Gastro Duodenal Haemorrhage

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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.

Aetiology

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

disorders.

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.

Clinical Features

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.

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