The patient presents with an 8-year history of duodenal ulcer. Two days ago he felt abdominal pain, the pain was located in the epigastric area and was burning in quality. The pain occurred on an empty stomach 2 to 4 hours after meals and/or at night, was relieved by antacids and accompanied with the symptoms of epigastric fullness, belching, bloating and early satiety. After the pain he emptied the bowels characterized by dark black, liquid, tarry, metallic-smelling stool, it was about 5oo ml, 2-3 times per day. The patient also reported vomiting 50 ml “coffee grounds” material once. After then he felt palpitation, cold sweating and dizzy, and syncoped for 10 minutes. So he was presented to emergency room. Occult blood test +, skull CT scan (-) , emergency endoscopy showed duodenal ulcer (A1stage), blood routine: WBC 11*109, GN 75% ,Hgb 9.5g/l ,hematocrit value 29%.He was then admitted to the hospital for evaluation and treatment.
He denied having taken Non-steroidal Anti-inflammatory drugs before hemorrhage.
Past history :
prior major illnesses and injuries : The patient has a 3-year history of Hypertension. he denied the history of Diabetes Mellitus.
prior operations :No prior operations
prior hospitalizations : No prior hospitalizations
allergies : No food, medications, chemicals allergy.
blood routine: WBC 11*109, GN 75% ,Hgb 9.5g/l ,hematocrit value 29%
Duodenal ulcer accompanied by hemarrhage
Acute erosive gastritis :The patient has not a history of stress and denies taking the Non-steroidal Anti-inflammatory drugs before hemorrhage, emergency endoscopy does not find the erosive lesions. So we can exclude it.
Rupture of oesophago- gastric varices: The patient has not a history of liver disease, no sign, symptom and lab experiment indicate liver cirrhosis. All evidence do not support the diease.
Gastric tumor: It always occurs in elder people, makes the patients in bad condition. Occult blood test persistent positive, antacids usually can not relieve the symptom. Endoscopy and GI may help the diagnosis.