Treatment for abdominal internal bleeding depends on the source and severity of the bleed. Often, gastrointestinal (GI) bleeding will stop on its own. However, when intervention is required, treatment options range from medication to surgical procedures. The specific approach is tailored to the individual case and the underlying cause.
Initial Stabilization
Before addressing the source of the bleeding, the immediate priority is to stabilize the patient. This often involves:
- Fluid Resuscitation: Administering intravenous (IV) fluids to restore blood volume and blood pressure.
- Blood Transfusion: Replacing lost blood with packed red blood cells (PRBCs) if the bleeding is significant and the patient is anemic.
- Oxygen Therapy: Providing supplemental oxygen to ensure adequate oxygen delivery to tissues.
- Monitoring: Closely monitoring vital signs (heart rate, blood pressure, oxygen saturation) and urine output.
Diagnostic Procedures to Identify the Source
Identifying the source of the bleeding is crucial for effective treatment. Common diagnostic procedures include:
- Upper Endoscopy (EGD): A procedure where a thin, flexible tube with a camera is inserted through the mouth into the esophagus, stomach, and duodenum to visualize the upper GI tract.
- Colonoscopy: A procedure where a similar tube is inserted through the rectum into the colon to visualize the lower GI tract.
- CT Angiography: A CT scan that uses contrast dye to visualize blood vessels and identify areas of active bleeding.
- Angiography: A procedure where a catheter is inserted into a blood vessel and contrast dye is injected to visualize the vessels using X-rays.
- Tagged Red Blood Cell Scan: A nuclear medicine scan that uses radioactive tracers to detect areas of active bleeding.
Treatment Options
Once the source of bleeding is identified, various treatment options may be employed:
- Medications:
- Proton Pump Inhibitors (PPIs): Used to reduce stomach acid production and promote healing of ulcers.
- H2 Receptor Antagonists: Also reduce stomach acid production.
- Octreotide: Can reduce blood flow to the GI tract and is sometimes used for bleeding varices (enlarged veins).
- Vasopressin: Another medication that can constrict blood vessels and reduce bleeding.
- Endoscopic Therapy: Many bleeding sites can be treated directly during an endoscopy or colonoscopy. Techniques include:
- Cauterization: Using heat to seal off bleeding vessels.
- Clipping: Applying small metal clips to the bleeding vessel to stop the flow of blood.
- Injection Therapy: Injecting medications (e.g., epinephrine) to constrict blood vessels and stop bleeding.
- Variceal Banding: Placing rubber bands around esophageal varices to cut off their blood supply.
- Argon Plasma Coagulation (APC): A non-contact thermal method used to coagulate bleeding tissue.
- Angiographic Embolization: If endoscopic therapy is not possible or fails, a radiologist can use angiography to locate the bleeding vessel and block it with coils or other materials (embolization).
- Surgery: Surgery is generally reserved for cases where other treatments have failed, or when the bleeding is severe and life-threatening. Examples include:
- Resection: Removing the portion of the bowel that is bleeding.
- Ligation: Tying off bleeding vessels.
- Repair of Perforations: Addressing any holes or tears in the GI tract.
Specific Examples
- Bleeding Peptic Ulcer: Often treated endoscopically with cauterization, clipping, or injection therapy. PPIs are also used to promote healing.
- Bleeding Varices: Treated with endoscopic variceal banding, medications (octreotide, vasopressin), or a transjugular intrahepatic portosystemic shunt (TIPS) procedure.
- Diverticular Bleeding: Often stops spontaneously. If it continues, it may be treated with colonoscopy or angiography with embolization.
- Bleeding from Polyps: Polyps can be removed during a colonoscopy (polypectomy).
In summary, the treatment of abdominal internal bleeding is a multifaceted approach focused on stabilization, diagnosis, and targeted intervention to stop the bleeding and address the underlying cause.
