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Clinical Aspects of Acute Upper G-Ⅰ Lesions, Especially Seen from the Standpoint of Hematemesis K. Kawai 1 , Y. Akasaka 1 , K. Hidaka 1 , K. Yamaguchi 1 , H. Sudo 1 13rd. Dept. of Internal Med., Kyoto Prefectural University pp.17-23
Published Date 1973/1/25
DOI https://doi.org/10.11477/mf.1403108337
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 From the clinical standpoint acute gastric lesions are defined as those that harbor both endoscopically and roentgenologically abnormal findings on the gastric mucosa accompanied with acute gastric symptoms. After they have been divided according to their frequency, clinical pictures caused by them have been correlated as well between patients treated in general hospitals and those in affiliated hospitals.

 Subjective symptoms most often given by both groups of patients were in the order of their freque-ncy epigastric pain followed by nausea and vomiting. Patients in general hospitals received medical attention earlier than those in affiliated hospitals: about half of the former were treated within there days after the onset of symptoms. In about 70 per cent of patients in both groups a definite diagnosis was arrived at more than five days after the initial consultation with subsequent x-ray and endoscopic examinations. Only minor changes without any apparent causes (so-called gastritis) weer seen in 70 per cent of patients in both groups, followed in the order of frequency by peptic ulcer and specific gastritis due to chemical agents.

 Most of subjective symptoms in acute gastric lesions subsided within a day or two, and their clinical manifestations also disappeared mostly within a week. Sometimes x-ray revealed scirrhus-like findings in acute lesions as well, and permanency of pathological pictures was most important for discrimination between benign and malignant lesions. Occasional slight bleeding, edema and decreased distensibility of the gastric wall at times confused the overall picture, but differentiation was not so difficult because these findings were transient. Were stress simply laid on hemorrhage in the upper digestive tract, acute gastric lesions with complaint of gross bleeding should be endoscopied more than three days after the initial hemorrhage. Instruments most suited for this purpose are either GIF type D (Olympus) or Panview endoscope (Machida).

 Except for gross gastric bleeding, internal management alone suffices mostly for the treatment of acute gastric lesions. Our three fundamental principles for it are (1) rest, both local and general; (2) causal treatment; and (3) medical manamegent. In view of recent increasing tendency of iatrogenic acute gastric lesions due to medication such as steroids, their prevention is especially emphasized here.


Copyright © 1973, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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