Hematemesis

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Hematemesis Classification & external resources
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ICD-10	K92.0}}
ICD-9	578.0}}
ICD-O:	}}
OMIM	[1] }}
DiseasesDB	30745 }}
MedlinePlus	[2] }}
eMedicine	search | topic list | med/3565 }} }}
MeSH	{{{MeshID}}} }}
MeSH	C23.550.414.788.400}}

Hematemesis or haematemesis (see American and British spelling differences) 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.

Contents 1 Signs 2 Causes 3 Management 3.1 Minimal blood loss 3.2 Significant blood loss 4 See also 5 External links

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)

Causes

Causes can be:

• Prolonged and vigorous retching (may cause a tear in the small blood vessels of the throat or the esophagus, producing streaks of blood in the vomit, and is called Mallory-Weiss bleeding).
• Irritation or erosion of the lining of the esophagus or stomach
• Bleeding ulcer located in the stomach, duodenum, or esophagus
• Ingested blood (for example, swallowed after a nosebleed)
• Vomiting of ingested blood after hemorrhage in the oral cavity, nose or throat
• Vascular malfunctions of the gastrointestinal tract
• Tumors of the stomach or esophagus
• Esophagitis
• Gastroenteritis
• Gastritis
• Mallory-Weiss syndrome (esophageal tear)
• Esophageal varices
• Peptic ulcer
• Gastric varices
• Dieulafoy's lesion
• Wilson's disease (hepatolenticular degeneration)
• Trichophagia

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 pneumonoultramicroscopicsilivolcanoconiosis (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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duodenum|}}}}{{#if:Inguinal (Indirect, Direct) - Femoral - Umbilical - Incisional - Diaphragmatic - Hiatus|{{#if:Hernia|}}}}{{#if:IBD (Crohn's, Ulcerative colitis) - noninfective gastroenteritis|{{#if:Noninfective enteritis and colitis|}}}}{{#if:vascular (Abdominal angina, Mesenteric ischemia, Ischemic colitis, Angiodysplasia) - Ileus/Bowel obstruction (Intussusception, Volvulus) - Diverticulitis/Diverticulosis - IBS
other functional intestinal disorders (Constipation, Diarrhea, Megacolon/Toxic megacolon, Proctalgia fugax) - Anal fissure/Anal fistula - Anal abscess - Rectal prolapse - Proctitis (Radiation proctitis)|{{#if:Other intestinal|}}}}{{#if:Alcoholic liver disease - Liver failure (Acute liver failure) - Cirrhosis - PBC - NASH - Fatty liver - Peliosis hepatis - Portal hypertension - Hepatorenal syndrome|{{#if:Liver/hepatitis|}}}}{{#if:Gallbladder (Gallstones, Choledocholithiasis, Cholecystitis, Cholesterolosis, Rokitansky-Aschoff sinuses)

Biliary tree (Cholangitis, Cholestasis/Mirizzi's syndrome, PSC, Biliary fistula, Ascending cholangitis)

Pancreas (Acute pancreatitis, Chronic pancreatitis, Pancreatic pseudocyst, Hereditary pancreatitis)|{{#if:Accessory digestive|}}}}{{#if:Appendicitis - Peritonitis (Spontaneous bacterial peritonitis) Malabsorption (celiac, Tropical sprue, Blind loop syndrome, Whipple's) postprocedural:Gastric dumping syndrome - Postcholecystectomy syndromebleeding:Hematemesis - Melena - Gastrointestinal bleeding (Upper, Lower)|{{#if:Other/general|}}}}{{#if:See also congenital|{{#if:|}}}}{{#if:|{{#if:|}}}}{{#if:|{{#if:|}}}}{{#if:|{{#if:|}}}}{{#if:|{{#if:|}}}}{{#if:|{{#if:|}}}}{{#if:|{{#if:|}}}}{{#if:|{{#if:|}}}}{{#if:|{{#if:|}}}}{{#if:|{{#if:|}}}}{{#if:|{{#if:|}}}}{{#if:|{{#if:|}}}}{{#if:|}}

{{#ifeq:|plain||{{#if:| | }}{{#ifeq:1|1||This box: }}{{#ifeq:|1|{{#if:|view|v}}|{{#if:1|v|view}} • {{#if:1|d|talk}} • {{#if:1|e|edit}}}}{{#if:|</span> | }} }} Digestive system - Gastroenterology (primarily K20-K93, 530-579)
	Esophagus	Esophagitis - GERD - Achalasia - Boerhaave syndrome - Nutcracker esophagus - Zenker's diverticulum - Mallory-Weiss syndrome - Barrett's esophagus
Stomach/ duodenum	Peptic (gastric/duodenal) ulcer - Gastritis - Gastroenteritis - Duodenitis - Dyspepsia - Pyloric stenosis - Achlorhydria - Gastroparesis - Gastroptosis - Portal hypertensive gastropathy
Hernia	Inguinal (Indirect, Direct) - Femoral - Umbilical - Incisional - Diaphragmatic - Hiatus
Noninfective enteritis and colitis	IBD (Crohn's, Ulcerative colitis) - noninfective gastroenteritis
Other intestinal	vascular (Abdominal angina, Mesenteric ischemia, Ischemic colitis, Angiodysplasia) - Ileus/Bowel obstruction (Intussusception, Volvulus) - Diverticulitis/Diverticulosis - IBS other functional intestinal disorders (Constipation, Diarrhea, Megacolon/Toxic megacolon, Proctalgia fugax) - Anal fissure/Anal fistula - Anal abscess - Rectal prolapse - Proctitis (Radiation proctitis)
Liver/hepatitis	Alcoholic liver disease - Liver failure (Acute liver failure) - Cirrhosis - PBC - NASH - Fatty liver - Peliosis hepatis - Portal hypertension - Hepatorenal syndrome
Accessory digestive	Gallbladder (Gallstones, Choledocholithiasis, Cholecystitis, Cholesterolosis, Rokitansky-Aschoff sinuses) Biliary tree (Cholangitis, Cholestasis/Mirizzi's syndrome, PSC, Biliary fistula, Ascending cholangitis) Pancreas (Acute pancreatitis, Chronic pancreatitis, Pancreatic pseudocyst, Hereditary pancreatitis)
Other/general	Appendicitis - Peritonitis (Spontaneous bacterial peritonitis) Malabsorption (celiac, Tropical sprue, Blind loop syndrome, Whipple's) postprocedural: Gastric dumping syndrome - Postcholecystectomy syndrome bleeding: Hematemesis - Melena - Gastrointestinal bleeding (Upper, Lower)
	See also congenital

]]

ar:قيء دموي de:Hämatemesis es:Hematemesis fr:Hématémèse ja:吐血 pl:Wymioty fusowate pt:Hematemese