Hematemesis

Hematemesis or haematemesis (see American and British spelling differences) is the vomiting of blood. The source is generally the upper gastrointestinal tract. Patients can easily confuse it with hemoptysis (coughing up blood), although the former is more common.

Signs

Signs of the onset of hematemesis may include:

A history of excessive alcohol use or liver disease
Any esophago-gastric symptoms, such as nausea or vomiting
Brown or black vomit
Vomit that looks like coffee grounds
Dark colored, tar like stools (a condition known as melena)

Causes

Causes can be:

Prolonged and vigorous retching (may cause a tear in the small blood vessels of the throat or the esophagus, producing streaks of blood in the vomit, and is called Mallory-Weiss syndrome).
Irritation or erosion of the lining of the esophagus or stomach
Bleeding ulcer located in the stomach, duodenum, or esophagus
Ingested blood (for example, swallowed after a nosebleed)
Vomiting of ingested blood after hemorrhage in the oral cavity, nose or throat
Vascular malfunctions of the gastrointestinal tract
Tumors of the stomach or esophagus
Esophagitis
Gastroenteritis
Gastritis
Mallory-Weiss syndrome (esophageal tear)
Esophageal varices
Peptic ulcer
Gastric varices
Dieulafoy's lesion
Wilson's disease (hepatolenticular degeneration)
Trichophagia
Ebola or Marburg Virus
Yellow Fever

Management

Hematemesis is treated as a medical emergency. The most vital distinction is whether there is blood loss sufficient to cause shock.

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 nil per os(nil by mouth) 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 central venous catheter, 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.