Etiology.—Hemorrhage from the stomach is a symptom, rather than a disease, and may arise from a variety of causes, some of which are outside of the organ entirely. The following are among the principal causes:
Mechanical.—Any injury either external or internal. Thus a penetrating wound, or a blow over the stomach, the unskillful use of a stomach-pump or tube, or the presence of hard, rough substances, which have been swallowed may give rise to hemorrhage. The taking of corrosive substances, such as acids or alkalies, acts in the same way, though perhaps they should be classed as chemical rather than mechanical.
Hemorrhage from the stomach sometimes occurs following a laparotomy, where the omentum has been injured.
Local diseases, such as cancer, peptic ulcer, or the ulceration accompanying chronic gastric catarrh; disease of the blood-vessels, such as fatty or amyloid changes of the gastric vessels, or varicose veins. And miliary aneurisms have produced fatal hemorrhages. Acute congestion, as intense acute gastritis and vicarious menstruation, have, in rare cases, been considered exciting causes.
Passive Congestion.—Obstruction of the portal circulation, whether from cirrhosis of the liver, thrombosis of the portal vein, or pressure from tumors or adhesions, as well as chronic diseases of the heart and lungs, may be exciting causes. Infectious diseases, by changing the character of the blood, as in typhoid, typhus, diphtheria, measles, smallpox, malaria, yellow fever, etc., may give rise to hemorrhage.
External to the Stomach.—The blood may be swallowed, as often occurs in epistaxis, or hemoptysis, or in injuries of the pharynx and esophagus, or a nursing child may take considerable blood from a cracked and bleeding nipple, following which vomiting occurs, suggesting hemorrhage from the stomach.
Nervous Affections.—Progressive paralysis of the insane, hysteria, epilepsy, and tubercular meningitis, may give rise to hemorrhage, though the reason is not clear.
Of all the conditions that give rise to hemorrhage, cancer, peptic ulcer, and cirrhosis of the liver form the greater part.
Pathology.—As will be seen by studying the etiology of this condition, the pathology will be varied. When due to ulceration or cancer, the lesion is readily observed, but if the result of cirrhosis of the liver, the condition of the stomach remains unchanged, as it does in the more obscure cases.
If a fatal hemorrhage follows a miliary aneurism, it may open into the stomach by so small a perforation—pinhole—as to be undiscovered, or the rupture of a submucous vein may leave so small an injury to the mucous membrane as to be readily overlooked.
Symptoms.—Those accompanying this condition are necessarily quite varied, the causes being many, and diverse. The hemorrhage may be so small that it is entirely digested, neither being vomited nor passed by stool. Again, the hemorrhage may be so copious as to result in sudden death before the blood is expelled from the stomach. Osier relates such a case, where the stomach contained between three and four pounds of blood after death.
When the hemorrhage persists for several days in succession, it is generally due to ulceration or cancer. Usually the blood is dark and clotted, being changed by the gastric secretions; where retained but for a short time, however, it is bright red. Where the blood is from the nose, and has been swallowed, it is usually dark, clotted, and offensive.
Frequently some blood passes into the intestines, and is passed at stool, a black, tarry mass. When the hemorrhage is copious, symptoms of anemia rapidly appear. If the hemorrhage be from the lungs, and has been retained some time, the blood will still be dark and clotted, but the oppressed respiration, and history of cough, will readily determine the source of the bleeding. When the hemorrhage is the result of the infectious fevers, and due to toxic conditions, the amount is usually small and dark in character.
Diagnosis.—Usually it is not very difficult to determine whence the blood comes. The previous history of the case will-assist materially in determining this fact. We are not to forget that the vomitus may be stained by wine, the juice of berries, bile, and the use of certain drugs, notably iron and bismuth. Hysterical patients and malingerers have been known to swallow animal blood, which can only be determined by carefully studying the condition of the patient.
In hemoptysis, the blood is generally bright red and frothy, and is expelled by paroxyisms of coughing, or, if swallowed, the cough gives rise to vomiting. Physical examination of the chest usually detects respiratory trouble, and the expectorated material is usually tinged with blood for a few days after the hemorrhage. The salty taste of the blood, and the tickling sensation in the throat, usually attends hemoptysis and will assist in the diagnosis.
Prognosis.—Unless there be a rupture of an aneurism or a large vein in the walls of the stomach, the prognosis will be favorable, so far as life is concerned; even in cancer, the hemorrhage is rarely sufficient to cause death.
Treatment.—Absolute quiet should be enjoined, all unnecessary talking avoided, and the patient be required to assume the recumbent position. Small bits of ice may be given the patient, but fluids in considerable quantities should be withheld. If the hemorrhage be passive, and not alarming, carbo-vegetabilis, first trituration, in five-grain doses, may be given. Where the hemorrhage is active, gallic acid in five-grain doses will be preferable. Ergot hypodermically will be effective where it can not be retained by mouth. In some cases, small doses of ipecac act kindly, ten drops in half a glass of water, teaspoonful every thirty or sixty minutes.
Nourishment should be given in very small quantities, and in liquid form, for several days. The patient should be kept quiet and free from excitement. After the hemorrhage subsides, the after treatment will be symptomatic, treating the conditions as they arise.
The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.