Hematemesis (American English) or haematemesis (International English) is the vomiting of fresh red 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.

Causes

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Causes can be:

• Vomiting of ingested blood after hemorrhage in the oral cavity, nose or throat
• Mallory-Weiss syndrome (esophageal tear)
• Esophageal varices
• Peptic ulcer
• Gastritis
• Gastric varices
• Dieulafoy's lesion

Management

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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 mg/dL or 4.5-5.0 mmol/L), and kept nil per os until esophagogastroduodenoscopy (EGD, 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 adminstered, 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.

See also

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• Upper gastrointestinal bleeding
• Shock

External links

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• NIH/Medline

Symptoms | Vomiting

Hämatemesis | Hematemesis