Hematemesis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: John Fani Srour, M.D.
Synonyms and keywords: Vomiting of blood; haematemesis; blood in the vomit, bloody vomiting
Overview
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: John Fani Srour, M.D.
Overview
Hematemesis or haematemesis is the vomiting of blood. The source is generally the upper gastrointestinal tract (UGI). Patients can easily confuse it with hemoptysis (coughing up blood), although the former is more common. The most common causes of upper GI bleeding include bleeding peptic ulcer disease, gastritis, and variceal bleed. A nasogastric tube lavage that yields blood or coffee-ground like material confirms the diagnosis and predicts whether bleeding is caused by a high-risk lesion. The initial evaluation of the patient with UGI bleeding involves an assessment of hemodynamic stability and resuscitation if necessary. Upper endoscopy usually follows, with the goal of both diagnosis, and in some circumstances, treatment of the specific disorder. Important elements of the history include use of NSAIDs, alcohol, history of liver disease or variceal bleeding, history of ulcers, weight loss, dysphagia, or an abdominal aortic aneurysm (AAA). The latter may indicate aortoenteric fistula. Any recent surgical procedure especially one involving the GI tract is also relevant. Endoscopic, clinical, and laboratory features are useful for risk stratification of patients who present with UGI bleeding. In addition, gastroenterology and surgical consultation are usually required, especially for high risk patients.
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Hematemesis from other Diseases
Hematemesis must be differentiated from hemoptysis.
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications, and Prognosis
Natural History
Complications
Prognosis
Diagnosis
Laboratory Findings
Blood tests, such as a complete blood count (CBC), blood chemistries, blood clotting tests, and liver function tests, are used to assess the condition of the patient.
Chest X Ray
Chest X ray in a patient with hematemesis should be ordered to exclude aspiration pneumonia, effusion, and esophageal perforation.
CT
CT scan may be indicated to evaluate liver disease with cirrhosis, cholecystitis with hemorrhage, pancreatitis with pseudocyst and hemorrhage, aortoenteric fistula, and other unusual causes of upper gastrointestinal hemorrhage.
Other Imaging Findings
Angiography may be useful if bleeding persists and endoscopy fails to identify a bleeding site. As salvage therapy, embolization of the bleeding vessel can be as successful as emergent surgery in patients who have failed a second attempt of endoscopic therapy. Nuclear medicine scans may be useful to determine the area of active hemorrhage.
Other Diagnostic Studies
Endoscopy and biopsy can be used to indicate the diseases in esophagus, stomach and duodenum. Also, bleeding can be stanched through the tube. If abnormal areas are noted, tissue samples can be obtained through the endoscope. The tissue samples will be checked to identify the cause of bleeding.
Treatment
Medical Therapy
Surgery
Surgery or angiographic therapy is needed to patients who seem unstable or bleeding continues after initial resuscitation.
Prevention
References
Historical Perspective
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
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Overview
Historical Perspective
References
Classification
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
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Overview
Classification
References
Pathophysiology
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
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Overview
Pathophysiology
References
Causes
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: John Fani Srour, M.D.
Overview
Causes
Causes by Organ System
| Cardiovascular | Arterial, venous, or other vascular malformations, Idiopathic angiomas, Dieulafoy’s lesion, Angiodysplasia, Aortic Coarctation, Aortoenteric fistula |
| Chemical / poisoning | Caustic ingestion |
| Dermatologic | No underlying causes |
| Drug Side Effect | Abciximab, Alendronate, Aspirin, Clopidogrel , Coumadin, Drotrecogin alfa, Febuxostat, Flurbiprofen, Goserelin, Heparin, Mitomycin, Nonsteroidal antiinflammatory drugs, Oxaprozin, Oxcarbazepine, Potassium chloride, Pramipexole, Quinidine, Quinidine, Sargramostim, Tetracycline, Tetracycline (pill induced esophagitis), Ticlopidine, Theophylline, Zonisamide |
| Ear Nose Throat | No underlying causes |
| Endocrine | No underlying causes |
| Environmental | No underlying causes |
| Gastroenterologic | Portal hypertension, Esophageal varices, Gastric varices, Duodenal varices, Portal hypertensive gastropathy, Acute esophageal necrosis (AEN), Pseudomembranous esophagitis, Watermelon stomach (gastric antral vascular ectasia), Mallory-Weiss tear, Aortoenteric fistula, Carcinoid, Cow’s milk allergy, Dieulafoy’s lesion, Esophageal cancer, Esophageal dilatation, Esophageal melanosis, Esophagitis, Helicobacter pylori, Hemobilia, Hemosuccus pancreaticus, Hereditary hemorrhagic telangiectasia, Heterotopic pancreatic tissue, Intestinal duplication, Parasites, Schistosomiasis |
| Genetic | Duplication cysts, Ehlers-Danlos syndrome, Hereditary hemorrhagic telangiectasia, Osler-Weber-Rendu syndrome, Intestinal duplication |
| Hematologic | Ticlopidine, Clopidogrel, Hemophilia, Drug-induced thrombocytopenia, Von Willebrand disease, Idiopathic thrombocytopenic purpura, Coagulopathy, Disseminated intravascular coagulation, Drotrecogin alfa, Osler-Weber-Rendu syndrome |
| Iatrogenic | Radiation-induced telangiectasia, Traumatic or post-surgical, Mallory-Weiss tear, Foreign body ingestion, pill induced esophagitis, Post-surgical anastamosis
Aortoenteric fistula, Post gastric/duodenal polypectomy, Munchausen syndrome by proxy, Caustic ingestion, Esophageal dilatation, Foreign body ingestion |
| Infectious Disease | Helicobacter pylori, Cytomegalovirus, Herpes simplex virus, Candida albicans, Parasites, Crimean-Congo hemorrhagic fever, Schistosomiasis |
| Musculoskeletal / Ortho | No underlying causes |
| Neurologic | No underlying causes |
| Nutritional / Metabolic | No underlying causes |
| Obstetric/Gynecologic | No underlying causes |
| Oncologic | Leiomyoma, Lipoma, Polyp (hyperplastic, adenomatous, hamartomatous),
Adenocarcinoma, Lymphoma, Kaposi’s sarcoma, Carcinoid, Melanoma, Metastatic tumor, Kasabach-Merritt syndromes, Systemic mastocytosis, Zollinger Ellison syndrome, |
| Opthalmologic | No underlying causes |
| Overdose / Toxicity | No underlying causes |
| Psychiatric | Munchausen syndrome by proxy, Stress-induced ulcer, |
| Pulmonary | No underlying causes |
| Renal / Electrolyte | No underlying causes |
| Rheum / Immune / Allergy | Cow’s milk allergy, Vasculitis |
| Sexual | No underlying causes |
| Trauma | No underlying causes |
| Urologic | No underlying causes |
| Miscellaneous | Heterotopic pancreatic tissue |
Causes in Alphabetical Order
- Abciximab
- Acute esophageal necrosis (AEN)
- Adenocarcinoma
- Alendronate induced esophagitis
- Angiodysplasia
- Angioma
- Aortic Coarctation
- Aortoenteric fistula
- Arterial, venous, or other vascular malformations
- Aspirin induced ulcers or gastritis
- Blue rubber bleb nevus syndrome
- Candida albicans esophagitis
- Carcinoid tumors in the stomach
- Caustic ingestion
- Clopidogrel
- Coagulopathy
- Congenital malformations
- Coumadin
- Cow’s milk allergy is a significant reason for haematemesis in newborns
- Crimean-Congo hemorrhagic fever
- Cytomegalovirus esophagitis
- Dieulafoy’s lesion
- Disseminated intravascular coagulation
- Drotrecogin alfa
- Drug-induced thrombocytopenia
- Duodenal varices
- Duplication cysts
- Ehlers-Danlos syndrome
- Esophageal cancer
- Esophageal dilatation (iatrogenic)
- Esophageal melanosis
- Esophagitis
- Flurbiprofen
- Foreign body ingestion especially in children
- Gastric varices
- Helicobacter pylorirelated gastritis or peptic ulcer disease
- Hemobilia
- Hemophilia
- Hemosuccus pancreaticus
- Heparin
- Hereditary hemorrhagic telangiectasia
- Herpes simplex virus esophagitis
- Heterotopic pancreatic tissue
- Idiopathic
- Idiopathic thrombocytopenic purpura
- Intestinal duplication a cause of haematemesis in children
- Kaposi’s sarcoma
- Kasabach-Merritt syndromes
- Leiomyoma
- Lipoma
- Lymphoma
- Mallory-Weiss syndrome
- Melanoma
- Metastatic tumor to the upper GI tract
- Munchausen syndrome by proxy a reason for recurrent haemtemesis in children
- Nonsteroidal antiinflammatory drugs
- Osler-Weber-Rendu syndrome
- Oxaprozin
- Parasites
- Peptic ulcer disease
- Pill-induced esophagitis
- Polyp (hyperplastic, adenomatous, hamartomatous, etc)
- Portal hypertension
- Portal hypertensive gastropathy
- Post gastric/duodenal polypectomy
- Post-surgical anastamosis
- Potassium chloride induced esophagitis or gastritis
- Pseudomembranous esophagitis
- Quinidine
- Radiation-induced telangiectasia
- Rift valley fever
- Sargramostim
- Schistosomiasis
- Sibutramine
- Stress-induced ulcer
- Systemic mastocytosis
- Tetracycline (pill induced esophagitis)
- Ticlopidine
- Traumatic or post-surgical
- Vasculitis
- Von Willebrand disease
- Watermelon stomach (gastric antral vascular ectasia)
- Zollinger Ellison syndrome ( diffuse upper GI ulcerations)
References
Differentiating Hematemesis from other Diseases
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Please help WikiDoc by adding more content here. It’s easy! Click here to learn about editing.
Overview
Hematemesis must be differentiated from hemoptysis.
Differential Diagnosis
References
Epidemiology and Demographics
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
Please help WikiDoc by adding content here. It’s easy! Click here to learn about editing.
Overview
Epidemiology and Demographics
References
Risk Factors
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
Please help WikiDoc by adding content here. It’s easy! Click here to learn about editing.
Overview
Risk Factors
References
Screening
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
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Overview
Screening
References
Natural History, Complications and Prognosis
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Jinhui Wu, M.D.
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Overview
Natural History
Complications
Prognosis
The prognosis of hematemesis depends on:
- The underlying cause of hematemsis
- The rate and extent of hemorrhage
- Patient’s general status
References
Diagnosis
Diagnosis
History and Symptoms | Physical Examination | Laboratory Findings | CT | MRI | Other Imaging Findings | Other Diagnostic Studies
Treatment
Treatment
Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies
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