Massive Upper Gastrointestinal Hemorrhage

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SUDDEN massive hemorrhage from the upper gastrointestinal tract is an unwelcome emergency. It is no longer sound practice to treat every patient with this condition by conservative measures, and the physician therefore is taxed with a delicate question: Which patient will require an emergency operation to save his life? The problem is rendered no less difficult by the fact that it is only the occasional patient — less than one in ten — in whom such an operation will be necessary. The physician (and the term is used to include family physician, internist, gastroenterologist or surgeon) should adopt the view that emergency surgery is to be performed only upon that patient who he believes may die without operation.

How can this occasional patient be selected for emergency operation? The crux of the matter is the rapidity of the bleeding. Other factors such as the duration of the hemorrhage, the age of the patient and the number of previous hemorrhages, are of secondary importance. The reasoning behind this view is that in slow hemorrhage, no matter how persistent, the physician can keep abreast of the bleeding with blood transfusion, and sudden circulatory collapse with death from exsanguination is unlikely. Occasionally a slow but persistent bleeder will require surgery while the bleeding is in progress (Case 3) but a more leisurely decision is then possible. The most reliable guide to the rapidity of the hemorrhage is the state of the circulation; in rapid hemorrhage, peripheral vascular collapse is present or impending.

It is rarely. . .



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