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).
- 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.
- 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.
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