How to Manage Acute Gastric Bleeding

Aug 24, 2022 Source: Cainiu Health

Dr. Zhao Haiming

Introduction

Patients with acute gastric hemorrhage should temporarily fast and promptly receive fluid replacement to replenish nutrients. While lying down, the patient’s head should be tilted to one side to prevent aspiration and airway obstruction caused by blood reflux. In cases of massive gastric hemorrhage occurring over a short period, resulting in a rapid decline in red blood cell count, fresh plasma should be administered immediately to restore intravascular volume and prevent shock, along with hemostatic therapy.

Increasing numbers of people are now suffering from acute gastric hemorrhage. Patients with acute gastric hemorrhage often exhibit progressively elevated heart rates, cold extremities, and reduced urine output. Prompt medical attention at a hospital is essential following an episode of acute gastric hemorrhage. So, how should acute gastric hemorrhage be managed?

Management of Acute Gastric Hemorrhage

Patients with acute gastric hemorrhage should temporarily fast and receive timely fluid resuscitation to restore intravascular volume and replenish nutritional deficits. While lying down, the patient’s head should be tilted to one side to prevent aspiration or airway obstruction caused by blood reflux. In cases of massive gastric hemorrhage occurring over a short period—leading to a rapid decline in red blood cell count—fresh plasma transfusion may be urgently required to restore circulating blood volume and prevent shock, alongside hemostatic therapy. Acid-suppressing medications (e.g., omeprazole) and gastric mucosal protectants (e.g., sucralfate) may be administered. For hemorrhage due to ruptured esophageal or gastric varices, a Sengstaken–Blakemore tube (triple-lumen, double-balloon catheter) can be used for tamponade. If bleeding originates from gastric ulcers or gastric tumors and remains uncontrolled with pharmacotherapy, surgical intervention may be necessary.

Acute gastric hemorrhage may also lead to anemia. Although hematocrit, red blood cell count, and hemoglobin concentration may initially appear only mildly altered, anemia typically develops within several hours. Prolonged upper gastrointestinal bleeding may cause leukocytosis. Additionally, acute gastric hemorrhage can precipitate hypovolemic peripheral circulatory failure. Severe hemorrhage may manifest as profound weakness, dizziness, pallor, sudden coldness of the limbs, intense thirst, syncope, and—when blood loss escalates—shock, dyspnea, mental confusion, and marked pallor. Inadequate or delayed management may result in death.

Following onset, the diet should consist primarily of liquid or semi-liquid foods. Porridge is recommended as the staple food—for example, millet porridge, Chinese yam preparations, noodles, or dumpling soup. Such foods supply readily digestible carbohydrates, promote efficient nutrient absorption, and minimize gastric irritation or burden. We hope this information proves helpful to you.

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