Hematemesis
| Hematemesis | ||
| ICD-10 | K92.0 | |
|---|---|---|
| ICD-9 | 578.0 | |
| DiseasesDB | 30745 | |
| eMedicine | med/3565 | |
| MeSH | C23.550.414.788.400 | |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
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. 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). 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.
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)
Complete Differential Diagnosis of the Causes of hematmesis
(In alphabetical order)
- Abciximab
- 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
(By organ system)
| Cardiovascular | No underlying causes |
| Chemical / poisoning | No underlying causes |
| Dermatologic | No underlying causes |
| Drug Side Effect | No underlying causes |
| Ear Nose Throat | No underlying causes |
| Endocrine | No underlying causes |
| Environmental | No underlying causes |
| Gastroenterologic | No underlying causes |
| Genetic | No underlying causes |
| Hematologic | No underlying causes |
| Iatrogenic | No underlying causes |
| Infectious Disease | No underlying causes |
| Musculoskeletal / Ortho | No underlying causes |
| Neurologic | No underlying causes |
| Nutritional / Metabolic | No underlying causes |
| Obstetric/Gynecologic | No underlying causes |
| Oncologic | No underlying causes |
| Opthalmologic | No underlying causes |
| Overdose / Toxicity | No underlying causes |
| Psychiatric | No underlying causes |
| Pulmonary | No underlying causes |
| Renal / Electrolyte | No underlying causes |
| Rheum / Immune / Allergy | No underlying causes |
| Sexual | No underlying causes |
| Trauma | No underlying causes |
| Urologic | No underlying causes |
| Miscellaneous | No underlying causes |
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 pneumonoultramicroscopic silivolcano coniosis (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.
References
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External links
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