<!--Definition, Mechanism, Differential Diagnosis-->
Hematemesis is the vomiting of blood. It can be confused with hemoptysis (coughing up blood) or epistaxis (nosebleed), which are more common. The source is generally the upper gastrointestinal tract, typically above the suspensory muscle of duodenum. It may be caused by ulcers, tumors of the stomach or esophagus, varices, prolonged and vigorous retching, gastroenteritis, ingested blood (from bleeding in the mouth, nose, or throat), or certain drugs. However, this is not found in stomach viruses (norovirus, rotovirus, etc.)
<!--Diagnosis and Management-->
Hematemesis is treated as a medical emergency, with treatments based on the amount of blood loss. Investigations include endoscopy. Any blood loss may be corrected with intravenous fluids and blood transfusions. Patients may need to avoid taking anything by mouth.
Definition
Hematemesis is the vomiting of blood. This is usually vomit that contains bright red blood. Coffee ground vomiting is similar to hematemesis, but is distinct in not involving bright red blood.
Hematemesis must be differentiated from hemoptysis (coughing up blood) and epistaxis (nosebleed). Both of these are more common conditions. These may be difficult to distinguish.
Differential diagnosis
Hematemesis may be caused by:
- Peptic ulcer. This is caused by the parasite Schistosoma mansoni.
- Certain drugs.
Evaluation
Hematemesis may be investigated with endoscopy of the upper gastrointestinal tract. Barium meal may also be used. The most vital distinction is whether there is blood loss sufficient to cause shock. Correct management is required in such conditions. It is required to perform all tests such as endoscopy before medication. A platelet test is also an important test in such conditions. Medicines such as painkillers or antibiotics, e.g. ciprofloxacin, could decrease platelet count which can lead to thrombocytopenia (when the body does not have sufficient platelets in the blood and cannot form clots). In such conditions wrong medication or management could be deadly. Blood transfusion is required in such conditions if the body loses more than 20 percent of body blood volume. Severe loss makes it impossible for the heart to pump a sufficient amount of blood to the body. In such conditions unmaintained blood volume could lead to hypovolemic shock (hypovolemic shock could lead to damage of body organs e.g. kidney, brain, or gangrene of arms or legs). An untreated patient could develop cerebral atrophy.
Minimal blood loss
In cases that do not involve shock, treatment may involve proton pump inhibitors (such as omeprazole) to treat stomach ulcers if they are present. Intravenous fluids and blood transfusions can be given, preferably by large-bore intravenous cannula. The patient is prepared for emergency endoscopy, which is typically done in a operating theatre. Surgical opinion is usually sought in case the source of bleeding cannot be identified endoscopically, and laparotomy is necessary. Securing the airway is a top priority in hematemesis patients, especially those with a disturbed conscious level (hepatic encephalopathy in esophageal varices patient). This may be achieved with a cuffed endotracheal tube. Octreotide may be used if bleeding may be caused by varices.