Hematemesis: Difference between revisions
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* Dark colored, tar like stools (a condition known as [[melena]]) | * Dark colored, tar like stools (a condition known as [[melena]]) | ||
==Complete Differential Diagnosis of the Causes of hematmesis== | |||
(In alphabetical order) | (In alphabetical order) | ||
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*[[Aortic Coarctation]] | *[[Aortic Coarctation]] | ||
*[[Aortoenteric fistula]] | *[[Aortoenteric fistula]] | ||
Arterial, venous, or other vascular malformations | *Arterial, venous, or other vascular malformations | ||
*[[Aspirin]] | *[[Aspirin]] | ||
*[[Blue rubber bleb nevus syndrome]] | *[[Blue rubber bleb nevus syndrome]] | ||
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==Management== | ==Management== | ||
Individuals who are at low risk for recurrent or life-threatening hemorrhage may be suitable for early hospital discharge or even outpatient care. All patients with hemodynamic instability or active bleeding should be admitted to an intensive care unit for resuscitation and close observation. Two large caliber peripheral catheters or a central venous line should be inserted for intravenous access. Gastroenterological consultation should be obtained. A surgical consultation can be obtained in high-risk patients. These patients should also receive packed red blood cell transfusions to maintain the hematocrit above 30 percent. In general, patients with upper GI bleeding ( high and low risk) should be treated with an intravenous PPI at presentation until confirmation of the cause of bleeding, after which the need for specific therapy can be determined. Patients known to have cirrhosis who present with upper GI bleeding receive antibiotics, preferably before endoscopy, as bacterial infections are present in up to 20 percent of these patients. Somatostatin may also reduce the risk of bleeding due to variceal and nonvariceal causes. | |||
In | |||
==References== | ==References== | ||
Revision as of 21:51, 28 January 2009
| Hematemesis | ||
| ICD-10 | K92.0 | |
|---|---|---|
| ICD-9 | 578.0 | |
| DiseasesDB | 30745 | |
| eMedicine | med/3565 | |
| MeSH | C23.550.414.788.400 | |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editor-In-Chief: John Fani Srour, M.D.
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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. 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). 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 for high risk patients.
Signs
Signs of the onset of hematemesis may include:
- A history of excessive alcohol use or liver disease
- Any esophogastric symptoms, such as nausea or vomiting
- Brown or black blood
- Blood that looks like coffee grounds
- Dark colored, tar like stools (a condition known as melena)
Complete Differential Diagnosis of the Causes of hematmesis
(In alphabetical order)
- Abciximab
- Acute esophageal necrosis (AEN)
- Adenocarcinoma
- Alendronate
- Angiodysplasia
- Angiomas
- Aortic Coarctation
- Aortoenteric fistula
- Arterial, venous, or other vascular malformations
- Aspirin
- Blue rubber bleb nevus syndrome
- Candida albicans
- Carcinoid
- Caustic ingestion
- Clopidogrel
- Coagulopathy
- Congenital malformations
- Coumarin
- Cow's milk allergy
- Crimean-Congo hemorrhagic fever
- Cytomegalovirus
- Dieulafoy's lesion
- Disseminated intravascular coagulation
- Drotrecogin alfa
- Drug-induced thrombocytopenia
- Duodenal varices
- Duplication cysts
- Ehlers-Danlos syndrome
- Esophageal cancer
- Esophageal dilatation
- Esophageal melanosis
- Esophagitis
- Foreign body ingestion
- Gastric varices
- Helicobacter pylori
- Hemobilia
- Hemophilia
- Hemosuccus pancreaticus
- Hereditary hemorrhagic telangiectasia
- Herpes simplex virus
- Heterotopic pancreatic tissue
- Idiopathic
- Idiopathic thrombocytopenic purpura
- Intestinal duplication
- Kaposi's sarcoma
- Kasabach-Merritt syndromes
- Leiomyoma
- Lipoma
- Lymphoma
- Mallory-Weiss syndrome
- Melanoma
- Melanoma
- Metastatic tumor
- Munchausen syndrome by proxy
- Nonsteroidal antiinflammatory drugs
- Osler-Weber-Rendu syndrome
- Parasites
- Peptic ulcer disease
- Pill-induced
- Polyp (hyperplastic, adenomatous, hamartomatous)
- Portal hypertension
- Portal hypertensive gastropathy
- Post gastric/duodenal polypectomy
- Post-surgical anastamosis
- Potassium chloride
- Pseudomembranous esophagitis
- Quinidine
- Radiation-induced telangiectasia
- Rift valley fever
- Schistosomiasis
- Sibutramine
- Stress-induced ulcer
- Systemic mastocytosis
- Tetracycline
- Ticlopidine
- Traumatic or post-surgical
- Vasculitis,
- Von Willebrand disease
- Watermelon stomach (gastric antral vascular ectasia)
- Zollinger Ellison syndrome
Complete Differential Diagnosis of the Causes of hematmesis
(By organ system)
| Cardiovascular | No underlying causes |
| Chemical / poisoning | No underlying causes |
| Dermatologic | No underlying causes |
| Drug Side Effect | No underlying causes |
| Ear Nose Throat | No underlying causes |
| Endocrine | No underlying causes |
| Environmental | No underlying causes |
| Gastroenterologic | No underlying causes |
| Genetic | No underlying causes |
| Hematologic | No underlying causes |
| Iatrogenic | No underlying causes |
| Infectious Disease | No underlying causes |
| Musculoskeletal / Ortho | No underlying causes |
| Neurologic | No underlying causes |
| Nutritional / Metabolic | No underlying causes |
| Obstetric/Gynecologic | No underlying causes |
| Oncologic | No underlying causes |
| Opthalmologic | No underlying causes |
| Overdose / Toxicity | No underlying causes |
| Psychiatric | No underlying causes |
| Pulmonary | No underlying causes |
| Renal / Electrolyte | No underlying causes |
| Rheum / Immune / Allergy | No underlying causes |
| Sexual | No underlying causes |
| Trauma | No underlying causes |
| Urologic | No underlying causes |
| Miscellaneous | No underlying causes |
Management
Individuals who are at low risk for recurrent or life-threatening hemorrhage may be suitable for early hospital discharge or even outpatient care. All patients with hemodynamic instability or active bleeding should be admitted to an intensive care unit for resuscitation and close observation. Two large caliber peripheral catheters or a central venous line should be inserted for intravenous access. Gastroenterological consultation should be obtained. A surgical consultation can be obtained in high-risk patients. These patients should also receive packed red blood cell transfusions to maintain the hematocrit above 30 percent. In general, patients with upper GI bleeding ( high and low risk) should be treated with an intravenous PPI at presentation until confirmation of the cause of bleeding, after which the need for specific therapy can be determined. Patients known to have cirrhosis who present with upper GI bleeding receive antibiotics, preferably before endoscopy, as bacterial infections are present in up to 20 percent of these patients. Somatostatin may also reduce the risk of bleeding due to variceal and nonvariceal causes.
References
See also
External links
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