https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(00)02816-6.pdf

A risk score to predict need for treatment for upper-gastrointestinal haemorrhage.

ObjectiveTo review, systematically, the physical diagnosis of
hypovolemia in adults.MethodsWe searched MEDLINE (January 1966-November 1997), personal
files, and bibliographies of textbooks on physical diagnosis and
identified 10 studies investigating postural vital signs or the
capillary refill time of healthy volunteers, some of whom underwent
phlebotomy of up to 1150 mL of blood, and 4 studies of patients
presenting to emergency departments with suspected hypovolemia, usually
due to vomiting, diarrhea, or decreased oral intake.ResultsWhen clinicians evaluate adults with suspected blood loss,
the most helpful physical findings are either severe postural dizziness
(preventing measurement of upright vital signs) or a postural pulse
increment of 30 beats/min or more. The presence of either finding has a
sensitivity for moderate blood loss of only 22% (95% confidence
interval [CI], 6%-48%) but a much greater sensitivity for large
blood loss of 97% (95% CI, 91%-100%); the corresponding specificity
is 98% (95% CI, 97%-99%). Supine hypotension and tachycardia are
frequently absent, even after up to 1150 mL of blood loss (sensitivity,
33%; 95% CI, 21%-47%, for supine hypotension). The finding of mild
postural dizziness has no proven value. In patients with vomiting,
diarrhea, or decreased oral intake, the presence of a dry axilla
supports the diagnosis of hypovolemia (positive likelihood ratio, 2.8;
95% CI, 1.4-5.4), and moist mucous membranes and a tongue without
furrows argue against it (negative likelihood ratio, 0.3; 95% CI,
0.1-0.6 for both findings). In adults, the capillary refill time and
poor skin turgor have no proven diagnostic value.ConclusionsA large postural pulse change (≥30 beats/min) or
severe postural dizziness is required to clinically diagnose
hypovolemia due to blood loss, although these findings are often absent
after moderate amounts of blood loss. In patients with vomiting,
diarrhea, or decreased oral intake, few findings have proven utility,
and clinicians should measure serum electrolytes, serum blood urea
nitrogen, and creatinine levels when diagnostic certainty is
required.

https://jamanetwork.com/journals/JAMA/articlepdf/189113/jrc80003.pdf

Is This Patient Hypovolemic

Intraperitoneal free gas seen radiologically as air under the diaphragm nearly always indicates a perforated abdominal viscus that requires surgical intervention. Rarely, however, the presence of a pneumoperitoneum may not indicate an intra-abdominal perforation and thus may not require laparotomy. Such a situation is termed spontaneous or nonsurgical pneumoperitoneum. In this review, we explore the aetiological mechanisms and the pathophysiology of the appearance of intra-abdominal free gas. An appreciation of the condition and its likely aetiological factors should improve awareness and possibly reduce the imperative to perform an emergency laparotomy on an otherwise well patient with an unexplained pneumoperitoneum.

https://pmj.bmj.com/content/postgradmedj/73/863/531.full.pdf

Spontaneous pneumoperitoneum and other nonsurgical causes of intraperitoneal free gas.

https://www.emed.theclinics.com/article/S0733-8627(05)70055-9/pdf

Evaluation of the patient with gastrointestinal bleeding: an evidence based approach.

Nonvariceal upper gastrointestinal bleeding

Observations on the oral administration of citrated blood in man

Excerpt Perforation of the stomach is said to occur very infrequently following the use of the flexible gastroscope. According to Schindler and Renshaw,1this accident is known to have occurred five...

Pneumoperitoneum following use of the flexible gastroscope

Case histories are presented of five patients with a gastroscopic diagnosis of chronic atrophic gastritis not associated with other gastric disease, pernicious anemia, or other anemia, protein deficiency, or obvious vitamin deficiency. The patients were given hog’s stomach extract, Ventriculin, in doses averaging 30 to 60 grams per day in addition to a bland or regular diet. All five patients showed marked symptomatic improvement together with disappearance of the atrophic changes. When the Ventriculin was withdrawn in three of the patients, two showed a return of the atrophic changes and one an associated return of symptoms. In a fourth patient atrophic changes reappeared when Ventriculin was taken in a total dosage of 500 grams during a period of four months. These results suggest that atrophic gastritis in some instances may be due to a deficiency of a substance contained in desiccated hog’s stomach extract.

Desiccated Hog’s stomach extract (ventriculin) in the treatment of atrophic gastritis

Gastric secretory studies to determine the effectiveness of heteronium bromide as an anticholinergic agent were undertaken using 7 elderly patients with peptic ulcer who were shown to have elevated basal and post-Histalog gastric secretion.

Evaluation of the Antisecretory Effect of a New Anticholinergic Agent Heteronium Bromide

Observations On The Oral Administration Of Citrated Blood In Man: Ii. The Effect On The Stools

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