Hemorrhage from the Stomach. 321 



11. Hemorrhage from the Stomach. Haemorrhagia ventriculi. 



{Bhdhreclien, [German] ; Hoematemesis.) 



Etiology. Arterial hyperemia of the gastric mucosa easily 

 causes hemorrhages per diapedesin or per rhexin, which are 

 rarely so abundant that there is a free blood extravasation 

 into the cavity of the stomach. This may however be the case 

 if acrid or caustic substances have caused a deeply penetrating 

 inflammation or a necrosis of superficial layers of the mucosa 

 with subsequent ulceration. 



Hemorrhages from the stomach likewise appear in the 

 course of certain acute infectious diseases; they may then be 

 due to local inflammatory processes or more generally to the 

 general infection. Diseases of this type are particularly pur- 

 pura hsemorrhagica, anthrax, hog cholera, swine plague, dis- 

 temper in dogs, smallpox, scorbutus, etc. 



Diseases of the blood vessels and changes in the blood are 

 the cause of hematemesis wdiich occurs in blood diseases and 

 cachexia. Ulcer of the stomach gives rise to hemorrhages from 

 the stomach. Swallowed foreign bodies sometimes injure vessels 

 of the gastric w^all and cause hemorrhages into the stomach, 

 gastric vessels may also be torn in a fall or in overwork. In 

 horses gastrophilus larvae sometimes produce injuries which 

 lead to hematemesis (Qualitz). Eupture of the enlarged and 

 subsequently adherent abdominal aorta or of the coeliac artery 

 may also form an extremely rare cause of fatal hemorrhage 

 into the cavity of the stomach. 



Congestion of the gastric mucosa leads usually at most to 

 parenchymatous hemorrhages, as is seen in the course of dis- 

 eases of the liver, of the portal vein, of the heart and of the 

 lungs. 



Symptoms. The only reliable symptom of hemorrhage of 

 the stomach consists in the vomiting of blood (hEematemesis, 

 sive vomitus cruentus) ; it is however usually observed only in 

 carnivora and then only after more severe hemorrhages. The 

 animals then expel either feed-material streaked with blood or 

 pure blood through the mouth and nose. The latter may be 

 fluid and bright red or coagulated into dark brown masses. 

 After having been in the stomach for a longer time, the vomited 

 blood is dirty brown or of a chocolate color, similar to ground 

 coffee, since the hemoglobin has been changed into hematin by 

 the action of the hydrochloric acid of the gastric juice. Micro- 

 scopic examination of the vomited masses which have an acid 

 reaction or of the gastric contents removed by catheter shows, 

 aside from more or less changed particles of food, pale or dis- 

 integrating^ blood corpuscles, although they may be entirely 

 absent, having been completely dissolved by the gastric juice. 



