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| {{Infobox_Disease |
| | __NOTOC__ |
| Name = Hematemesis |
| | '''For patient information, click [[{{PAGENAME}} (patient information)|here]]''' |
| Image = |
| | {{Hematemesis}} |
| Caption = |
| | {{CMG}}; {{JFS}} |
| DiseasesDB = 30745 |
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| ICD10 = {{ICD10|K|92|0|k|92}} |
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| ICD9 = {{ICD9|578.0}} |
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| ICDO = |
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| OMIM = |
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| MedlinePlus = |
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| eMedicineSubj = med |
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| eMedicineTopic = 3565 |
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| MeshName = Hematemesis |
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| MeshNumber = C23.550.414.788.400 |
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| }} | |
| {{SI}} | |
| {{CMG}} | |
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| {{JFS}} | | {{SK}} Vomiting of blood; haematemesis; blood in the vomit, bloody vomiting |
| {{Editor Help}}
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| ==Overview== | | ==[[Hematemesis overview|Overview]]== |
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| '''Hematemesis''' or '''haematemesis''' is the [[vomiting]] of [[blood]]. The source is generally the upper [[gastrointestinal tract]] (UGI). Patients can easily confuse it with [[hemoptysis]] (coughing up blood), although the former is more common. A nasogastric tube lavage that yields blood or coffee-ground like material confirms the diagnosis and predicts whether bleeding is caused by a high-risk lesion. The initial evaluation of the patient with UGI bleeding involves an assessment of hemodynamic stability and resuscitation if necessary. Upper endoscopy usually follows, with the goal of both diagnosis, and in some circumstances, treatment of the specific disorder.
| | ==[[Hematemesis historical perspective|Historical Perspective]]== |
| Important elements of the history include use of [[NSAIDs]], [[alcohol]], history of [[liver disease]] or [[variceal]] bleeding, history of [[ulcers]], weight loss, dysphagia, or an [[abdominal aortic aneurysm]] (AAA).
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| Endoscopic, clinical, and laboratory features are useful for risk stratification of patients who present with UGI bleeding. In addition, gastroenterology and surgical consultation are usually required for high risk patients.
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| ==Signs== | | ==[[Hematemesis classification|Classification]]== |
| Signs of the onset of hematemesis may include:
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| * A history of [[alcohol abuse|excessive alcohol use]] or [[liver disease]]
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| * Any esophogastric symptoms, such as nausea or vomiting
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| * Brown or black blood
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| * Blood that looks like coffee grounds
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| * Dark colored, tar like stools (a condition known as [[melena]])
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| ===Complete Differential Diagnosis of the Causes of hematmesis=== | | ==[[Hematemesis pathophysiology|Pathophysiology]]== |
| (In alphabetical order)
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| *[[Abciximab]]
| | ==[[Hematemesis causes|Causes]]== |
| *[[Acute esophageal necrosis (AEN)]]
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| *[[Adenocarcinoma ]]
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| *[[Alendronate]]
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| *[[Angiodysplasia]]
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| *[[Angiomas]]
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| *[[Aortic Coarctation]]
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| *[[Aortoenteric fistula]]
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| Arterial, venous, or other vascular malformations
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| *[[Aspirin]]
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| *[[Blue rubber bleb nevus syndrome]]
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| *[[Candida albicans]]
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| *[[Carcinoid]]
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| *[[Caustic ingestion]]
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| *[[Clopidogrel ]]
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| *[[Coagulopathy]]
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| *[[Congenital malformations]]
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| *[[Coumarin]]
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| *[[Cow's milk allergy]]
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| *[[Crimean-Congo hemorrhagic fever]]
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| *[[Cytomegalovirus]]
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| *[[Dieulafoy's lesion]]
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| *[[Disseminated intravascular coagulation]]
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| *[[Drotrecogin alfa]]
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| *[[Drug-induced thrombocytopenia]]
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| *[[Duodenal varices]]
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| *[[Duplication cysts]]
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| *[[Ehlers-Danlos syndrome]]
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| *[[Esophageal cancer]]
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| *[[Esophageal dilatation]]
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| *[[Esophageal melanosis ]]
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| *[[Esophagitis]]
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| *[[Foreign body ingestion]]
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| *[[Gastric varices]]
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| *[[Helicobacter pylori]]
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| *[[Hemobilia]]
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| *[[Hemophilia]]
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| *[[Hemosuccus pancreaticus]]
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| *[[Hereditary hemorrhagic telangiectasia ]]
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| *[[Herpes simplex virus]]
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| *[[Heterotopic pancreatic tissue]]
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| *[[Idiopathic]]
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| *[[Idiopathic thrombocytopenic purpura ]]
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| *[[Intestinal duplication]]
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| *[[Kaposi's sarcoma]]
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| *[[Kasabach-Merritt syndromes]]
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| *[[Leiomyoma]]
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| *[[Lipoma]]
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| *[[Lymphoma]]
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| *[[Mallory-Weiss syndrome]]
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| *[[Melanoma]]
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| *[[Melanoma]]
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| *[[Metastatic tumor]]
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| *[[Munchausen syndrome by proxy]]
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| *[[Nonsteroidal antiinflammatory drugs]]
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| *[[Osler-Weber-Rendu syndrome]]
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| *[[Parasites]]
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| *[[Peptic ulcer disease]]
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| *[[Pill-induced]]
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| *[[Polyp (hyperplastic, adenomatous, hamartomatous)]]
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| *[[Portal hypertension]]
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| *[[Portal hypertensive gastropathy]]
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| *[[Post gastric/duodenal polypectomy]]
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| *[[Post-surgical anastamosis]]
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| *[[Potassium chloride]]
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| *[[Pseudomembranous esophagitis ]]
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| *[[Quinidine]]
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| *[[Radiation-induced telangiectasia]]
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| *[[Rift valley fever]]
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| *[[Schistosomiasis]]
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| *[[Sibutramine]]
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| *[[Stress-induced ulcer]]
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| *[[Systemic mastocytosis]]
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| *[[Tetracycline]]
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| *[[Ticlopidine]]
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| *[[Traumatic or post-surgical]]
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| *[[Vasculitis,]]
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| *[[Von Willebrand disease ]]
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| *[[Watermelon stomach (gastric antral vascular ectasia)]]
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| *[[Zollinger Ellison syndrome]]
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| ===Complete Differential Diagnosis of the Causes of hematmesis=== | | ==[[Hematemesis differential diagnosis|Differentiating Hematemesis from other Diseases]]== |
| (By organ system)
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| {|style="width:80%; height:100px" border="1"
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| |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
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| |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Chemical / poisoning'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Dermatologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Drug Side Effect'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Ear Nose Throat'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Endocrine'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Environmental'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Gastroenterologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Genetic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Hematologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Iatrogenic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Infectious Disease'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Musculoskeletal / Ortho'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Neurologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Nutritional / Metabolic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Obstetric/Gynecologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Oncologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Opthalmologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Overdose / Toxicity'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Psychiatric'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Pulmonary'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Renal / Electrolyte'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Rheum / Immune / Allergy'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Sexual'''
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| |bgcolor="Beige"| No underlying causes | |
| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Trauma'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Urologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Miscellaneous'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |}
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| | ==[[Hematemesis epidemiology and demographics|Epidemiology and Demographics]]== |
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| | ==[[Hematemesis risk factors|Risk Factors]]== |
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| ==Management== | | ==[[Hematemesis screening|Screening]]== |
| [[Hematemesis]] is treated as a [[medical emergency]]. The most vital distinction is whether there is blood loss sufficient to cause [[Shock (medical)|shock]]. | |
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| ===Minimal blood loss=== | | ==[[Hematemesis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| 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.
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| ===Significant blood loss=== | | ==Diagnosis== |
| 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.
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| ==References==
| | [[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]] |
| {{Reflist|2}}
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| == See also == | | ==Treatment== |
| * [[Upper gastrointestinal bleeding]]
| | [[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]] |
| * [[Shock (medical)|Shock]]
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| * [[Melena]]
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| ==External links== | | ==Case Studies== |
| | [[Hematemesis case study one|Case #1]] |
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| * [http://www.umm.edu/ency/article/003118.htm]
| | ==External Links== |
| * [http://www.nlm.nih.gov/medlineplus/ency/article/003118.htm NIH/Medline] | | * [http://www.nlm.nih.gov/medlineplus/ency/article/003118.htm Vomiting blood - NIH/Medline ] |
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| {{Gastroenterology}}
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| {{SIB}}
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| [[ar:قيء دموي]]
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| [[de:Hämatemesis]]
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| [[es:Hematemesis]] | | [[es:Hematemesis]] |
| [[fr:Hématémèse]] | | [[fr:Hématémèse]] |
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| [[pl:Wymioty fusowate]] | | [[pl:Wymioty fusowate]] |
| [[Category:Vomiting]]
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| [[Category:Gastroenterology]]
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| [[Category:Signs and symptoms]]
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