| • Opened stomach
demonstrates innumerable small punctate
gastric mucosal hemorrhages
• Large numbers of small mucosal hemorrhages associated with
mucosal erosians are often seen in severe illnesses "stress
ulcers" or NSAID
• Esophageal-gastric junction is seen at left(arrow) |
| Gastric Hemorrhage |
| Etiology |
•Multiple etiologies exist for upper GI bleeding of gastric origin •Peptic ulcer represents 50% of upper GI bleeds with duodenal ulcer being twice as common as gastric bleeds. NSAIDs are the most frequent cause of bleeding in peptic ulcer disease •Esophagogastric varices account for 10% of upper GI bleeding •Erosions associated with gastritis represent 15% of upper GI bleeding •Neoplasms, primarily adenocarcinoma may cause chronic upper GI bleeding |
| Pathogenesis |
•See individual diseases |
| Epidemiology |
•See individual diseases for epidemiologic data |
| Clinical |
•Bleeding from esophagogastric varices are often significant with the highest mortality of any cause of upper GI bleeding (50% in the first year after first bleed) •Most bleeding from peptic ulcer disease ceases spontaneously, but in spite of this there is a mortality of about 5% •The course of peptic ulcer disease with hemorrhage is hard to predict, but ulcers >1cm have a more serious prognosis •Tumors produce chronic hemorrhage, and rarely cause massive bleeding •See individual diseases for methods of diagnosis and treatment |
| General Gross Description |
•Gastric bleeding may be occult, in which case little may be seen grossly •Grossly apparent bleeding takes two forms •The first is multiple small punctate areas of hemorrhage typical of NSAID use. These are often associated with erythema of the adjoining mucosa •Single foci of bleeding may vary in size depending on the depth and severity of the underlying lesion •Diffuse massive hemorrhage as can be seen in ruptured varices may cover the entire mucosal surface and present difficulty in pinpointing its origin |
| General Micro Description |
•See individual diseases |
| Reference |
• Sleisenger MH, Fordtran JS. Gastrointestinal disease. 5th ed. Philadelphia: Saunders, 1993, pp. 162-192
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