Hemorrhage into the Stomach.
Synonyms:—Gastric hemorrhage; gastrorrhagia.
Etiology:—Hemorrhage into the stomach is not always due to disease of that organ, and should not be classed as a disease, but as a symptom only.
Those causes which most frequently induce hemorrhage are: (a) diseases of the walls of the stomach, which are heretofore described, involving the blood vessels, such as gastric ulcer and cancer. The ulceration of chronic gastritis, or the profound congestion of acute gastritis, especially that which results from the ingestion of irritants and corrosives, induces hemorrhage. The condition may follow diseases of the blood vessels, as (b) aneurism of the arteries, or fatty degeneration of the local blood vessels, or varicose veins, in the gastric walls; (c) diseases of the liver affecting the portal circulation, as cirrhosis, cancer or tumor, or thrombosis; (d) diseases of the spleen; (e) chronic disease of the heart or of the lungs; (f) severe prolonged infectious diseases, which induce serious changes in the blood, affecting its coagulation, as typhus, yellow fever, cholera, smallpox, and, rarely, scarlet fever, diphtheria and measles; (g) cancer in some contiguous organ, penetrating the stomach walls; (h) traumatism, as gunshot or knife wound, or a severe blow, or laceration from a fall or severe muscular strain or injury from a sharp foreign body swallowed, or from a severe surgical operation; (i) vicarious menstruation; (j) hemophilia; (k) very rarely a patient suffering from epilepsy or hysteria or tubercular meningitis will have gastric hemorrhage.
Hematemesis, strictly considered, is a vomiting of blood, and while including all that is stated above, it does not necessitate an acutal hemorrhage from the stomach. An injury to the mouth, throat or esophagus may induce hemorrhage, and blood may be swallowed, as it often is, in nose bleed, and in hemoptysis, and from the extraction of a tooth. An infant may suck blood from a fissured or ulcerated nipple. In these cases the simple vomiting of blood must be distinguished from hemorrhage into the stomach.
Symptomatology:—Hemorrhage into the stomach, may occur without vomiting, or hematemesis. There may be but a small quantity of blood, which may be digested, or a portion of the blood may be passed by stool from the intestines as a black, disintegrated, tarry mass, seldom in the form of clots, unless from hemorrhage of the lower bowel. In an occasional case hemorrhage into the stomach may be so profuse as to result in sudden death, before vomiting occurs. Usually preceding vomiting there is a sensation of warmth in the stomach, the patient is faint and there is vertigo, the face becomes pale, and occasionally there is a flash of heat over the surface of the body. Nausea only may be present, or there may be nausea for some time before vomiting occurs, or vomiting may occur abruptly. Where the hemorrhage persists for a period of two or three days, there may be constant nausea, with frequent vomiting of the contents of the stomach, the paleness increases to pallor, and acute anemia is induced. Blood vomited immediately is usually of a brighter red color, and not altered by the gastric secretion. That which is retained is dark, grumous and materially changed by the gastric fluids.
Diagnosis:—The difficulty in diagnosis is in determining, in the absence of vomiting, first, that there is hemorrhage; and, second, the source of the hemorrhage. The other symptoms of disease must be carefully weighed and the previous history of the case fully considered. A careful physical examination may be necessary. A common error is made in distinguishing between hemorrhage from the stomach and hemorrhage from the lungs. In the former case there is nausea and vomiting, usually of a large quantity of dark, clotted blood, mingled with food remnants. In the latter case there is much cough, a warm, salty taste in the mouth, a much smaller quantity of blood, which is bright red and frothy. That from the stomach is of acid reaction, while that from the lungs is of alkaline reaction. With hemoptisis there is difficult respiration and rapid, feeble heart action.
Prognosis:—It is seldom that death occurs from the hemorrhage. The rupture of a blood vessel or of an aneurism may prove fatal. In other cases the seriousness depends upon the progress of the condition which causes the disease.
Treatment:—In the treatment of hemorrhage from the stomach, the cause must have full consideration. The treatment of the hemorrhage is fully considered in the treatment of gastric ulcer, to which the reader is referred. If the case is severe and the impression upon the system is a marked one, the entire course of treatment laid down for gastric ulcer should be closely carried out for a few days. If there is not actual disease of the stomach, the use of the compound tincture of erigeron and cinnamon may be persisted in with only good results. Twenty drops may be given every hour, for three or four doses, to be continued later at longer intervals. The subsequent treatment and care of the patient will be the same as in gastric ulcer.
