| Hematemesis | |
|---|---|
| Other names | Haematemesis |
| Specialty | General surgery,gastroenterology |
| Symptoms | Vomiting bright blood |
| Causes | Hemorrhoid Gastritis Gastrointestinal bleeding Stomach cancer Septicemic plague |
| Diagnostic method | Endoscopy |
| Differential diagnosis | Epistaxis,hemoptysis |
Hematemesis is thevomiting ofblood. It can be confused withhemoptysis (coughing up blood) orepistaxis (nosebleed), which are more common. The source is generally the uppergastrointestinal tract, typically above thesuspensory muscle of duodenum. It may be caused by ulcers, tumors of the stomach or esophagus, varices, prolonged and vigorous retching, gastroenteritis, ingested blood (from bleeding in themouth,nose, orthroat), or certain drugs.[citation needed]
Hematemesis is treated as a medical emergency, with treatments based on the amount of blood loss. Investigations includeendoscopy. Any blood loss may be corrected withintravenous fluids andblood transfusions. Patients may need toavoid taking anything by mouth.[citation needed]
Hematemesis is thevomiting ofblood.[1] This is usually vomit that contains bright red blood.[2]Coffee ground vomiting is similar to hematemesis, but is distinct in not involving bright red blood.[3]
Hematemesis must be differentiated fromhemoptysis (coughing up blood) andepistaxis (nosebleed).[4] Both of these are more common conditions. These may be difficult to distinguish.
Hematemesis may be caused by:
The source of vomited blood is usually from theupper gastrointestinal tract.[1] This can include theesophagus,stomach, and parts of thesmall intestine.[4] This may be thesuspensory muscle of duodenum.[1] Hematemesis tends to occur only after significant blood loss.[7]
Hematemesis may be investigated withendoscopy of theupper gastrointestinal tract.[8][9]Barium meal may also be used.[8]
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Hematemesis is treated as amedical emergency.[7][10] The most vital distinction is whether there is blood loss sufficient to causeshock. Correct management is required in such conditions. It is required to perform all tests such as endoscopy before medication. A platelet test is also an important test in such conditions. Medicines such as painkillers or antibiotics, e.g. ciprofloxacin, could decrease platelet count which can lead to thrombocytopenia (when the body does not have sufficient platelets in the blood and cannot form clots). In such conditions wrong medication or management could be deadly. Blood transfusion is required in such conditions if the body loses more than 20 percent of body blood volume. Severe loss makes it impossible for the heart to pump a sufficient amount of blood to the body. In such conditions unmaintained blood volume could lead tohypovolemic shock (hypovolemic shock could lead to damage of body organs e.g. kidney, brain, or gangrene of arms or legs). An untreated patient could develop cerebral atrophy.[citation needed]
In cases that do not involveshock, treatment may involveproton pump inhibitors (such asomeprazole) to treatstomach ulcers if they are present.[9] This is given until endoscopy can be arranged.Blood transfusions may be given if the level ofhemoglobin in the blood is extremely low, that is less than 8.0 g/dL or 4.5–5.0 mmol/L. A patient may be keptnothing by mouth (or no eating or drinking). Adequate venous access (such as with large-borecannulas or acentral venous catheter) is generally obtained, in case the patient develops a further bleed and becomes unstable.
In a "hemodynamically significant" case of hematemesis, there may beshock.Resuscitation is an immediate priority to prevent death.[11]Intravenous fluids andblood transfusions can be given, preferably by large-bore intravenous cannula. The patient is prepared for emergency endoscopy, which is typically done in aoperating theatre.Surgical opinion is usually sought in case the source of bleeding cannot be identified endoscopically, andlaparotomy is necessary. Securing the airway is a top priority in hematemesis patients, especially those with a disturbed conscious level (hepatic encephalopathy inesophageal varices patient). This may be achieved with a cuffedendotracheal tube.Octreotide may be used if bleeding may be caused byvarices.[9]
Hematemesis,melena, andhematochezia are symptoms of acute gastrointestinal bleeding. Bleeding that brings the patient to the physician is a potential emergency and must be considered as such until its seriousness can be evaluated. The goals in managing a major acute gastrointestinal hemorrhage are to treat hypovolemia by restoring the blood volume to normal, to make a diagnosis of the bleeding site and its underlying cause, and to treat the cause of the bleeding as definitively as possible. The history should be directed toward (1) confirming the presence of bleeding; (2) estimating its amount and rapidity; (3) identifying the source and potential specific causes; and (4) eliciting the presence of serious associated diseases that might adversely affect the outcome. The information obtained is especially helpful in identifying situations that require aggressive management.
