Hematemesis

Hematemesis - Definition, Description, Causes and Risk Factors:HematemesisHematemesis is the vomiting of blood, which may be obviously red or have an appearance similar to coffee grounds.

Hematemesis - Causes and Risk Factors:

Any bleeding from the upper gastrointestinal tract (GI tract) like esophagus, stomach, or intestine can lead to hematemesis.
  • Bleeding peptic ulcer is the most common cause of hematemesis.
  • Disorders of the blood vessels of the gastrointestinal system.
  • Swallowing of coughed up blood or even a nosebleed may be another factor causing hematemesis.
  • Pancreatic ulcer.
  • Dieulafoy's lesion: This is caused by a large stomach arteriole (a small blood vessel that branches out from an artery leading to the smaller capillaries in the blood circulation) that erodes and bleeds. This can lead to a bleed in the stomach but is an uncommon condition.
  • Cancer of the esophagus, stomach or upper intestine (benign and malignant).
  • Acute liver failure and alcoholic hepatitis can lead to hematemesis.
  • Cirrhosis of liver, a chronic condition which causes scarring of the liver cells.
  • Stomach problems like gastritis (inflammation of the stomach) or gastric erosion (defects in the inner lining of the stomach).
  • Esophageal disorders like esophageal varices (enlarged blood vessels around the esophagus) and esophagitis (inflammation of the esophagus).
  • Portal hypertension - a condition characterized by high blood pressure in the portal blood vessels supplying the liver.
  • Excessive use of NSAID's (nonsteroidal anti-inflammatory drugs).
In children hematemesis much more common than adults and may be related to foreign body ingestion. Hemorrhagic disease of the neonate and esophageal erosion may also cause hematemesis and such cases require immediate treatment.Hematemesis is a medical emergency and you should see a doctor immediately. It is important to identify quickly the cause of the bleeding and prevent more severe blood loss or complications. Call the emergency service if hematemesis causes dizziness after standing, rapid shallow breathing or displaying signs of shock (pallor, fast weak pulse, low blood pressure, feeling faint or cold clammy skin).Symptoms:The person may have symptoms of the problem causing hematemesis. For example, if a person has a peptic ulcer there may be complaints like acidity, a feeling of fullness in the abdomen; a person having a malignant tumor may have nausea, loss of weight, malaise and loss of appetite.If a person starts vomiting blood along with symptoms like confusion, nausea, fainting, rapid shallow breathing and cold clammy limbs it is a sign that the patient might be going into shock and needs ICU admission straightaway.Diagnosis:When the patient is brought to the hospital with hematemesis, it is imperative to know the cause so the physician should ask for the medical history. The next step is to check vital signs like pulse, blood pressure and breathing.Necessary lab studies:CBC with platelet count and differential: CBC is necessary to assess the level of blood loss. Where possible, having the patient's previous results is useful to gauge the level of blood loss. CBC should be checked frequently (every four to six hours) during the first day.
  • Basic metabolic profile (BMP): The BMP is useful to evaluate for renal comorbidity; however, blood in the upper intestine can elevate the blood urea nitrogen (BUN) level as well.
  • Measurement of coagulation parameters: This is necessary to assess for continued bleeding. Abnormalities should be corrected rapidly. Prothrombin time/activated partial thromboplastin time.
  • Liver profile: The liver profile can identify hepatic comorbidity and suggest underlying liver disease.
  • Calcium level: A calcium level is useful to identify the patient with hyperparathyroidism as well as to monitor calcium in patients receiving multiple transfusions of citrated blood.
  • Gastrin level: A gastrin level can identify the rare patient with gastrinoma as the cause of UGIB and multiple ulcers.
Other tests:Chest radiographs should be ordered to exclude aspiration pneumonia, effusion, and esophageal perforation; abdominal scout and upright films should be ordered to exclude perforated viscus and ileus.
  • Barium contrast studies are not usually helpful and can make endoscopic procedures more difficult (i.e., white barium obscuring the view) and dangerous (i.e., risk of aspiration).
  • 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.
  • Nuclear medicine scans may be useful to determine the area of active hemorrhage.
  • An ECG should be ordered to exclude arrhythmia and cardiac disease, especially acute myocardial infarction due to hypotension.
  • Performing a troponin test may be useful to identify patients with severe coronary ischemia or atypical myocardial infarction.
Treatment:In a patient has lost a lot of blood, transfusion will be recommended to bolster blood volume. Diagnostic tests can be run to find out why the patient is vomiting blood. With a diagnosis, a doctor can make treatment recommendations which will address the problem in the long term. These recommendations can include surgery, medications, and dietary recommendations. The patient may be kept in the hospital until she or he stops vomiting blood and appears stable.NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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