Massive hemorrhage from gastric and duodenal ulcers

　　Massive hemorrhage from gastric and duodenal ulcers is the result of erosion of the base vessels by ulcers, mostly medium artery bleeding. The ulcers with massive bleeding are generally located on the lesser curvature of the stomach or the posterior wall of the duodenum.

　　Gastric ulcer hemorrhage often originates from the branches of the right and left gastric arteries, while duodenal ulcer hemorrhage usually comes from the superior pancreaticoduodenal artery or the gastric duodenal artery and its branches. The lateral wall rupture of the blood vessels is more difficult to stop bleeding than the terminal bleeding. Sometimes, due to the decrease in blood volume and blood pressure after massive bleeding, blood clots may form at the site of vessel rupture, and bleeding may stop spontaneously. However, about 30% of cases may experience a second massive hemorrhage.

　　Most cases of massive hemorrhage from ulcers occur suddenly, with bleeding often not accompanied by abdominal pain. Patients usually feel nausea, dizziness, and discomfort in the upper abdomen first, followed by hematemesis or melena, or both occurring simultaneously. The most common complications are shock and anemia.

　　1, Shock

　　When the blood loss reaches 400 milliliters, compensation for shock occurs, with pale complexion, thirst, rapid and strong pulse, normal or slightly high blood pressure. When the blood loss reaches 800 milliliters, significant shock symptoms may occur, with cold sweat, thin and rapid pulse, shallow breathing, and decreased blood pressure.

　　2, Anemia

　　Massive bleeding leads to a decrease in hemoglobin, red blood cell count, and hematocrit. In the early stage, due to blood concentration, the decrease may not be obvious, and therefore short-term repeated measurements are required. Repeated measurements can show the severity of bleeding, whether the bleeding is still continuing or has stopped, and whether the treatment is effective.

　　The clinical manifestations of massive hemorrhage from gastric and duodenal ulcers depend on the amount and speed of bleeding. The main symptoms of the patients are hematemesis and melena, with most patients only having melena without hematemesis. Rapid bleeding may result in a large amount of hematemesis and dark purple stools.

　　Nausea often occurs before vomiting, and palpitations, fatigue, and general weakness may occur before and after bloody stools, even fainting and shock symptoms: anxiety, cold extremities, rapid pulse, rapid breathing, and blood pressure drop. There may be mild tenderness in the upper abdomen, and hyperactive bowel sounds. Patients with severe abdominal pain should pay attention to whether there are complications such as ulcer perforation.

　　Patients with ulcers should also pay attention to their daily diet, focusing on easily digestible foods to avoid irritants that can cause massive bleeding. Eat to seven-tenths fullness, maintain regular and normal eating habits. Although ulcers are easy to treat, they are prone to recurrence. In addition to diet, smoking and alcohol should be restricted, and sufficient sleep, moderate exercise, and the elimination of excessive tension are basic effective methods.

　　1. Potatoes

　　Potatoes are rich in vitamin C, potassium, and balanced minerals, and they also contain starch. Even after heating, vitamin C is not easily destroyed, making it convenient to absorb.

　　2. Pumpkin

　　Pumpkin is rich in vitamin C and beta-carotene (vitamin A), and its fruit, flowers, seeds, and leaves all have medicinal effects. It contains a lot of starch and still contains a lot of vitamin C after cooking. To fully exert the medicinal effect, steaming is ideal. For those with a slight stomachache, pumpkin soup can be cooked to aid digestion. Pumpkin flowers can be cooked into soup, which has the effect of reducing fever and stopping diarrhea.

　　3. Kale

　　Kale contains vitamin C and K, which can promote the regeneration of the mucosa of the stomach or duodenum and treat ulcers. Both raw and cooked kale are delicious, and it is commonly consumed to adjust the body. However, cooking or stir-frying will destroy vitamin C, so it is better to eat it raw or slightly heated for ulcer treatment. Put kale into a juicer to make juice, then slightly heat it, and drink it before meals. It is recommended to drink it for about 10 days, and the effect will be apparent.

　　4. Figs

　　Figs can treat ulcers and strengthen weak intestines and stomachs. The dried figs should be chopped, cooked to semi-dry, and then added a little honey and water for drinking. To preserve figs, they can be dried first, cooked on the fire, and then ground into powder. They can be used by adding boiling water or water for infusion.

　　Ulcers with massive bleeding are generally located on the lesser curvature of the stomach or the posterior wall of the duodenum. Bleeding from gastric ulcer on the lesser curvature usually originates from the branches of the right and left gastric arteries, while bleeding from duodenal ulcer mostly comes from the superior pancreaticoduodenal artery or the gastric duodenal artery and its branches. The bleeding location can be determined and the patient's physical condition can be evaluated based on the following examinations:

　　1. The red blood cell count, hemoglobin value, and hematocrit all show progressive decline.

　　2. Fiberoptic gastroscopy is the first choice for the examination of upper gastrointestinal bleeding and should be performed within 6～12 hours after bleeding. If the examination time exceeds 12 hours, it may be difficult to detect the healing of the mucosa due to the cessation of bleeding.

　　3. Selective arteriography has a high accuracy in diagnosing the bleeding site of gastric ulcer, and bleeding rate as low as 0.5～2ml/min can be displayed. If the angiography shows multiple small bleeding points in the distribution area of the left gastric artery, hemostasis can be achieved by infusing vasoconstrictors through the left gastric artery; while for confirmed large vessel bleeding, early surgical treatment should be performed.

　　Patients with severe hemorrhage from gastric and duodenal ulcers should choose easily digestible, high-calorie, protein-rich, and vitamin-rich foods after treatment. Such as congee, thin noodles, milk, soft rice, soy milk, eggs, lean meat, tofu, and soy products; foods rich in vitamins A, B, and C, such as fresh vegetables and fruits, etc. These foods can enhance the patient's resistance and are also beneficial for repairing damaged tissues and promoting ulcer healing.

　　These foods can enhance the body's resistance, help repair damaged tissues, and promote the healing of ulcers. Patients with acid regurgitation should use less milk. Patients with gastric hemorrhage should eat more nutritious, easily digestible, high-calorie, protein-rich, and vitamin-rich foods such as congee, thin noodles, milk, soy milk, eggs, lean meat, etc.; in addition, more foods rich in vitamins A, B, and C, such as fresh vegetables and fruits, should be supplemented. These foods can enhance the patient's resistance and are also beneficial for repairing damaged tissues and promoting ulcer healing. Patients with acid regurgitation should eat less milk.

　　Most patients with severe hemorrhage from ulcerative diseases can stop bleeding after general treatment such as blood transfusion, fluid replacement, washing the stomach with cold saline, injection of adrenaline under endoscopy, laser coagulation, or selective arterial injection of vasoconstrictors. However, about 5 to 10% of patients continue to bleed. If the following conditions are present, surgical treatment should be considered.

　　1. Acute severe hemorrhage with shock symptoms usually indicates bleeding from larger blood vessels, which is difficult to stop on one's own.

　　2. If the condition does not improve after 600 to 1000 milliliters of blood transfusion within 6 to 8 hours, or if the condition temporarily improves but worsens again after stopping blood transfusion,

　　3. Patients who have had similar severe hemorrhages in the recent past.

　　Patients with severe hemorrhage during inpatient treatment in the department of internal medicine indicate that the ulcer has侵蚀性大, and it is difficult to stop bleeding without surgical treatment.

　　5. Those over 50 years old or with arteriosclerosis may find it difficult to stop bleeding on their own.

　　6. Severe hemorrhage with perforation or pyloric obstruction.