Hematemesis
540173
219759423
2008-06-16T19:30:21Z
74.160.9.76
/* Causes */ added a cause of hematemesis
{{Infobox_Disease |
Name = Hematemesis |
Image = |
Caption = |
DiseasesDB = 30745 |
ICD10 = {{ICD10|K|92|0|k|92}} |
ICD9 = {{ICD9|578.0}} |
ICDO = |
OMIM = |
MedlinePlus = |
eMedicineSubj = med |
eMedicineTopic = 3565 |
MeshName = Hematemesis |
MeshNumber = C23.550.414.788.400 |
}}
'''Hematemesis''' or '''haematemesis''' (see [[American_and_British_English_spelling_differences#Simplification_of_ae_.28.C3.A6.29_and_oe_.28.C5.93.29|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.
==Signs==
Signs of the onset of hematemesis may include:
* A history of [[alcohol abuse|excessive alcohol use]] or [[liver disease]]
* Any esophogastric symptoms, such as nausea or vomiting
* Brown or black vomit
* Vomit 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 syndrome]]).
* 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]]
* [[Tumor]]s 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]]
* [[Ebola]] or [[Marburg Virus]]
* [[Yellow Fever]]
==Management==
Hematemesis is treated as a [[medical emergency]]. The most vital distinction is whether there is blood loss sufficient to cause [[Shock (medical)|shock]].
===Minimal blood loss===
If this is not the case, the patient is generally administered a [[proton pump inhibitor]] (e.g. [[omeprazole]]), given [[blood transfusion]]s (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]](nil by mouth) until [[endoscopy]] can be arranged. Adequate venous access (large-bore [[cannula]]s 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. [[Surgery|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 (medical)|Shock]]
* [[Melena]]
==External links==
* [http://www.umm.edu/ency/article/003118.htm]
* [http://www.nlm.nih.gov/medlineplus/ency/article/003118.htm NIH/Medline]
[[Category:Symptoms]]
[[Category:Vomiting]]
{{med-sign-stub}}
{{Gastroenterology}}
[[ar:قيء دموي]]
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[[ja:吐血]]
[[pl:Wymioty fusowate]]
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