Main Symptoms of Acute Massive Hemorrhage from Peptic Ulcer

Acute massive hemorrhage from peptic ulcer, clinically referred to as acute upper gastrointestinal bleeding, is a serious medical condition with several distinct symptoms. Recognizing these signs early is crucial for prompt treatment and better patient outcomes.

Common Symptoms of Acute Upper Gastrointestinal Bleeding

Vomiting blood or passing black, tarry stools are among the most noticeable symptoms. Patients may vomit fresh red blood or material resembling coffee grounds. This is often accompanied by melena — dark, sticky stools — or in cases of rapid bleeding, bright red blood in the stool. Many patients with this condition have a prior history of peptic ulcer disease or have been taking nonsteroidal anti-inflammatory drugs (NSAIDs).

Signs of Hypovolemic Shock and Circulatory Failure

Following significant blood loss, low-grade fever may develop, typically with a temperature below 38.5°C. As the volume of blood loss increases, symptoms of hemorrhagic shock and circulatory collapse become apparent. Early signs include restlessness, anxiety, pale skin, bluish tint to the lips and nail beds, cold sweats, cold and clammy extremities, and a rapid but strong pulse. Blood pressure may initially remain normal or slightly low, with an elevated diastolic pressure and reduced pulse pressure. Urine output typically decreases.

Progression to Severe Shock

As the condition worsens, patients may exhibit emotional apathy, delayed responses, or even coma. Other signs include shallow and rapid breathing, muffled heart sounds, weak and rapid pulse, collapsed superficial veins, and a significant drop in blood pressure — sometimes falling below 80 mmHg or becoming unmeasurable. Pulse pressure narrows further, the skin becomes cold and cyanotic, and urine output diminishes drastically or stops altogether.

Importance of Timely Medical Intervention

Acute gastrointestinal bleeding is one of the most common complications of peptic ulcers and a frequent medical emergency seen in emergency departments. Without prompt diagnosis and treatment, it can lead to life-threatening complications. Early recognition of symptoms and immediate medical care are essential to prevent severe morbidity and mortality.