Emergency Room Series: Stomach ISH

Stomach ulcer is quite common in Nigeria and most people don't know they have the disease.

A man in his mid-thirties was rushed to the ER by his wife and neighbours. He was said to have been bleeding from his mouth and anus. The wife said the bloody stool started about a week ago but he 'thought it would go' and he started vomiting blood few minutes before presenting at the ER. He was said to have slumped at home.


Initially, we thought it was a case of Lassa fever but when he had no high temperature or any other symptoms asides bleeding, we knew it had to be something else. He was semiconscious and disoriented when he was brought in. His blood pressure was extremely low and at first the monitor couldn't read his heart beat because it was weak and of a poor volume. He was breathing heavily too, very pale(paper white) and dehydrated

The wife said he was a known peptic (stomach) ulcer patient but hadn't been using his drugs or eating right as instructed by his doctor. She claimed the man had been fasting and eating less for some days because of a religious program. It was when the bloody stools started that he commenced his drugs but I guess the damage was beyond what the drugs could handle and he became worse. His wife was so worried.

The doctor reassured her.


I passed an IV cannula and he had prescribed IV fluids to rehydrate him, dilute his blood, increase the blood volume and improve cardiac function. We had to quickly take blood samples to check his blood level as well as electrolyte counts. His blood level was 20%! That was extremely low, especially for a man. He must have passed a lot of bloody faeces to have that kind of low blood level. His blood type was identified and he had 3bags of blood transfused for a start. He was placed on oxygen to make him breath better. He had an ultrasound scan done and from the result we could see the ulcer was severe and had 'eaten' up his stomach wall and that's why he was passing bloody stools. 

 He also had IV medications to stop the bleeding and branded antibiotics to treat underlying infections. Gradually, his blood pressure and heart rate got better. He is to have a surgery to repair somethings in his stomach that was noticed to be abnormal in the ultrasound. He's still on admission and I hope he recovers fully.

Stomach Ulcers occur when stomach acid damages the lining of the digestive tract. Its like when the stomach is empty and begins to 'eat' itself. The stomach shouldn't be empty for a long time. I usually tell people never to wait till they fell the 'hunger pain' before they eat. Even water goes a long way in preventing ulcer. The common symptoms are burning stomach pain, feeling of fullness, bloating or belching, Heartburn and Nausea. Stomach acid makes the pain worse, especially when you have an empty stomach. 

Common causes include the bacteria H. Pylori and anti-inflammatory pain relievers including diclofenac, ibrupofen and aspirin. There are more than 100 thousand cases per year in Nigeria.
Other people that are likely to have stomach ulcer are those who skip breakfast(most important meal of the day) or those who go on spiritual fasts for a long time. Smoking and drinking alcohol also increases the risk of peptic ulcers 

People who eat very spicy foods(the pepper gang) also have a high risk of developing ulcer
Nearly three-quarters of people with peptic ulcers don't have symptoms and so they won't know.

 Do you usually feel sharp and burning pains in your stomach especially in the morning or at night when you haven't eaten? It could most likely be ulcer.

Less often, ulcers may cause severe signs or symptoms such as: vomiting or vomiting blood — which may appear red or black, dark blood in stools, or stools that are black or tarry, trouble breathing, feeling faint, nausea or vomiting, unexplained weight loss, appetite changes.
If you're a known ulcer patient, its important that you follow your doctor's advise and eat right. If you're lucky and sure you don't have stomach ulcer, its important you eat often or take sips of water regularly when you don't have food around. Its better to prevent a disease than spend money to cure it.