Haematemesis
Medical Emergency - Haematemesis is an emergency. The key point is whether there is blood loss sufficient to cause shock.
Definition
Throwing up blood. Not a good sign.
Epidemiology
Urgent, but not really that common. Often haemoptysis is mistaken for it.
Pathophysiology
Generally caused by something in the upper digestive tract bleeding.
Clinical and Associated Features
The obvious one is vomiting up blood.
Accompanying this can be other GI symptoms such as nausea and vomiting. Blood in stool can happen too, with dark, tar like stools that smell awful.
Vomit that looks like coffee grounds, when you have, in fact, not swallowed coffee grounds, is a specific type of haematemesis. It shows the blood has been exposed to stomach acid, and turned brown. More dangerous and acute bleeding is more likely to be bright red.
Differential Diagnosis
Medical Emergency - All the below are either emergencies, or pretty urgent. Most need dealing with immediately to prevent shock!
The commonest cause of admission for haematemesis is use of NSAIDs, causing a bleeding stomach ulcer.
Other causes:
- Peptic ulcer disease
- Oesophageal varices - caused by portal hypertension, from liver problems or alcohol abuse.
- Mallory-Weiss tear - oesophageal tears caused by vomiting, often seen in those with eating disorders.
- Malignancy - of the stomach or the oesophagus.
- Coagulation/bleeding disorders.
- Gastritis
Management
Loads of blood lost
- If the patient has lost a couple of pints of blood, they are at risk of hypovolaemic shock. You need to deal with that with ABC, oxygen and fluid replacement.
- You then book them in for an emergency endoscopy and theatre.
Not much blood lost
- Do an OGD.
- Give 'em a proton pump inhibitor.
- Maybe a blood transfusion if the Haemoglobin is below 8g/dL.
- Deal with whatever the problem is.