Hematemesis

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ICD9 = | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = med | eMedicineTopic = 3565 | MeshName = Hematemesis | MeshNumber = C23.550.414.788.400 |Hematemesis or haematemesis (see American and British spelling differences) 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)

Causes

Causes can be:

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.