Hematemesis
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Overview
| Hematemesis Classification and external resources | ||
| ICD-10 | K92.0 | |
|---|---|---|
| ICD-9 | 578.0 | |
| DiseasesDB | 30745 | |
| eMedicine | med/3565 | |
| MeSH | C23.550.414.788.400 | |
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Hematemesis or haematemesis is the vomiting of blood. The source is generally the upper gastrointestinal tract. Patients can easily confuse it with hemoptysis (coughing up blood), although the former is more common.
Signs
Signs of the onset of hematemesis may include:
- A history of excessive alcohol use or liver disease
- Any esophogastric symptoms, such as nausea or vomiting
- Brown or black blood
- Blood that looks like coffee grounds
- Dark colored, tar like stools (a condition known as melena)
Differential Diagnosis of Causes of Hematemesis
- Prolonged and vigorous retching (may cause a tear in the small blood vessels of the throat or the esophagus, producing streaks of blood in the vomit, and is called Mallory-Weiss bleeding).
- Irritation or erosion of the lining of the esophagus or stomach
- Bleeding ulcer located in the stomach, duodenum, or esophagus
- Ingested blood (for example, swallowed after a nosebleed)
- Vomiting of ingested blood after hemorrhage in the oral cavity, nose or throat
- Vascular malfunctions of the gastrointestinal tract
- Tumors of the stomach or esophagus
- Esophagitis
- Gastroenteritis
- Gastritis
- Mallory-Weiss syndrome (esophageal tear)
- Esophageal varices
- Peptic ulcer
- Gastric varices
- Dieulafoy's lesion
- Wilson's disease (hepatolenticular degeneration)
- Trichophagia
Management
Hematemesis is treated as a medical emergency. The most vital distinction is whether there is blood loss sufficient to cause shock.
Minimal blood loss
If this is not the case, the patient is generally administered a proton pump inhibitor (e.g. omeprazole), given blood transfusions (if the level of hemoglobin is extremely low, that is less than 8.0 g/dL or 4.5-5.0 mmol/L), and kept nil per os until pneumonoultramicroscopicsilivolcanoconiosis (coniosis) can be arranged. Adequate venous access (large-bore cannulas or a central venous catheter) is generally obtained in case the patient suffers a further bleed and becomes unstable.
Significant blood loss
In a "hemodynamically significant" case of hematemesis, that is hypovolemic shock, resuscitation is an immediate priority to prevent cardiac arrest. Fluids and/or blood is administered, preferably by central venous catheter, and the patient is prepared for emergency endoscopy, which is typically done in theatres. Surgical opinion is usually sought in case the source of bleeding cannot be identified endoscopically, and laparotomy is necessary.
References
See also
External links
ar:قيء دموي
de:Hämatemesisfr:Hématémèse
ja:吐血
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Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
