Hematemesis or Vomiting of Blood
When blood is present in the vomitus it is called Hematemesis. The color may be red when profuse. Often Black to coffee ground color when less sever – acid degraded due to formation of acid-hematin.
It usually indicated Bleeding proximal to Ligament of Teitz.
It should be differentiated from Malena and Hematochezia which present as blood in stool.
Causes of Hematemesis
- Peptic Ulcer 35-50%
- Gastric erosion 10-20%
- Esophagitis- 10%
- Mallory-Weiss Tear 5%
- Vascular Malformations 5%
- Variceal bleeding 2-4%
- Cancer of Stomach and esophagus 2%
- Aorto-enteric fistula 1%
- IV access
- Initial Assessment- History, examination, Vitals, Comorbidities.
- Blood tests- CBC, KFT,bleeding profiles, Blood grouping and matching
- Resuscitation with Crystalloids, colloids or Blood transfusion
- Monitor Central Venous Pressure.
- Oxygen to all shocked patients
- Endoscopy followed by Electrocautery, Sclerotherapy etc
- Visceral Angiography
- Drug therapy- PPI, H2 blockers, Somatostatin or Octreotide, Vasopressin