|
|
| (33 intermediate revisions by 11 users not shown) |
| Line 1: |
Line 1: |
| {{Infobox_Disease |
| | __NOTOC__ |
| Name = Hematemesis |
| | '''For patient information, click [[{{PAGENAME}} (patient information)|here]]''' |
| Image = |
| | {{Hematemesis}} |
| Caption = |
| | {{CMG}}; {{JFS}} |
| DiseasesDB = 30745 |
| |
| ICD10 = {{ICD10|K|92|0|k|92}} |
| |
| ICD9 = {{ICD9|578.0}} |
| |
| ICDO = |
| |
| OMIM = |
| |
| MedlinePlus = |
| |
| eMedicineSubj = med |
| |
| eMedicineTopic = 3565 |
| |
| MeshName = Hematemesis |
| |
| MeshNumber = C23.550.414.788.400 |
| |
| }}
| |
| {{SI}}
| |
| {{CMG}} | |
| {{JFS}} | |
| {{Editor Help}}
| |
|
| |
|
| ==Overview==
| | {{SK}} Vomiting of blood; haematemesis; blood in the vomit, bloody vomiting |
|
| |
|
| '''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.
| | ==[[Hematemesis overview|Overview]]== |
|
| |
|
| ==Signs== | | ==[[Hematemesis historical perspective|Historical Perspective]]== |
| Signs of the onset of hematemesis may include:
| |
| * A history of [[alcohol abuse|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]])
| |
|
| |
|
| ===Complete Differential Diagnosis of the Causes of hematmesis=== | | ==[[Hematemesis classification|Classification]]== |
| (In alphabetical order)
| |
|
| |
|
| *[[Abciximab]]
| | ==[[Hematemesis pathophysiology|Pathophysiology]]== |
| *[[Acute esophageal necrosis (AEN)]]
| |
| *[[Adenocarcinoma ]]
| |
| *[[Alendronate]]
| |
| *[[Angiodysplasia]]
| |
| *[[Angiomas]]
| |
| *[[Aortic Coarctation]]
| |
| *[[Aortoenteric fistula]]
| |
| Arterial, venous, or other vascular malformations
| |
| *[[Aspirin]]
| |
| *[[Blue rubber bleb nevus syndrome]]
| |
| *[[Candida albicans]]
| |
| *[[Carcinoid]]
| |
| *[[Caustic ingestion]]
| |
| *[[Clopidogrel ]]
| |
| *[[Coagulopathy]]
| |
| *[[Congenital malformations]]
| |
| *[[Coumarin]]
| |
| *[[Cow's milk allergy]]
| |
| *[[Crimean-Congo hemorrhagic fever]]
| |
| *[[Cytomegalovirus]]
| |
| *[[Dieulafoy's lesion]]
| |
| *[[Disseminated intravascular coagulation]]
| |
| *[[Drotrecogin alfa]]
| |
| *[[Drug-induced thrombocytopenia]]
| |
| *[[Duodenal varices]]
| |
| *[[Duplication cysts]]
| |
| *[[Ehlers-Danlos syndrome]]
| |
| *[[Esophageal cancer]]
| |
| *[[Esophageal dilatation]]
| |
| *[[Esophageal melanosis ]]
| |
| *[[Esophagitis]]
| |
| *[[Foreign body ingestion]]
| |
| *[[Gastric varices]]
| |
| *[[Helicobacter pylori]]
| |
| *[[Hemobilia]]
| |
| *[[Hemophilia]]
| |
| *[[Hemosuccus pancreaticus]]
| |
| *[[Hereditary hemorrhagic telangiectasia ]]
| |
| *[[Herpes simplex virus]]
| |
| *[[Heterotopic pancreatic tissue]]
| |
| *[[Idiopathic]]
| |
| *[[Idiopathic thrombocytopenic purpura ]]
| |
| *[[Intestinal duplication]]
| |
| *[[Kaposi's sarcoma]]
| |
| *[[Kasabach-Merritt syndromes]]
| |
| *[[Leiomyoma]]
| |
| *[[Lipoma]]
| |
| *[[Lymphoma]]
| |
| *[[Mallory-Weiss syndrome]]
| |
| *[[Melanoma]]
| |
| *[[Melanoma]]
| |
| *[[Metastatic tumor]]
| |
| *[[Munchausen syndrome by proxy]]
| |
| *[[Nonsteroidal antiinflammatory drugs]]
| |
| *[[Osler-Weber-Rendu syndrome]]
| |
| *[[Parasites]]
| |
| *[[Peptic ulcer disease]]
| |
| *[[Pill-induced]]
| |
| *[[Polyp (hyperplastic, adenomatous, hamartomatous)]]
| |
| *[[Portal hypertension]]
| |
| *[[Portal hypertensive gastropathy]]
| |
| *[[Post gastric/duodenal polypectomy]]
| |
| *[[Post-surgical anastamosis]]
| |
| *[[Potassium chloride]]
| |
| *[[Pseudomembranous esophagitis ]]
| |
| *[[Quinidine]]
| |
| *[[Radiation-induced telangiectasia]]
| |
| *[[Rift valley fever]]
| |
| *[[Schistosomiasis]]
| |
| *[[Sibutramine]]
| |
| *[[Stress-induced ulcer]]
| |
| *[[Systemic mastocytosis]]
| |
| *[[Tetracycline]]
| |
| *[[Ticlopidine]]
| |
| *[[Traumatic or post-surgical]]
| |
| *[[Vasculitis,]]
| |
| *[[Von Willebrand disease ]]
| |
| *[[Watermelon stomach (gastric antral vascular ectasia)]]
| |
| *[[Zollinger Ellison syndrome]]
| |
|
| |
|
| ===Complete Differential Diagnosis of the Causes of hematmesis=== | | ==[[Hematemesis causes|Causes]]== |
| (By organ system)
| |
| {|style="width:80%; height:100px" border="1"
| |
| |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
| |
| |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
| |
| |- | |
| |-bgcolor="LightSteelBlue"
| |
| | '''Chemical / poisoning'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Dermatologic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Drug Side Effect'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Ear Nose Throat'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Endocrine'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Environmental'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Gastroenterologic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Genetic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Hematologic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Iatrogenic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Infectious Disease'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Musculoskeletal / Ortho'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Neurologic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Nutritional / Metabolic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Obstetric/Gynecologic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Oncologic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Opthalmologic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Overdose / Toxicity'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Psychiatric'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Pulmonary'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Renal / Electrolyte'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Rheum / Immune / Allergy'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Sexual'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Trauma'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Urologic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Miscellaneous'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |}
| |
|
| |
|
| | ==[[Hematemesis differential diagnosis|Differentiating Hematemesis from other Diseases]]== |
|
| |
|
| | ==[[Hematemesis epidemiology and demographics|Epidemiology and Demographics]]== |
|
| |
|
| ==Management== | | ==[[Hematemesis risk factors|Risk Factors]]== |
| [[Hematemesis]] is treated as a [[medical emergency]]. The most vital distinction is whether there is blood loss sufficient to cause [[Shock (medical)|shock]]. | |
|
| |
|
| ===Minimal blood loss=== | | ==[[Hematemesis screening|Screening]]== |
| If this is not the case, the patient is generally administered a [[proton pump inhibitor]] (e.g. [[omeprazole]]), given [[blood transfusion]]s (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 pneumonoultramicroscopic silivolcano coniosis (coniosis) can be arranged. Adequate venous access (large-bore [[cannula]]s or a [[central venous catheter]]) is generally obtained in case the patient suffers a further bleed and becomes unstable.
| |
|
| |
|
| ===Significant blood loss=== | | ==[[Hematemesis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| 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. [[Surgery|Surgical]] opinion is usually sought in case the source of bleeding cannot be identified endoscopically, and [[laparotomy]] is necessary.
| |
|
| |
|
| ==References== | | ==Diagnosis== |
| {{Reflist|2}}
| |
|
| |
|
| == See also ==
| | [[Hematemesis history and symptoms|History and Symptoms]] | [[Hematemesis physical examination|Physical Examination]] | [[Hematemesis laboratory findings|Laboratory Findings]] | [[Hematemesis CT|CT]] | [[Hematemesis MRI|MRI]] | [[Hematemesis other imaging findings|Other Imaging Findings]] | [[Hematemesis other diagnostic studies|Other Diagnostic Studies]] |
| * [[Upper gastrointestinal bleeding]]
| |
| * [[Shock (medical)|Shock]]
| |
| * [[Melena]]
| |
|
| |
|
| ==External links== | | ==Treatment== |
| | [[Hematemesis medical therapy|Medical Therapy]] | [[Hematemesis surgery|Surgery]] | [[Hematemesis primary prevention|Primary Prevention]] | [[Hematemesis secondary prevention|Secondary Prevention]] | [[Hematemesis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Hematemesis future or investigational therapies|Future or Investigational Therapies]] |
|
| |
|
| * [http://www.umm.edu/ency/article/003118.htm]
| | ==Case Studies== |
| * [http://www.nlm.nih.gov/medlineplus/ency/article/003118.htm NIH/Medline]
| | [[Hematemesis case study one|Case #1]] |
|
| |
|
| {{Gastroenterology}}
| | ==External Links== |
| {{SIB}}
| | * [http://www.nlm.nih.gov/medlineplus/ency/article/003118.htm Vomiting blood - NIH/Medline ] |
|
| |
|
|
| |
|
|
| |
| [[ar:قيء دموي]]
| |
| [[de:Hämatemesis]]
| |
| [[es:Hematemesis]] | | [[es:Hematemesis]] |
| [[fr:Hématémèse]] | | [[fr:Hématémèse]] |
| Line 264: |
Line 46: |
|
| |
|
| [[pl:Wymioty fusowate]] | | [[pl:Wymioty fusowate]] |
| [[Category:Vomiting]]
| |
| [[Category:Gastroenterology]]
| |
| [[Category:Signs and symptoms]]
| |
|
| |
|
| |
|
| |
| {{WikiDoc Help Menu}} | | {{WikiDoc Help Menu}} |
| {{WikiDoc Sources}} | | {{WikiDoc Sources}} |
| | |
| | [[Category:Gastroenterology]] |
| | [[Category:Emergency medicine]] |