Hematemesis
From Freepedia
Hematemesis (American English) or haematemesis (International English) is the vomiting of fresh red blood. The source is generally the upper gastrointestinal tract. Patients can easily confuse it with hemoptysis (coughing up blood), although the reverse is more common.
Causes
Causes can be:
- Vomiting of ingested blood after hemorrhage in the oral cavity, nose or throat
- Mallory-Weiss syndrome (esophageal tear)
- Esophageal varices
- Peptic ulcer
- Gastritis
- Gastric varices
Management
Hematemesis is treated as a medical emergency. The most vital distinction is whether there is blood loss sufficient to cause shock. 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 found to be low), and kept nil per os until esophagogastroduodenoscopy (EGD, endoscopy) can be arranged. Adequate venous access (large-bore cannulas or a central line) is generally obtained in case the patient suffers a further bleed and becomes unstable.
In a "hemodynamically significant" case of hematemesis resuscitation is an immediate priority to prevent cardiac arrest. Fluids and/or blood is adminstered, 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
