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.

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.

External bleeding

Bleeding from rozpadayuchyh, externally located tumors neridkisni in the practice of palliative medicine. To stop bleeding apply similar methods of hemostasis entire arsenal: pressing vessel that bleeds (not less than 25-30 minutes), pressure bandage, bandaging and suturing blood vessels in the wound and over, thermocoagulation, topical hemostatics ( Hemostatic sponge tahokomb, helfoum), the overall haemostatic therapy. If vaginal bleeding is widely used plugging the vagina. For emergency stop external bleeding is the most effective pressing vessels with subsequent stitching and overlay pressure bandage.

Of great importance is the proper organization of patient care: placement in a separate chamber, timely dressing, use a dark (preferably green) linen, which is less visible blood; sedative therapy; permanent residence at the nursing bed patient.

 

5.3. Quiz:

Score skarzhen and history of cancer patients.

Rules students in oncology clinic. Supervision of patients.

Indications for the appointment of palliative care cancer patients

Caring for patients with stoma

Ascites, hydrothorax

Voles. Care.

Retention of urine

External bleeding

 

5.4. Final stage:

Control and correction of professional skills and knowledge held by solving situational and clinical tasks, tests for self-control. Assesses knowledge and skills students study each assessment.

The teacher has homework, recommended literature on the subject next class basic and additional.

 

VI. Materials for methods of classes

6.1.Materialy control baseline (rising levels) of students: T estovi task

With the development of hydrothorax should:

- Appoint diuretics;

- Appoint narcotic analgesics;

-         to pleural puncture with evacuation of fluid *;

- To all lists manipulation

Most complications pleurocentesis:

Injury to the heart;

Hemothorax;

Pneumothorax *;

Injury to the liver.

2nd stage pressure ulcers - a :

- Redness and swelling of the skin induration, blisters appearing or step vovylyvy no visible damage to the epidermis;

- Damage to the epidermis and surface ulcers *;

- The spread of necrosis on the entire thickness of the skin to form deep ulcers, performed necrotic masses;

- Distribution of necrosis on hlybsheroztashovani tissue and bone.

 

6.2. Materials for the methods of the main stage sessions T able, owner of anticancer chemotherapy, hospital records and medical history of patients with precancerous diseases and cancer of various locations, medicines.

 

6.3. Materials for the final stage of the study: clinical case studies

Final Test

clinical case studies (Correct answers are marked "*")

Task 1. D at General Hospital Patient came in '56 with complaints of shortness of breath at rest, general weakness. Objectively t - 36,5 respiration frequent, free, to the left - a significant easing breathing. When chest radiograph - a shadow that merges with a dome diaphragm, reaches the third rib. Upper contour napivkulepodibnyy. I) What is the preliminary diagnosis? II) What therapeutic approach?

I

A. hydrothorax *.

B. hidropnevmotoraks.

C. Lung cancer.

D. Left-sided pneumonia.

II

A. pleural puncture with evacuation contents *.

B. antibiotic.

C. Calls diuretics.

D. appointment of anti-inflammatory drugs

Task 2. Patient entered the clinic N., 53, with neglected tumor of the right breast. Tumor size 13 x 15 cm, bleeding in the right axillary area - not driven conglomerate. Which therapeutic approach her?

A. Haemostatic therapy.

B. * Palliative sanitary mamektomiya followed himiohormonoterapiyeyu.

C. Appointment of narcotic analgesics.

D. Palliative radiotherapy and chemotherapy.