What are the signs of recent hemorrhage, and what do they mean? Criteria for massive bleeding.
Hematemesis, melena, shock, vague symptoms, anemia, blood examinations and endoscopic findings are reviewed as signs of recent hemorrhage. An assessment of the condition of patients with upper GI bleeding is important for planning treatment. Therefore, in order to be able to evaluate a method of treatment of GI bleeding, reports referring to treatment of GI bleeding must contain a clear record of the severity of the patient's state and of the bleeding source. A common criterion for massive bleeding has been proposed. Specifically, a patient suffering from shock who needs more than 1,000 ml of blood or plasma expander by rapid transfusion within one hour, or more than 2,000 ml within the initial 24 hours, to stabilize his circulation, and whose Hb level is 8.0 g/dl or less, should be graded as having massive bleeding. Gastric ulcers with exposed blood vessels need endoscopic YAG laser hemostasis or ethanol injection therapy as quickly as possible, since 43% of the cases rebleed within 72 hours under conventional drug therapy, and such rebleeding can be prevented by the endoscopic hemostatic methods.