The role of seromucoid estimations in the investigation of haematemesis.
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This paper reports the role of seromucoid estimations in the diagnosis of upper gastrointestinal haemorrhage. Oesophageal varices, peptic ulcer, and carcinoma of the stomach tend to be divided by low, normal, and high levels respectively. (+info)
PEPTIC ULCER IN ASSAM.
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Big differences in the prevalence of peptic ulcer are known to exist in different parts of India. This paper reports a high incidence in Assam and records certain differences with peptic ulcers found in south India. (+info)
The use of high positive end-expiratory pressure for respiratory failure in abdominal compartment syndrome.
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We report a case in which a non-trauma patient suffering hematemesis and undergoing massive volume resuscitation developed abdominal compartment syndrome (ACS). The abdominal distension severely compromised his pulmonary functioning: a chest radiograph showed low lung volumes and dense bilateral parenchymal opacities. His blood oxygen saturation reached as low as 32%. Because he was hemodynamically unstable and coagulopathic, decompressive surgery was not possible. We gradually raised the ventilator settings to reinflate the lungs (positive end-expiratory pressure [PEEP] was raised to 50 cm H(2)O, peak inspiratory pressure to 100 cm H(2)O, and plateau inspiratory pressure to 80 cm H(2)O) and continued fluid resuscitation, and within an hour his blood oxygen saturation increased to 100%. In this case high PEEP was beneficial in a situation in which decompressive surgery was not feasible, but we do not suggest that high PEEP necessarily improves survival or that high PEEP is better than surgical decompression. On the contrary, high-pressure ventilation can be harmful in the setting of acute lung injury and acute respiratory distress syndrome, so we do not advocate high PEEP for all patients with hypoxemia and ACS, especially considering that many of the conditions associated with ACS can also precipitate acute lung injury and acute respiratory distress syndrome. As well, high-pressure ventilation can increase the risk of hypotension by impairing venous return. However, our case suggests that high PEEP may temporize in certain situations in which ACS causes life-threatening hypoxia but surgical decompression is not possible. (+info)
Hematemesis in infants induced by cow milk allergy.
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This study was conducted in order to analyze the clinical manifestations, the endoscopic findings, the histology of the gastrointestinal mucosa, the treatments and the clinical course in infants who had hematemesis induced by cow milk allergy. The medical records were reviewed retrospectively. The criteria for the diagnosis of CMA included elimination of cow milk formula resulting in improvement of symptoms, specific endoscopic and histologic findings as well as the exclusion of other causes. Twenty-three infants with a diagnosis of hematemesis were analyzed, which included 20 infants with CMA and 3 infants with gastroesophageal reflux disease (GERD). In the CMA group were 12 girls and 8 boys whose ages were 4.3 +/- 1.4 months. The onset of vomiting after starting cow milk formulas was 70.6 +/- 48.9 days. Gastroduodenoscopy was performed on 15 patients showing erythema, erosion and friability of the gastric mucosa in all patients and lymphoid hyperplasia in the duodenal bulb in 7 patients. Eight patients had mild to moderate eosinophilic infiltration and 5 patients had eosinophilia. Cow milk formulas were changed to other formulas: two children were initially given extensively hydrolyzed casein formulas and later followed by a soy formula, 14 were given a soy formula and 4 were given partially whey hydrolyzed formulas. All patients showed clinical signs of improvement a few days later. Patients that were able to tolerate cow milk were 1.5 +/- 0.9 years old. During the follow-up period (2.6 +/- 1.8 years after treatment) 4 patients were diagnosed with asthma, 4 patients with chronic respiratory symptoms, 4 patients with constipation and 2 others with food allergies. CMA induced gastritis in infancy may not be classified as eosinophilic gastritis because of the low level of eosinophilic infiltration. The elimination of cow milk and subsequent substitution with a soy formula is the proper management. (+info)
Management of haematemesis and melaena.
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Acute upper gastrointestinal bleeding is a common medical emergency which carries hospital mortality in excess of 10%. The most important causes are peptic ulcer and varices. Varices are treated by endoscopic band ligation or injection sclerotherapy and management of the underlying liver disease. Ulcers with major stigmata are treated by injection with dilute adrenaline, thrombin, or fibrin glue; application of heat using the heater probe, multipolar electrocoagulation, or Argon plasma coagulation; or endoclips. Intravenous omeprazole reduces the risk of re-bleeding in ulcer patients undergoing endoscopic therapy. Repeat endoscopic therapy or operative surgery are required if bleeding recurs. (+info)
Fulminant and fatal gas gangrene of the stomach in a healthy live liver donor.
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A 57-year-old male with a history of hypercholesterolemia and anxiety but otherwise in good health volunteered to donate the right lobe of his liver to his brother. The operation was performed uneventfully, without transfusion. Postoperatively he did well, until he developed tachycardia, profound hypotension, and coffee ground emesis on postoperative day 3. Despite resuscitative measures, he arrested and expired. Autopsy demonstrated gas gangrene of the stomach as the underlying cause of the hemorrhage and numerous colonies of Gram-positive bacilli were identified. Subsequent polymerase chain reaction (PCR) analysis identified these bacteria to be Clostridium perfringens (C. perfringens) type D. This patient's death was devastating, both to his family and his medical team. The impact of his death has transcended that of an individual occurrence. In conclusion, herein we present the facts and discuss this extraordinary example of florid clostridial infection and toxin-mediated shock. It was completely unexpected and probably unpreventable, and its cause was almost inconceivable. (+info)
Criteria for selective admission of patients with haematemesis.
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A retrospective survey of 157 consecutive admissions for haematemesis was carried out in order to determine whether patients at low risk of adverse events could be identified at the time of admission from simple clinical features. In addition to known prognostic factors such as hypotension, tachycardia and anaemia, we studied the character of the vomit classified into altered or frank blood. Death, surgical intervention and transfusion of more than 2 units of blood were defined as 'adverse events'. No adverse event occurred in 37 patients who vomited only altered blood and who did not have melaena, or in 42 patients with a concentration of haemoglobin of 12 g/dl or more who vomited altered blood only. Classification by other prognostic criteria was not as sensitive. These results suggested that patients with haematemesis who have negligible risk of serious sequelae can be identified at an early stage in the course of their disease from simple features of clinical history and examination. Excessive use of resources should be avoided in such patients, and selective admission may be justified. (+info)
Pseudocyst formation in gastric ectopic pancreas.
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CONTEXT: It is rare for ectopic pancreatic tissue to cause symptoms or require treatment, however diseases of normal pancreas may also occur in ectopic pancreas tissue. CASE REPORT: This report describes the clinical, endoscopic, radiologic and histologic features of a pseudocyst occurring in gastric ectopic pancreas in a 19-year-old man. The difficulty and implications of making an accurate pre-operative diagnosis are highlighted. CONCLUSION: Ectopic pancreatic tissue, although rare, should be considered in the differential diagnosis of a submucosal gastric mass. (+info)