Bleeding from ulcers stomach or duodenal ulcers

In contrast to the frequently expressed opinion that the bleeding is one of the typical manifestations of peptic ulcer, correct to assume that it represents its complication and not necessarily for every sick with a stomach ulcer or duodenal ulcer. From this point of view it makes sense to distinguish between implicit and explicit hemorrhage. First take place with ulcers often; they really typical for it, can be a very long time, even when the so-called "dumb" ulcers; the second (explicit) arise only from a limited number of patients, are either in single or then exhibit a tendency to persistent repetition, containing a variety of displacement. In our country in the study of problems of ulcer bleeding, especially a lot of work put S. S. Yudin, B. S. Rozanov, A. T. Lida, I. I. Brothers and other
The frequency of bleeding from stomach ulcer or duodenal ulcer, according to different authors, is very different. Varay (1966) notes that most ulcers never bleed. Lamling wrote that ulcers often bleed at the time of their occurrence - 15-20% among them; the risk of heavy bleeding, according to him, does not exceed 3-5%. Heavy bleeding, and he believed that occur mainly in the first year of the apparent existence of an ulcer, but can occur in various later dates. To predict the occurrence of bleeding from the ulcer is very difficult; they often arise as a "bombshell; often, however, the bleeding is preceded by a brief, a long period of exacerbation of ulcer. Bleeding can be immediately extraordinarily massive (profuse); in other cases, preceded by periods small bleeding, bloody vomiting (not profuse) or bloody stools.
The pathogenesis of bleeding from the stomach or duodenum not the same. It is believed that most often bleeding occurs due to the explicit and more or less significant violations intact walls of the blood vessel. This is usually seen in the bottom of ulcer in the form of a specific hole gaping at the end of blood stem; often the source of bleeding is significant erosion on the territory of which you can see the destruction of a network of blood vessels. On a separate preparations of the stomach - the initial part of the duodenum received after urgent resection, you can often see lots of erosions and thrombosis change in the wall of the body each other.
In other cases, haemorrhage due eritropoaiza. The reason for it can serve a variety of factors. So, Varay admits that the occurrence of bleeding per diapedesin sites mucosa is due neuro-causes an allergic-type phenomenon Arthus or'reilly. Other authors tend to explain their appearance in the result of infringement of function of arteriovenous shunts (glomi), existing in the thickness of the gastric wall. In the external form such hemorrhages may also not be the same: they look like strips bloody mucous, annular ("crown"), environmental ulcer, bleeding at the edges calloused ulcers granulomatous polypoid growths, in the form of creeping and moving bleeding sites on the mucous membrane in the area of ulcers. Clearly this morphological diversity of the bleeding site at a bleeding from stomach ulcers - duodenal ulcers can be when the operation is estimated surgeon differently. This may affect the choice of further progress.