Hacmatemesis and Melaena

Incidence of Ulcer in Haematemesis

“…Small drinks of sweetened fluids were allowed in most cases if vomiting ceased soon after admission. Where it was apparent that bleeding had stopped, as evidenced by the return to normal of temperature, pulse, and blood pressure, the recognized Witts (1937) modification of the Meulengracht two-hourly dietetic regimen (so far as warfime conditions would allow) was instituted, together with full doses of iron, phenobarbitone, magnesium trisilicate a-id belladonna mixture, and adequate vitamin dosage. The iron was administered in the form of ferri et ammon.…”

Renal Function and the Azotemia Following Hematemesis 12

“…Its mechanism is not the same as that associated with high intestinal obstruction, as it occurs in the absence of any vomiting (2) (e.g. in the presence of melena alone4), and is associated with a normal or increased blood chloride concentration (3,4,5) and a normal carbon dioxide combining power of the blood (4,5). The factors contributing to this increase of the urea nitrogen content of the blood have been said to comprise shock, dehydration, starvation, renal insufficiency, and absorption of decomposition products of the blood liberated in the intestinal tract.…”

“…Clausen (10) reported a reduction of urea clearance in three cases, though not sufficient to account for the azotemia. 5 In five patients with increased blood urea content following hematemesis, Borst (4) found a normal urea clearance in two and a reduction to 19, 47, and 58 per cent respectively in the remaining three. In another group of three patients with shock he found the urea clearance reduced to 10 per cent or less of the normal (3), presumably as a result of the shock.…”

“…Witts (5) believes that the increase in the blood urea is due to the fall in the blood volume and the blood flow through the kidneys at a time when the kidneys have the extra work of excreting a large amount of nitrogen derived from the blood in the intestine.…”

The Pathogenesis of Azotemia in Hemorrhage From the Upper Gastro-Intestinal Tract 1

“…The reason for this disparity has not been clarified. Several theories, none of which has been universally accepted, have been proposed to explain the pathogenesis of posthemorrhagic azotemia: (1) Toxic destruction of body protein (1,2,3,12); (2) toxicosis due to bacterial decomposition of the stagnant blood (1,4); (3) absorption of digested blood (1,5,6,7); (4) abnormality of chloride metabolism (6,8); and (5) functional impairment of renal activity (6,7,9,10,12,13,14).…”