Value of a centralised approach in the management of haematemesis and melaena: experience in a district general hospital.

Abstract

Ali patients presenting with acute upper gastrointestinal bleeding between November 1986 and April 1988 were admitted to a centralised joint medical/surgical unit, with a policy of early clinical and endoscopic assessment and rapid surgical intervention in those at high risk. Of the 430 patients admitted 69*5% were over the age of60 and 30% had significant additional medical conditions. 50 4% were bleeding from peptic ulcers and one third had been taking non-steroidal anti-inflammatory agents. Fifty five patients underwent surgery, which in two thirds was carried out within 24 hours of admission, usually for continued bleeding. In patients with peptic ulcer the operation rate was 21*6%. Overall mortality was 3*7%, and in those with bleeding gastric or duodenal ulcers 5-5%; surgical mortality in the later group was 15-2%. All patients who died had serious concomitant pathology and 87% were over 70 years of age. Adoption of a centralised approach to management ofhaematemasis and melaena is feasible in a District General Hospital and associated with an improved survival.

Predictors of hemostatic failure after adrenaline injection in patients with peptic ulcers with non‐bleeding visible vessel

“…A cute upper gastrointestinal bleeding caused by a benign peptic ulcer remains a common medical emergency and an important cause of morbidity and mortality (1)(2)(3)(4). Peptic ulcer bleeding is treated successfully by conservative measures in approximately 70%-80% of cases, while the remainder of cases is prone to further bleeding or bleeding recurrence, which represents the main adverse factor in clinical outcome.…”

Predictors of Mortality in Patients Admitted to Hospital for Acute Upper Gastrointestinal Hemorrhage

“…The mortality associated with this complication (4-1 1%) remains appreciable despite major advances in the management of the critically ill (2)(3)(4)(5)(6)(7). Until the late 1970s a specific therapy was not available, and the therapeutic options included general supportive measures and, when these proved ineffective, surgery.…”

Épidémiologie des hémorragies digestives hautes en Tunisie

“…Plusieurs études ont constaté qu'une grande proportion des décès surviennent chez des patients présentant une comorbidité sévère, chez qui, l'hémorragie, même mineure, est mal tolérée [39][40][41][42][43].…”