cancer of the lung, esophagus, tumors of the mediastinum. In most cases, the cause of bleeding are: destruction of endobronchial tumor or lung tissue, erosion of the walls of large vessels in the background of the inflammatory process in pneumonia, lung abscess and esophageal-bronchial fistulas. Depending on the intensity of bleeding distinguish different degrees of hemoptysis and pulmonary hemoptysis own, which quickly leads to a forthcoming tragedy patient.

The main symptom is hemoptysis of pulmonary hemorrhage, however, we must remember that this symptom occurs in many different diseases that must be differentiated tumor pathology to establish the correct diagnosis.

Treatment of pulmonary hemorrhage.

Tactics treatment of pulmonary hemorrhage depends on its intensity and the patient.

Drug therapy includes drugs that reduce the pressure in the pulmonary circulation (aminophylline), hemostatic means of different groups (etamzylat, Dicynone, pamba, vikasol, aminocaproic acid, gordoks, kontrikal, corticosteroids, calcium chloride), sedatives.

Prolonged hemoptysis, caused by local tumor process may conduct remote palliative course of radiotherapy, which is a 60 - 80% of cases gives effect. The following methods are used: a single exposure at a dose of 10 Gy, double exposure with a break in the week, a total dose of 17 Gray, irradiation of large factions within 5 days - 20 Gray.

Massive bleeding that occurred acutely requires use of emergency measures: drainage position on the side of the lesion, complete rest, intravenous hemostatic therapy; 50 -100 ml hypertonic solution of sodium chloride per os; bundles on a limb to reduce venous flow. The patient and his relatives should, if possible, to reassure and provide care by medical personnel. We must remember that with massive pulmonary hemorrhage patients die within a few minutes, in a similar case in the practice of palliative medicine resuscitative measures are not carried out.

Gastrointestinal bleeding

Bleeding from the gastrointestinal tract are common, their main reason: the collapse of the tumor, located in the opening of the digestive tract or diffuse erosive and ulcerative lesions as a result of complications. Clinical manifestations of such bleeding depends primarily on the level of injury.

When bleeding from the mouth sick splovuyut blood and clots may be swallowing blood and vomiting "coffee grounds" ground (dihtopodibne black liquid stool), anemia.

Esophageal-gastric bleeding occur vomiting fresh blood with clots and "coffee grounds", melena, anemia.

Bleeding from the duodenum, biliary tract, pancreatic duct, jejunum accompanied with ground and anemia.

In cases where the source of bleeding is localized in the terminal small intestine and in the colon, the main symptom is the presence of unmodified blood in the stool.

Treatment of gastrointestinal bleeding.

To determine the treatment strategy must first clarify the nature and localization of bleeding. In diffuse lesions of the digestive tract or its parts shown haemostatic therapy in full.

In cases where the source of bleeding can be precisely localized, must together with the surgeon-oncologist to consider the possibility of surgery: tumors of the oropharynx - ligation of the external carotid artery or its branches; gastric cancer - endoscopic stop bleeding, palliative gastrectomy ( resection) or ligation of vessels in tumors intestine - palliative resection of the bowel. In all cases deciding on surgical intervention should be guided by considerations of expediency, the interests of the patient and the real prospect of continuing his life.

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