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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Overview

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.

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.

See also

• Upper gastrointestinal bleeding
• Shock
• Melena

External links

• [3]
• NIH/Medline

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