Low grade B cell gastric mucosa associated lymphoma presenting as upper gastrointestinal bleeding from non-healing stomal ulcers

Primary gastric lymphoma is a rare tumour. It is thought that low grade gastric mucosa associated lymphoid tissue lymphoma has not been previously reported to occur in a patient with gastrojejunostomy. This report describes such a case. The patient presented with bleeding from non-healing stomal ulcers. The ulcers healed and there was regression of the tumour after eradication of Helicobacter pylori.     

Rifampicin-induced upper gastrointestinal bleeding

Gastrointestinal disturbances like anorexia, nausea, vomiting, abdominal discomfort and diarrhoea are known adverse effects of rifampicin. We report an upper gastrointestinal bleeding due to haemorrhagic gastric erosions after ingestion of rifampicin for pulmonary tuberculosis. The cause and effect relationship between development of haemorrhagic gastric erosions and rifampicin administration was confirmed by rechallenge with rifampicin. To our knowledge no such adverse effect of rifampicin has been reported previously.     

A gastric fibrolipoma presenting as acute gastrointestinal hemorrhage

A 56-year-old woman was admitted to our hospital with upper gastrointestinal hemorrhage from a gastric submucosal tumor that was treated by a laparoscopic technique. Endoscopy and endoscopic ultrasonography (EUS) revealed a 2-cm submucosal tumor located in the posterior wall of the upper gastric body, showing a heterogeneous hyperechoic tumor. A laparoscopic wedge resection of the stomach was performed. Pathological examinations revealed that the tumor was composed of spindle cells like fibroblasts and mature adipocytes. Immunohistochemical examinations revealed that the tumor was negative for desmin and alpha-smooth muscle actin. Based on these findings, a diagnosis of fibrolipoma was made. EUS is useful for differentiating a fibrolipoma from a gastrointestinal stromal tumor or lipoma by the findings of characteristic echogenesity and detection of the tumor origin.     

Diffuse nodular hyperplasia of Brunner's gland presenting as upper gastrointestinal haemorrhage

Brunner's gland adenoma is a very unusual cause of upper gastrointestinal bleeding. We report a 16-year-old boy who presented with upper gastrointestinal haemorrhage from diffuse nodular hyperplasia of Brunner's gland without involvement of the first part of the duodenum. The patient was managed conservatively during his hospital stay, and was doing well without any recurrence after nine months of follow-up.     

上消化道出血合并截瘫一例

1 病例资料 患者女性,65岁.主因"黑便1 d、呕血 2 h"于2006年12月20日入北京大学第三医院.患者1 d前无明显诱因排黑便1次,量约400 mL,2 h来呕鲜血2次,总量约500 mL,伴头晕、心悸、中上腹不适,无腹痛、晕厥、胸痛等不适.既往史:高血压、冠心病、糖尿病及肾功能不全,近期服用阿司匹林.否认肝病史.入院查体:血压153/93 mm Hg(1 mm Hg=0.133 kPa),脉搏80次/min,外周淋巴结未触及,贫血貌,巩膜无黄染,结膜苍白,双肺呼吸音清,心率80次/min,律齐,未闻及杂音.腹软,剑下压痛,无反跳痛、肌紧张,肝脾未触及,肠鸣音2～3次/min.     

Audit of mortality in upper gastrointestinal bleeding

The outcome in 1017 patients with haematemesis and malaena referred to two major hospitals in Nottingham within a 2-year period has been prospectively evaluated. Ninety one (9%) patients died during the time period under consideration and all but four were found to have been over 60 years of age. There were 13 (14%) deaths following rebleeding, of whom 5 (5%) could have been potentially avoided by alterations in management. Some improvement of mortality might result from intensive-care facilities with better management of transfusions and earlier detection of rebleeding allowing earlier endoscopy or surgery. The majority of patients (81%), however, died from concomitant disease which was exacerbated by gastrointestinal haemorrhage or bleeding developed in patients with an already existing end-stage disease. These results show that a reduction of mortality in patients with gastrointestinal bleeding is hampered by the high number of poor-risk patients. The rise in the proportion of elderly patients with this disorder seems to continue.     

舒适护理模式在上消化道出血患者中的临床观察

目的探讨舒适护理模式在上消化道出血患者护理中的应用价值。方法按入院先后顺序,100例上消化道出血患者被随机分为观察和对照两组(n=50);对照组采用常规护理,观察组在此基础上依据患者情况实施舒适护理;比较两组患者的各项临床指标。结果观察组的平均止血时间与住院时间(2.3±0.74和6.1±1.05)d短于对照组(4.7±0.85和10.8±3.72)d;治疗费用(3009.2±321.6)元少于对照组(4216.5±523.3)元;而临床治疗有效率和对护理工作满意度(95.0%和96.7%)高于对照组(80.0%和76.5%),组间差异有统计学意义(P<0.05)。结论舒适护理能够改善上消化道出血的临床疗效,减少治疗费用,提高护理质量,值得临床推广。     

Aortoduodenal fistula presenting as acute massive gastrointestinal bleeding and recurrent syncope: case report

Aortoenteric fistula is a rare condition that may cause death in patients due to gastrointestinal bleeding. The duodenum is the most frequently involved site, at 78.5% of 191 cases by Nagy and Marshall's meta-analysis. It is characterized by the clinical triad of abdominal pain, gastrointestinal bleeding, and an abdominal mass. Abdominal computed tomography is the most useful tool in detecting an aortoenteric fistula. To prevent a high mortality rate, early diagnosis is necessary. Exploratory laparotomy is required for patients who are highly suspected of having an aortoduodenal fistula. Herein, we report a 60-year-old man who suffered from acute gastrointestinal bleeding, recurrent syncope, and impending shock. Abdominal computed tomography revealed a 6 cm longitudinal aneurysm in the infrarenal aorta. Emergency laparotomy was performed and revealed an aortoduodenal fistula in the fourth portion of the duodenum causing acute duodenal bleeding. The patient survived and has undergone 2 years worth of regular follow-up in our outpatient department.     

Acute upper gastrointestinal tract bleeding and recent alcohol ingestion

Alcohol ingestion is a reason for hospital admission for what may be termed trivial or even spurious gastrointestinal bleeding. This clinical entity can be recognized and hospital admission avoided. It is suggested that in the case of men under the age of 40 who present with a history of hematemesis and who are intoxicated to a variable degree but without a history of recent salicylate ingestion or previous dyspepsia, and in whom the hemoglobin level is above 13.0 g/dl it is acceptable management to send them home with instructions to seek help only if there is fresh, authenticated bleeding. This attitude is further supported by a normal blood volume measurement and the absence of blood from a gastric aspirate.     

上消化道出血与ABO血型关系探讨

目的 探讨上消化道出血与ABO血型之间的关系.方法 将宁夏医科大学总院非静脉曲张性上消化道出血患者(包括消化性溃疡并出血的患者、糜烂出血性胃炎、胃癌并出血的患者)共538例作为出血组和同期780例健康体检者作为对照组,比较各组人群ABO血型分布,分析不同血型患者发生上消化道出血的危险率.结果 与对照组相比较,消化性溃疡合并出血组、胃癌合并出血组的患者血型分布差异具有显著性(P＜0.05);血型为O型的患者十二指肠溃疡并出血的危险率为1.763,胃溃疡并出血的危险率为1.526;血型为A型的患者胃癌并出血的危险率为1.547.结论 非静脉曲张性上消化道出血与ABO血型之间存在密切关系:血型为O型的消化性溃疡患者发生出血的危险增高,血型为A型的胃癌患者发生出血的危险增高.     

上消化道出血的急救和护理体会

目的:总结40例上消化道出血患者的急救措施和护理体会。方法:进行快速病情评估,包括病因评估,心肺评估,出血量评估,是否继续出血评估,及时正确采取急救护理措施。结果:38例上消化道出血患者均获得救治。结论:快速有效的急救护理对上消化道出血患者的康复有非常重要的作用。     

上消化道出血的病因及相关因素分析

目的 探讨上消化道出血的病因及相关因素.方法 回顾分析我院2007年1月-2011年12月收治住院197例上消化道出血患者的临床资料.结果 消化性溃疡、食管胃底静脉曲张、消化道肿瘤、急忙胃粘膜病变为常见病因,服非甾体类药及饮酒是常见诱因.结论 上消化道出血的病因主要是消化性溃疡、食管胃底静脉曲张、消化道肿瘤、急忙胃粘膜病变,性别及年龄是相关因素.