肝硬変症と大きな胃潰瘍を合併した1症例

A Case of Cirrhosis with a Large Gastric Ulcer

　今号の主題に関連して，肝硬変症と胃潰瘍を合併した症例の詳細を提示し，若干の考察を加える．

　A 72-year-old woman came to our hospital with complaints of epigastralgia, hematemesis, abdominal distension and edema. Where was the source of bleeding？ It was the most important problem. Laboratory findings suggested liver cirrhosis but endoscopic study revealed a giant ulcer on the gastric angulus as the source of bleeding. Repeated biopsied specimens showed no evidence of malignancy.

　One of the most important sources of upper gastrointestinal bleeding in cirrhotics is rupture of varices, but it has recently been emphasized that acute mucosal lesion, gastric erosion, and acute or chronic ulceration of the stomach should be more considered as the source of hematemesis.

　The reason why the presence of gastric ulcer in cirrhotics is so much more than in controls has not been brought to a conclusion. Some possibilities are discussed; dysfunction of metabolism due to hepatocellular damage, circulatory dysfunction with portal hypertension, impairment of histaminase or other enzymes.

　High progressive activity of hepatic lesion was noted under the examination of peritoneoscopy and biopsy of the liver. We should like to consider that gastric ulcer accompanied with malnutrition will correlate to the progression of cirrhosis.