Hematemesis (patient information)

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Hematemesis
Overview
What are the symptoms?
What are the causes?
Diagnosis
When to seek urgent medical care?
Treatment options
Where to find medical care for Hematemesis?
Prevention
What to expect (Outlook/Prognosis)?
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Jinhui Wu, M.D.

Overview

Hematemesis is a regurgitation of blood through the upper gastrointestinal (GI) tract. The upper GI tract includes the stomach, mouth, throat, esophagus, and the first part of the small intestine. The causes of hematemesis include the inflammation, uncler, cancer and varices caused by cirrhosis in the upper gastrointestinal tract. The accompany symptoms include nausea, weakness and fatigue, sweat, even abdominal pain and shock. Chest radiographs, CT scan, ultrasonography, endoscopy and biopsy can definite the location and characteristics of the bleeding sites. Treatment of hematesis depends on the underlying cause. The goal of medical and surgical therapy is to correct shock and coagulation abnormalities and to stabilize the patient so that further evaluation and treatment can proceed. The prognosis of hematemesis depends on the underlying cause and the rate and extent of hemorrhage.

What are the symptoms of Hematemesis?

Patients may experience the following symptoms:

• Vomiting blood
• Nausea
• Abdominal pain
• Fatigue and weakness
• Sweat
• Dark colored, tar like stools
• Hypotension
• Shock

Other health problems may also cause these symptoms. Only a doctor can tell for sure. A person with any of these symptoms should tell the doctor so that the problems can be diagnosed and treated as early as possible.

Diseases with similar symptoms include:

• Hemoptysis

What causes Hematemesis?

• Esophagus

• Esophagitis
• Ulcer
• Mallory-Weiss tear
• Esophageal varices caused by cirrhosis

• Stomach

• Peptic ulcer
• Gastric erosions
• Gastritis
• Varices caused by cirrhosis
• Portal-hypertensive gastropathy
• Gastric cancer
• Polyp
• Dieulafoy lesion

• Duodenum

• Peptic ulcer
• Duodenitis
• Aortoenteric fistula
• Pancreatic pseudocyst
• Post-sphincterotomy

• Liver disease

• Cirrhosis
• Hepatocellular carcinoma

Diagnosis

• Blood tests, such as a complete blood count (CBC), blood chemistries, blood clotting tests, and liver function tests, are used to assess the condition of the patient.
• Chest radiographs: These images should be ordered to exclude aspiration pneumonia, effusion, and esophageal perforation.
• CT scan and ultrasonography may be indicated to evaluate liver disease with cirrhosis, cholecystitis with hemorrhage, pancreatitis with pseudocyst and hemorrhage, aortoenteric fistula, and other unusual causes of upper gastrointestinal hemorrhage.
• Endoscopy and biopsy: This test can be used to indicate the diseases in esophagus, stomach and duodenum. Also, the doctor can stanch bleeding through the tube. If abnormal areas are noted, tissue samples can be obtained through the endoscope. The tissue samples will be checked by pathologists to identify the cause of bleeding.
• Angiography may be useful if bleeding persists and endoscopy fails to identify a bleeding site. As salvage therapy, embolization of the bleeding vessel can be as successful as emergent surgery in patients who have failed a second attempt of endoscopic therapy.
• Nuclear medicine scans may be useful to determine the area of active hemorrhage.

When to seek urgent medical care?

Call your doctor or go to the emergency room if hematemesis occurs. This condition needs immediate medical evaluation.

Treatment options

Treatment of hematesis depends on the underlying cause. The goal of medical therapy is to correct shock and coagulation abnormalities and to stabilize the patient so that further evaluation and treatment can proceed.

• Stop diet, stabilize the patient with intravenous fluids, and transfuse to maintain a hemoglobin level of 8-10 g/dl, if necessary. Promptly correct any abnormalities in coagulation.
• Intravenous PPIs are the ideal pharmacologic therapy for patients with acute ulcer bleeding and rebleeding.
• Upper endoscopy can be used to treaat the active bleeding sites because it allows visualization of the entire mucosal surface of the esophagus, stomach, and proximal duodenum.
• Surgery or angiographic therapy is needed to patients who seem unstable or bleeding continues after initial resuscitation.

Where to find medical care for Hematemesis?

Directions to Hospitals Treating Hematemesis

Prevention

Treatment of underlying disease is the best way to prevent hematemsis.

What to expect (Outlook/Prognosis)?

The prognosis of hematemesis depends on:

• The underlying cause of hematemsis
• The rate and extent of hemorrhage
• Patient's general status

Sources

• http://www.nlm.nih.gov/medlineplus/ency/article/003118.htm