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Gastric Hemorrhage
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Gastric Hemorrhage

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)
(Description By:Martin Nadel, M.D. )
(Image Contrib. by: UCHC )
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
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 Microscopic Description

See individual diseases
Clinical Correlation

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
References

Sleisenger MH, Fordtran JS. Gastrointestinal disease. 5th ed. Philadelphia: Saunders, 1993, pp. 162-192
Gastric Hemorrhage
Synopsis by: Martin Nadel, M.D. (T63000M37000)[455]
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