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Acute gastrointestinal haemorrhage
Published in Louisa Baxter, Neel Sharma, Ian Mann, The Junior Doctor’s Guide to Gastroenterology, 2018
Louisa Baxter, Neel Sharma, Ian Mann, Ian Sanderson
This is bleeding that occurs proximal to the ligament of Treitz, which connects the duodenum to the diaphragm and is the landmark of the duodenojejeunal junction. It may present as haematemesis, coffee-ground vomiting and/or melaena. Very brisk upper GI bleeding may present as fresh blood per rectum.
Case 52: Coffee Ground Vomiting
Published in Layne Kerry, Janice Rymer, 100 Diagnostic Dilemmas in Clinical Medicine, 2017
A 57-year-old man was admitted to hospital complaining of several episodes of coffee ground vomiting. He described approximately 10 episodes of vomiting around 100 mL coffee ground matter over the preceding 24 hours. He reported symptoms of light-headedness and weakness, which had come on gradually over the past few hours. He had epigastric pain and complained of ‘heart burn’ whenever he tried to eat or drink. His past medical history included a hospital admission 6 months earlier with a bleeding duodenal ulcer, which required a laparotomy and a 14 unit blood transfusion. His regular prescribed medications included 20 mg omeprazole OD, which he admitted to only taking around once weekly. He had previously worked as a teacher but had been unemployed over recent years. He admitted to drinking a bottle of vodka (30 units) and smoking 40 cigarettes per day for the past 15 years. He lived alone and had not travelled abroad recently. He had no current sexual partners.
Anaemia
Published in Sherif Gonem, Ian Pavord, Diagnosis in Acute Medicine, 2017
Associated symptoms: – Haematemesis, coffee-ground vomiting, melaena or rectal bleeding suggest gastrointestinal haemorrhage.– Abdominal pain or distension may occur with intra-abdominal haemorrhage. Retroperitoneal haemorrhage (e.g. due to a ruptured abdominal aortic aneurysm) may cause loin or back pain.– Menorrhagia or haematuria suggests blood loss from the genital tract or urinary tract, respectively.– Abnormal bleeding or bruising suggests a bleeding diathesis.– Fever, skin rash or joint pain suggests chronic infection or inflammation.– Weight loss suggests underlying malignancy, and may also occur with chronic infection.– Dysphagia, diarrhoea, constipation or an abdominal mass may occur with gastrointestinal tract malignancy.– Cough and haemoptysis are features of lung cancer.– Jaundice and dark urine may occur with haemolysis.
Did poisoning play a role in Napoleon’s death? A systematic review
Published in Clinical Toxicology, 2021
Daniela Marchetti, Francesca Cittadini, Nadia De Giovanni
Supplementary Table 1 divided the primary symptoms of Napoleon’s illness into three periods according to the evidence reported by the three medical doctors who acted as Napoleon’s physicians in St. Helena. From October 1819 to September 1820, the symptoms were: right hypocondrium pain; right scapular pain; nausea and vomiting; constipation and diarrhoea; gaseous distension; fever and profuse sweating; coughing; alteration of pulse rate (rapid and irregular); legs swollen, weak, ice-cold feet; loss of appetite and weight; headaches, insomnia or somnolence, and vertigo; yellow skin and conjunctiva and exanthemata on legs [4]. Throughout April 1821, Napoleon reportedly experienced recurrent coffee-ground vomiting [4,14]. On 3 April, he vomited a great quantity of black blood [14].
Inhospital and delayed mortality after upper gastrointestinal bleeding: an analysis of risk factors in a prospective series
Published in Scandinavian Journal of Gastroenterology, 2018
Rita Jiménez-Rosales, Francisco Valverde-López, Francisco Vadillo-Calles, Juan Gabriel Martínez-Cara, Mercedes López de Hierro, Eduardo Redondo-Cerezo
The inclusion criteria were (a) age over 18 years and (b) an upper GI hemorrhage defined as bleeding from the upper GI tract as manifested as hematemesis (including coffee ground vomiting) and/or melena. Rebleeding was defined by the presence of fresh hematemesis and/or melena associated with the development of shock (pulse >100 beats/min, systolic blood pressure <100 mm Hg) or a reduction in hemoglobin concentration greater than 2 g/dL over 24 h, after a successful endoscopic and clinically apparent hemostasis. Rebleeding was defined as a new bleeding episode from the same source after a successful hemostasis. Persistent bleeding was considered when the endoscopist was unable to control bleeding for different reasons (i.e., massive bleeding, poor visualization, …) and the patient continued with hematemesis, melena and/or shock. Mortality directly related to upper GI bleeding was defined as the one in which the immediate cause of death was hemorrhagic shock caused by persistent or uncontrollable bleeding. When other conditions, such as stroke, myocardial infarction or heart failure were the main cause of death in a previously controlled upper GI bleeding, we considered that mortality was not directly related with upper GI bleeding. Pre-endoscopic exclusion criteria were: (a) patients unable to provide informed written consent for the study or who refused endoscopy, (b) patients with mental impairment, inability or refusal to follow instructions, (c) patients with an unstable medical or surgical problem precluding endoscopy. Endoscopic exclusion criteria included the absence of upper GI tract lesions.
Upper gastrointestinal vascular ectasia: an under-recognized complication of systemic sclerosis
Published in Scandinavian Journal of Rheumatology, 2021
R Shukla, R Warner, P Whorwell, AL Herrick
Patient 1. A 59-year-old female with anti-centromere-positive diffuse cutaneous SSc (disease duration 24 years) attended a routine follow-up appointment and reported coffee-ground vomiting that had started the previous day. She had a past history of angiodysplasia. On examination she was pale and had generalized upper abdominal tenderness. Her modified Rodnan skin score was 14. Haemoglobin checked in the clinic was 60 g/L (compared to 110 g/L 11 months previously), mean corpuscular volume (MCV) 83.9 fL, and urea 15.6 mmol/L, with normal creatinine (85 µmol/L) suggestive of an acute upper gastrointestinal bleed.