Blood bilirubin determinations as an aid in the differentiations between peptic ulcer and portal cirrhosis in gastric hemorrhage

ABSTRACT

1. Seven cases with massive gastric hemorrhage resulting in profuse hematemesis form the basis of this report. Four of these were admitted in the Medical Wards of the Philippine General Hospital, two were patients admitted in the Pay Section of the same Hospital, and the sixth was an American internee admitted in a special ward for internees of the same hospital2. Four of these patients died, and a complete pathologic report for each was available. Two were operated on and accurate operative findings were also available for these patients. One had no operative or autopsy verification of the clinical impression. But this appears well supported by clinical laboratory and X-ray findings3. Four of these patients were found suffering from peptic ulcer and the other three from portal chirrhosis. The patients with peptic ulcer showed practically no bilirubin in the blood (Whether B-I or B-II) while those with portal cirrhosis showed significant amounts of B-I4. When clinical, laboratory , or x-ray findings are not sufficiently distinct for the differentiation of these two conditions in cases of massive gastric hemorrhage, the bilirubin (B-I) content of the blood may help in the differentiation. Peptic ulcer is not accompanied by B-I in the blood, while portal cirrhosis is always accompanied by functional disturbances of the liver. This is shown by the constant presence of B-I in the blood. (Conclusion)