|Classification and external resources|
Hematemesis or haematemesis is the vomiting of blood. The source is generally the upper gastrointestinal tract, typically above the suspensory muscle of duodenum. Patients can easily confuse it with hemoptysis (coughing up blood), although the latter is more common. Hematemesis "is always an important sign".
Causes can be:
- Mallory-Weiss syndrome: bleeding tears in the esophagal mucosa, usually caused by prolonged and vigorous retching.
- Irritation or erosion of the lining of the esophagus or stomach
- Vomiting of ingested blood after hemorrhage in the oral cavity, nose or throat
- Vascular malfunctions of the gastrointestinal tract, such as bleeding gastric varices or intestinal varices
- Tumors of the stomach or esophagus.
- Radiation poisoning
- Viral hemorrhagic fevers
- Peptic ulcer
- Chronic viral hepatitis
- Intestinal schistosomiasis (caused by the parasite Schistosoma mansoni)
- History of smoking
- Iatrogenic injury (invasive procedure such as endoscopy or transesophageal echocardiography)
- Zollinger–Ellison syndrome (severe peptic ulcer)
- Atrio-oesophageal fistula
- Yellow fever
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 NPO, which stands for "nil per os" (Latin for "nothing by mouth", or no eating or drinking) until endoscopy 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 large bore intravenous cannula, 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. Securing the airway is a top priority in hematemesis patients, especially those with a disturbed conscious level (hepatic encephalopathy in esophageal varices patient.) A cuffed endotracheal tube could be a life saving choice.