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22. Bleeding from dilated veins of the esophagus in portal hypertension
The most severe and common complication of portal hypertension syndrome is bleeding from esophageal varices..
The cause of bleeding is mainly an increase in pressure in the portal system, peptic factor, as well as disorders in the blood coagulation system. Bleeding from dilated veins of the esophagus may be the first clinical manifestation of portal hypertension.
clinical picture. The first indirect signs of incipient bleeding are the child's complaints of weakness, malaise, nausea, and lack of appetite.
The body temperature rises. Sudden profuse hematemesis explains the sharp deterioration in the general condition of the child.
Vomiting is repeated after a short period of time. The child turns pale, complains of headache, dizziness, becomes lethargic, drowsy. A tarry, fetid stool appears.
Arterial pressure drops to 80/40-60/30 mm Hg. Art. A blood test reveals an increasing anemia. The volume of circulating blood decreases sharply. After 6-12 hours, the severity of the condition is aggravated by intoxication as a result of the absorption of blood decay products from the gastrointestinal tract.
Differential diagnosis. If the child is admitted to the surgical clinic again due to bleeding in the syndrome of portal hypertension or he underwent surgery for this disease, then the diagnosis should not be in doubt.
It is more difficult to make a differential diagnosis if bleeding was the first manifestation of portal hypertension, since similar clinical symptoms occur in children with a bleeding stomach ulcer, hiatal hernia, and after severe nosebleeds.
Children who bleed from chronic gastric ulcers usually have a characteristic and long-term "ulcerative" history. Profuse bleeding is extremely rare.
Acute ulcers in children receiving long-term hormonal therapy are also rarely complicated by bleeding.
In children with a hernia of the esophageal opening of the diaphragm, intermittent hematemesis is not abundant, the presence of a "black" stool is not always observed.
The general condition of the child worsens slowly over many months.
Children usually come to the clinic for mild anemia of unknown etiology. Clinical and radiological examination establish the presence of a hernia of the esophageal opening of the diaphragm.
The cause of bloody vomiting that occurs after nosebleeds is clarified with a detailed history taking and examination of the patient.
Authors: Drozdov A.A., Drozdova M.V.
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