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Abstract: The patient was a 60-year-old middle-aged female who came to the hospital with bright red mixed food residue in her vomit. The patient’s symptoms improved.
Basic information】Female, 60 years old
Disease Type】Upper gastrointestinal bleeding, erosive hemorrhagic gastritis, gastric ulcer, traumatic esophagitis
Hospital】Liaocheng Second People’s Hospital
Date of Consultation】April 2022
Treatment plan] Fasting + medication (Esomeprazole enteric capsule + Thioglycollate chewable tablet) + intravenous injection (5% dextrose injection)
[Treatment period] Hospitalization for 7 days, outpatient review after 2 months
【Treatment effect】The upper gastrointestinal bleeding has stopped and the esophageal mucosa has been repaired
I. Initial interview
In April 2022, the emergency department called for an emergency consultation with the gastroenterology department. A 60-year-old female patient was lying on the bed in the emergency resuscitation room with her eyes tightly closed. The patient’s family showed me pictures of bright red vomit mixed with food residue, with a volume of about 500 ml and some dark red blood clots, which was initially judged as upper gastrointestinal bleeding. But the cause of bleeding needs further communication, combined with medical history and examination to determine, reassure the family, came to the patient’s side to carefully observe, bedside monitoring indicates stable vital signs, physical examination can be seen all over the skin mucosa slightly pale, cardiopulmonary examination did not see obvious abnormalities, abdominal examination can be seen in the left upper abdomen there is obvious pressure pain, no rebound pain. The patient reported that he drank thin rice quickly yesterday, after which he had pain behind the sternum and did not care. This afternoon, the pain worsened after eating burritos and was accompanied by vomiting blood. Now the vomiting sensation disappeared, but the retrosternal pain was severe. The patient has no history of hypertension or coronary heart disease, and no history of long-term medication. The patient’s family added that the patient drank the thin rice just boiled yesterday relatively quickly. Therefore, in order to clarify the cause of upper gastrointestinal bleeding, the patient was advised to be hospitalized for observation and treatment before further diagnosis.
II. Treatment history
After the patient was admitted to the hospital, he was carefully questioned about his medical history. The patient usually did not have any chronic cardiovascular disease and had regular checkups with normal indicators. The patient was found to be in good physical condition with all indicators in the normal range, but the blood count indicated a hemoglobin of 91 g/L. After explaining the condition to the patient and his family, it was found that the patient’s overheated diet had caused damage to the esophageal mucosa, which was more likely to cause bleeding. The patient and family agreed to the gastroscopy and completed it early in the morning on the second day after admission. The gastroscopy showed that the patient’s entire esophageal mucosa was scalded with many blood bubbles, some of which had bloody fluid that could rupture at any time, suggesting erosive hemorrhagic gastritis, gastric ulcer, and traumatic esophagitis, which were considered to be related to the mucosal damage caused by the patient’s irritating diet. After the cause of bleeding was clearly identified, the patient was instructed to temporarily abstain from eating and drinking to avoid further aggravation of mucosal damage, and was given esomeprazole enteric capsules for acid suppression and chewable aluminum thioglycollate tablets for mucosal protection, as well as 5% dextrose injection for intensive intravenous nutritional support treatment.
III. Treatment effect
After admission, the patient did not vomit blood again, but only relieved black stool once, and there was no significant change in the routine blood test. After 3 days of treatment, the pain behind the sternum basically disappeared, but the patient still had discomfort. Then a warm liquid diet was gradually introduced and the patient started to eat thin rice, but the patient was instructed not to eat too fast or too hot, and needed to be warm and cool to avoid vasodilatation and bleeding, which could lead to esophageal mucosal damage. After 7 days of hospitalization, the patient’s symptoms stabilized, and the family discussed the discharge, telling the patient that he should continue this diet after discharge and wait for 1-2 months to review the gastroscopy again to carefully observe the recovery of the esophageal mucosa. 2 months later, the patient’s outpatient follow-up examination showed that the esophageal mucosa had been repaired and the inflammation had improved significantly compared with before.
IV. Notes
1. We are glad that the patient’s upper gastrointestinal symptoms were relieved after treatment. Advise the patient to observe the condition after discharge. Once vomiting blood and black stool appear, immediate hospital consultation is needed, but there is no need to be overly anxious and nervous, it is not that vomiting blood is an incurable disease, it may be just inflammation.
2, eat too fast, too hard irritating food will aggravate the disease, so during treatment and after discharge, eat less and more meals, especially do not eat spicy, fried, stimulating food, do not overeat, so as not to increase the burden on the esophagus as well as the stomach.
V. Personal insight
Nowadays, many people are paying more and more attention to health care, but the lack of professional knowledge of health care can lead to the consequences of overdoing it. In this case, the patient thought that not eating irritating food and drinking hot water and hot meals would warm the stomach, but this is not acceptable. If you often eat too hot food, it will lead to scalding of the oral and esophageal mucosa, and the surface layer of the mucosa will be shed and renewed, so that the cells in the base will proliferate and renew rapidly, and there may be abnormal acceleration of cell proliferation or mutation, leading to undesirable tendencies. After healing of ulcers caused by excessively hot food, scarring can form, causing narrowing of the esophagus, pain and a burning sensation behind the sternum, and gastritis.