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Urgent, but not really that common. Often haemoptysis is mistaken for it.
Generally caused by something in the upper digestive tract bleeding.
Clinical and Associated Features
The obvious one is vomiting up blood.
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 DiagnosisMedical Emergency - All the below are either emergencies, or pretty urgent. Most need dealing with immediately to prevent shock!
- 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.
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.