There can be many causes of hematemesis, such as: bleeding ulcers. prolonged and vigorous retching that causes tears in the esophageal mucosa (known as Mallory-Weiss Syndrome) gastric or intestinal varices.Haematemesis is simply defined as “vomiting blood”. It is caused by bleeding from part of the upper portion of the gastrointestinal tract. It has a wide range of possible causes, depending on the site of blood loss and the tissue that is actively bleeding. Hence it is necessary to analyse and treat the condition perfectly , this is brief study about all the aspects hematemesis ,vomiting of blood including etiology, definition,management ,treatment by drugs etc
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2. Vomiting blood (hematemesis) refers to
significant amounts of blood in your vomit.
Small streaks or flecks of blood in material
you spit up may come from the teeth,
mouth or throat and isn't usually
considered vomiting blood. Blood in vomit
may be bright red, or it may appear black
or dark brown like coffee grounds.
DEFINITION
3. Vomiting blood, or hematemesis, is the regurgitation of stomach contents mixed
with blood, or the regurgitation of blood only. Vomiting blood can be a
concerning, but in some cases, minor causes may trigger it. This includes
swallowing blood from a mouth injury or a nosebleed.
These minor situations will likely not cause any long-term harm. Vomiting blood
may also be caused by more serious conditions such as internal injuries, organ
bleeding, or organ rupture.
Regurgitated blood may appear brown, dark red, or bright red in color. Brown
blood often resembles coffee grounds when vomited. The color of vomited blood
can often indicate to your doctor the source and severity of the bleeding.
INTRODUCTION
4. For example, darker blood generally indicates that the bleeding is coming from
an upper gastrointestinal source, such as the stomach. Darker blood usually
represents a less brisk and steady source of bleeding.
Bright red blood, on the other hand, often indicates an acute bleeding episode
coming from the esophagus or stomach. It may represent a fast-bleeding
source.
The color of the blood in the vomit may not always indicate the source and
severity of the bleeding but should always prompt your doctor to investigate.
If you vomit a large amount of blood, typically 500 cc or the size of a small cup,
or if you vomit blood in conjunction with dizziness or changes in breathing,
INTRODUCTION (CONT..)
5. Vomiting blood may be caused by minor conditions such as:
esophagus irritation
nosebleeds
swallowing blood
tear in the esophagus due to chronic coughing or vomiting
swallowing a foreign object
ETIOLOGY
6. Other common causes of vomiting blood include:
stomach ulcers
aspirin side effects
gastritis, or stomach inflammation
no steroidal anti-inflammatory drug side effects
pancreatitis
ETIOLOGY(CONT…)
7. More serious causes of vomiting blood include:
cirrhosis
esophageal cancer
erosion of the stomach lining
pancreatic cancer
ETIOLOGY(CONT…)
8. Other causes of vomiting blood
Esophageal Varices
Hereditary Telangiectasia
Mallory-Weiss Tear
Tumor
ETIOLOGY(CONT…)
9. In infants and young children, vomiting blood may also result
from:
Birth defects
Blood-clotting disorders
Milk allergy
Swallowed blood, such as from the nose
Swallowed object
Vitamin K deficiency
ETIOLOGY(CONT…)
10. Less common causes of blood in vomit
Less commonly, vomit in the blood may be a result of:
Swallowing poisons such as corrosive acid or arsenic – read more
about poisoning.
A blood disease such as thrombocytopenia, leukemia, hemophilia or
anemia
Cancer of the esophagus or stomach cancer. Your doctor may
suspect cancer if you are over 55 and have also lost a lot of weight
(it is otherwise rare).
ETIOLOGY(CONT…)
11. Symptoms that accompany vomiting blood
Several symptoms may be present along with vomiting blood. These
symptoms include, but are not limited to:
nausea
abdominal discomfort
abdominal pain
vomiting stomach contents
12. Vomiting blood can indicate a serious medical emergency.
dizziness
blurred vision
rapid heartbeat
changes in breathing
cold or clammy skin
confusion
fainting
severe abdominal pain
vomiting blood after an injury
13. Imaging scans reveal abnormalities in the body
such as ruptured organs or abnormal growths.
Common imaging tests used for these purposes
are:
CT scan
endoscopy, a device that allows your doctor to
look in your stomach
ultrasound
X-ray
MRI
DIAGNOSIS
14. DIAGNOSIS (CONT…)
A biopsy may also be performed to determine if the source of
bleeding represents an inflammatory, infectious, or cancerous
source
15. Complications of vomiting blood
Choking, or aspiration, is one of the main complications of vomiting
blood. This can lead to blood collecting in the lungs, impairing your
ability to breathe properly. Aspiration of blood in the vomit, although
rare, can be life-threatening if not treated immediately.
People who are at risk for aspiration of stomach contents include:
older adults
people with a history of alcohol misuse
people with a history of stroke
people with a history of disorders affecting their ability to swallow
16. Depending on the cause, vomiting blood may cause additional health
complications.
Anemia is another complication of excessive bleeding. It’s a deficiency of healthy
red blood cells. It occurs particularly when the blood loss is rapid and sudden.
However, people with conditions that progress slowly, such as gastritis, or people
with chronic NSAID use may develop anemia over several weeks to months. In
this case, anemia may remain without symptoms until their hemoglobin, or blood
count, is very low.
Complications of vomiting blood(CONT…)
17. Vomiting blood caused by excessive bleeding can also lead to shock.
The following symptoms are indicators of shock:
dizziness upon standing
rapid, shallow breathing
low urine output
cold, pale skin
If not treated immediately, shock can lead to a decrease in blood
pressure followed by coma and death.
18. How is vomiting blood treated?
Depending on the amount of blood lost,
you may need a blood transfusion. A blood
transfusion replaces your lost blood with
donor blood. The blood is fed into your
vein through an IV line.
also require fluid to be given through an IV
to rehydrate your body.
19. The gastroenterologist may perform an upper endoscopy to not only
diagnose but also treat the source of the bleeding. In severe cases,
such as stomach or bowel perforation, surgery may be needed. Severe
cases may also include a bleeding ulcer or internal injuries.
Some foods and beverages increase the likelihood of vomiting blood.
These include but are not limited to highly acidic foods and alcoholic
beverages. If you regularly consume these foods or beverages, your
doctor can help you create a special diet to decrease this risk.
How is vomiting blood treated?(CONT…)
20. Certain medications and surgery can usually treat hematemesis.
In severe cases of hematemesis where the blood flow is heavy, an
individual might need a drip or a blood transfusion. In life-threatening
instances, they might require emergency resuscitation and fluid or
blood replacement
Treating hematemesis depends on the cause of the condition. Many
techniques for stopping internal bleeding involve passing instruments
down an endoscope and sealing an internal wound.
How is vomiting blood treated?(CONT…)
21. Management
Patients with haematemesis can be extremely unstable. The first
step in their management is a rapid ABCDE assessment, to insert two
large bore IV cannulas, start fluid resuscitation if needed, and
crossmatch blood.
Most cases will warrant an upper GI endoscopy (OGD), from which a
range of therapeutic options are available depending on the
underlying causes suspected or confirmed:
22. Esophageal varices –management should be swift and performed at
the same time as active resuscitation, including the use of blood
products and propylactic antibiotics
Endoscopic banding is the most definitive method of management*
however can be technically difficult
Peptic ulcer disease
requires injections of adrenaline and cauterization of the bleeding.
High dose intravenous PPI therapy should be administered (e.g. IV
40mg omeprazole) to reduce acid secretion +/- H. Pylori eradication
therapy if necessary
Management - PHARMACOLOGICAL
23. Long term management warrants repeated banding of the varices
and long-term beta-blocker therapy
An actively bleeding patient can also be treated with angio-
embolisation, in which the bleeding vessel is embolised. This is most
commonly the gastro-duodenal artery which is eroded into by an
ulcer at the back of the first part of the duodenum.
Somatostatin analogues (e.g. octreotide) or vasopressors (e.g.
terlipressin) should also be started, acting to reduce splanchnic
blood flow and hence reduce bleeding