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Article
April 21, 1956

ACUTE UPPER GASTROINTESTINAL HEMORRHAGEA RATIONAL APPROACH TO DIAGNOSIS AND MANAGEMENT

JAMA. 1956;160(16):1398-1402. doi:10.1001/jama.1956.02960510024007
Abstract

• Ten essential points in the anamnesis of a patient with massive hematemesis concern ulcer symptoms, easy satiety, anorexia, dysphagia, weight loss, nonrhythmic pain, previous bleeding, alcohol intake, diet, and previous jaundice. Ten essential points in the physical examination are the appearance of the mucous membranes (as indicating anemia or dehydration), the appearance of the tongue (nutritional deficiencies), jaundice, telangiectasia, condition of liver and spleen, ascites, umbilical protrusion or other signs of increased collateral circulation about the liver, tenderness or masses, peripheral edema, and the condition of the rectum.

Among 500 cases of acute gastrointestinal hemorrhage, 373 were attributable to peptic ulcer, 42 to esophageal varices, and 85 to miscellaneous or undetermined causes. Portal cirrhosis was the explanation of most cases of bleeding esophageal varices, and in this group there were 27 deaths, usually in hepatic coma.

Experience with medical as contrasted with surgical treatment in these cases led to acceptance of the following indications for early surgery: exsanguinating hemorrhage, nonstabilized hemorrhage, recurrent hemorrhage while under hospital management, signs of perforation or obstruction, and continued pain while bleeding.

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