Etiology

This symptom may result from cancer, ulcer, disease of the blood-vessels as described under the head of erosions, dilated blood-vessels such as are described as miliary aneurisms, varicose veins, acute congestion, acute gastritis, and the aftermath of wounds in the stomach. There is also hemorrhage from passive congestion due to liver derangements; also from cancer of the liver.

Symptoms

Sometimes cases will occur where the first symptoms will be fainting; indeed, fatal syncope has been known to result from hemorrhage of the stomach, the hemorrhage coming on suddenly from the giving-way of a large blood-vessel. In fatal hemorrhages the stomach will sometimes fill with blood without any warning by way of vomiting. These fatal hemorrhages occur in ulcer and cancer, or in cases where an aneurism ruptures in the stomach or in the esophagus.

In hemorrhage from the stomach the amount of blood lost is variable. This is a symptom that frightens all concerned. The rule is that patients exaggerate the amount of blood vomited. However, a half-pint to a pint is an ordinary hemorrhage from the stomach, except in those cases where there is just a slight oozing of blood from an erosion. The straining at vomiting may cause the ejected matter to be streaked with blood.

Diagnosis

As a rule, there is no question as to the origin of the blood. Occasionally, when the amount is small, there may be a question as to whether it is a hemorrhage from the nose, where the blood has passed into the throat--possibly been swallowed during sleep; and again there may occasionally be a patient who is morbid, and who will practice deception by swallowing blood for the purpose of being able to vomit it. Morbid, hysterical women may go to this trouble to elicit the sympathy and attention which they imagine they are not getting. It is not difficult to distinguish between hematemesis and hemoptysis; yet both are often preceded and accompanied by coughing. Irritation of the stomach produces coughing, and irritation from blood in the bronchial tubes and trachea may cause coughing. It is necessary to cough to raise blood from the lungs. In case of stomach hemorrhage the irritation that causes coughing is reflex. In bleeding from the lungs, the blood comes with the cough. In bleeding from the stomach, the blood does not necessarily come with the cough; it will precede or follow the cough, showing a sick condition of the stomach. The previous history will usually point to a difference. In hemorrhage from the stomach there is, usually a history of stomach trouble; besides, the blood is brought up in the act of vomiting, is clotted and mixed with food, and has an acid reaction. If the blood has been retained in the stomach for any length of time, it will be dark; if retained in the stomach for some time, it will have the appearance of coffee grounds. Where the blood has passed into the intestine, the patient will have stools that look like tar. Furthermore, there will be indications of derangement of the stomach and intestine. In bleeding from the lungs, on the other hand, there is an excited pulse, the blood-pressure is high, the patient brings up blood when coughing, the blood is bright red in color--rather inclined to be frothy, because the air is mixed with it--and the reaction is alkaline.

Treatment

Perfect quiet in bed; positively no food until the symptoms have disappeared. In bleeding from the lungs, the pulse must come down to the normal in number of beats and in volume. If feeding is persisted in when the pulse is high, it will be almost impossible to stop a hemorrhage from the lungs. In stomach hemorrhage the tendency is for the pulse to be very weak. At the beginning of the vomiting the pulse may be higher, but the tendency is for the pulse-rate to go down and the volume to sink much more rapidly in this hemorrhage than in hemorrhage from the lungs. The treatment should be perfect quiet, and liquid food for at least a week before solid food is eaten; always the mastication must be thorough.