Differential diagnosis

With wide use of gastroduodenoscopy the question of differential diagnosis of bleeding is less significant. However such a problem arises due to impossibility to use this method of examination when the general condition of patient is bad or taking into account other reasons. Differential diagnosis is conducted in bleeding of nonulcer origin, which can arise in different parts of digestive tract.

For bleeding from the varicose veins of esophagus in patients with portal hypertension with liver cirrhosis. This type of bleeding is massive and leading to considerable haemorrhage. Vomiting of fresh blood, expressed tachycardia, falling of arterial pressure are observed. In such patients it is possible to find the signs of cirrhosis of liver and portal hypertension.

The cancer of stomach in the destruction stage can be also compli­cated by bleeding. Such bleeding often are not massive, and chronic character is carried mostly with gradual growth of anaemia. Worsening of the general condition of patient, loss of weight, decreasing of appetite and waiver of meat are inherent in this pathology.

The gastric bleeding can be related to the diseases of the cardio­ vascular system (atherosclerosis, hypertensive disease), This is mainly seen in the older people.

Other diseases to be differenciated from ulcer bleeding are: the Mallory-Weiss syndrome, benign tumours of stomach and duodenum (more frequent leiomyoma), haemorrhagic gastritis, acute (stress) erosive defects of stomach, arteriovenous fistula of mucosa.