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Clinical Diagnosis in Gastrointestinal Hemorrhage

A Planned Investigation Including Arteriographic Studies of the Human Stomach
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      Summary

      A personal study of 250 cases of hematemesis or melena, planned to assess the value of symptoms and signs for determining the causal lesion, is reported. A comparison of gastric and duodenal ulcer shows that the following features were significantly more common (P < 0.05) with either one or the other.
      Gastric ulcer. (1) Pain or discomfort occuring within 1/2 hour of eating; (2) anorexia; (3) empty feeling between meals; (4) vomitus containing blood clots; and (5) chronic bronchitis.
      Duodenal ulcer. (1) Nocturnal pain or discomfort; (2) periodic pain or discomfort; (3) pain or discomfort confined to the right upper abdominal quadrant; (4) copious vomitus; (5) vomitus resembling coffee grounds; and (6) tenderness confined to the right upper abdominal quadrant.
      These findings were employed in an attempt to diagnose the cause of the hemorrhage in a further 100 cases at the time of their admission. The majority of the patients with duodenal ulcer gave a typical history whereby this lesion could be diagnosed with considerable assurance.
      The findings of the present series are compared with those of other studies.
      In contrast to series of gastric ulcer that include other modes of presentation besides hemorrhage, few of my ulcers were found in the antrum and a relatively high proportion lay in the upper third of the stomach. Arteriographic studies of the normal stomach made in this connection showed that in both the seromuscular and the submucosal layers the arteries that are large enough to cause really severe hemorrhage are mostly confined to the upper two-thirds of the stomach. Those of the submucosa are further limited to a band on either side of the lesser curvature and the greater curvature with its adjoining walls. These circumscribed areas are therefore the only likely source of severe hemorrhage from a shallow ulcer, and, what is more, all the acute lesions of the present series that caused such hemorrhage lay within a few centimeters of the upper two-thirds of the lesser curvature—most of them being on the adjoining part of the posterior wall.
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      References

        • Ryle J.A.
        The Natural History of Disease. Ed. 2. Oxford University Press, London1948: 106 (91)
        • Wagstaff J.K.
        Post-mortem arteriography of the normal stomach.
        Gastroenteroogy. 1953; 79: 378
        • Moynihan B.G.A.
        Duodenal Ulcer. W. B. Saunders Company, Philadelphia1910: 122
        • Graham C.
        Notes on gastric and duodenal ulcers.
        Boston M. & S. J. 1915; 173: 543
        • Barford L.J.
        A statistical enquiry into the etiology, symptoms, signs and results of treatment in 166 cases of gastric and duodenal ulcer.
        Guy's Hosp. Rep. 1928; 78: 127
        • Miller T.G.
        • Pendergrass E.P.
        • Andrews K.S.
        A statistical study of clinical and laboratory findings in gastric and duodenal ulcer, with special reference to roentgenologic data; based on the records of 279 operatively demonstrated cases.
        Am. J. M. Sc. 1929; 177: 15
        • Rivers A.B.
        Pain in benign ulcers of the esophagus, stomach and small intestine.
        J. A. M. A. 1935; 104: 169
        • Kirk R.C.
        The differential diagnosis of 207 hospitalized cases of peptic ulcer.
        Gastroenterology. 1946; 7: 168
        • Smith F.H.
        • Jordan S.M.
        Gastric ulcer; a study of 600 cases.
        Gastroenterology. 1948; 11: 575
        • Jones F.A.
        Haematemesis and melaena with special reference to bleeding peptic ulcer.
        Brit. M. J. 1947; 2 (477): 441
        • Nicholson Jr., S.T.
        Consideration of certain diagnostic features of cancer of the stomach.
        Pennsylvania M. J. 1930; 34: 169
        • Levitt A.
        • Argue J.F.
        The clinical and pathological manifestations of carcinoma of the stomach.
        Am. J. Digest. Dis. 1938; 4: 818
        • Marshall S.F.
        • Taylor E.S.
        Carcinoma of the stomach; an analysis of 291 cases.
        S. Clin. North America. 1937; 17: 629
        • Harnett W.L.
        A statistical study of 1,405 cases of cancer of the stomach.
        Brit. J. Surg. 1947; 34: 379
        • Ladue J.S.
        • Murison P.J.
        • McNeer G.
        • Pack G.T.
        Symptomatology and diagnosis of gastric cancer.
        Arch. Surg. 1950; 60: 305
        • Schindler R.
        • Murphy H.M.
        Symptomatology of chronic atrophic gastritis.
        Am. J. Digest. Dis. 1940; 7: 7
        • Schindler R.
        Gastritis. William Heinemann, London1947: 168 (b, p. 160; c, p. 159; d, p. 166; e, p. 167, f, p. 178)
        • Ricketts W.E.
        • Palmer W.L.
        • Kirsner J.B.
        “Chronic gastritis,” a study of the relation between mucosal changes and symptoms.
        Gastroenterology. 1949; 12: 391
        • Henrikson E.C.
        Cirrhosis of the liver, with special reference to the surgical aspects.
        Arch. Surg. 1936; 32: 413
        • Ratnoff O.D.
        • Patek Jr., A.J.
        The natural history of Laennec's cirrhosis of the liver; an analysis of 386 cases.
        Medicine. 1942; 21: 207
        • Armas-Cruz R.
        • Yazigi R.
        • Lopez O.
        • Montero E.
        • Cabello J.
        • Lobo G.
        Portal cirrhosis; an analysis of 208 cases, with correlation of clinical, laboratory and autopsy findings.
        Gastroenterology. 1951; 17: 327
        • Ivy A.C.
        • Grossman M.I.
        • Bachrach W.H.
        Peptic Ulcer. J. & A. Churchill, Ltd., London1950: 559 (b, p. 578; c, p. 576; d, p. 570; e, p. 777; f , p. 560; g, p. 532; h, p. 511; i, p. 508)
        • Jones F.A.
        • Pollak H.
        Civilian dyspepsia.
        Brit. M. J. 1945; 1: 797
        • Bockus H.L.
        Sandweiss D.J. Peptic Ulcer: Clinical Aspects, Diagnosis, Management. W. B. Saunders Company, Philadelphia1951: 201 (b, p. 205)
        • Walters W.
        • Gray H.K.
        • Priestley J.T.
        Carcinoma and Other Malignant Lesions of the Stomach. W. B. Saunders Company, Philadelphia1942: 525
        • Jones C.M.
        Digestive Tract Pain: Diagnosis and Treatment, Experimental Observations. The Macmillan Company, New York1938: 22
        • Albrecht H.U.
        (Quoted by W. L. Palmer)Portis S.A. Diseases of the Digestive System. Ed. 2. Lea & Febiger, Philadelphia1944: 195
        • Bockus H.L.
        Gasrro-Enterology. Vol. 1. W. B. Saunders Company, Philadelphia1944: 42 (b, p. 381)
        • Ohler W.R.
        • Ritvo M.
        Diaphragmatic (hiatus) hernia; a clinical study.
        New England J. Med. 1943; 229: 191
        • Hurst A.F.
        • Stewart M.J.
        Gastric and Duodenal Ulcer. Oxford University Press, London1929: 150 (b, p. 98)
        • Polley H.F.
        Congenital short esophagus with thoracic stomach and esophageal hiatus hernias; report on 47 cases.
        J. A. M. A. 1941; 116: 821
        • Sherlock S.
        Diseases of the Liver and Biliary System. Blackwell Scientific Publications, Oxford1955: 308
        • De Busscher G.
        La vascularisation de Festomac ulcéreux.
        Gastroenterologia. 1947; 72: 154