GASTRO DUODENAL HAEMORRHAGE
Gastro duodenal haemorrhage is the most common and important complication of gastric and duodenal ulcers. Although it can also occur in various other serious conditions like gastric carcinoma and other tumours, haemorrhage due to ulcers has a high incidence.
Gastroduodenal haemorrage is recognised by haematemesis
(vomiting of blood) or melaena (passage of blood in the stools) and usually
there are symptoms of hypovolaemia. Gastroduodenal heamorrhage
carries a mortality that may reach 30% in elderly and shocked patients. A
history of significant blood loss within the previous 48 hours should lead to
immediate admission to hospital.
The common causes of bleeding are chronic gastric and duodenal
ulcers (50%) ulcers erosions (15-30%) oesophageal varies (10%) and
mucosal laccerations at the cardia due to vomiting (mallory-weise
syndrome 7%). Less frequent causes are cancer of the stomach and other
tumours such as leiomyoma, oesophagitis, stress ulcer and bleeding
Erosions are usually caused by ingestion of aspirin either alone or in
combination with alcohol or by corticosteriods or non-steroidal antiinflammatory
drugs. In some patients the stomach shows petechiac,
multiple erosions and areas of confluent mucosal bleeding, this
appearance is called acute hemorrhagic gastritis. The usual
presentation of stress ulcer, caused by means of burns or head injury is
with haematemesis and melaena.
In severe bleeding from whatever cause, the patient complains of
weakness, faintness, nausea and sweating these symptoms are followed
by the vomiting of blood (haematemesis and malaena occur) with a sudden
large bleed whereas melaena alone indicates that bleeding is slower and
less in amount. If blood remains in the stomach it becomes partially
digested and appears brown and granular in the vomit or gastric aspirate,
like ‘coffee grounds’. Blood passing through the intestinal canal is also
altered in appearance, show that the faeces become black and sticky, a
tarry stool. But in severe bleeding, transmit may be so-rapid that the blood
in the rectum is bright red.
On examination, the patient may be shocked or restless and
disorientated because of cerebral anoxia. These signs may be absent in
the young patient in whom compensatory mechanism are more effective.
Immediate medical attention is essential in this condition.