Hematemesis
Hematemesis refers to the vomiting of blood or material resembling coffee grounds, indicating potential bleeding from the upper gastrointestinal (GI) tract, which encompasses the mouth, esophagus, stomach, and duodenum. This condition can arise from various underlying issues, including esophageal and gastric ulcers, gastritis, esophagitis, and even certain cancers. The incidence of hematemesis is notable, with approximately 48 to 160 cases reported per 100,000 hospitalizations each year. Symptoms may vary in severity, but significant blood loss can lead to low blood pressure and shock, necessitating immediate medical attention.
Diagnosis typically involves endoscopic procedures to locate the source of bleeding and evaluate the patient's condition, alongside blood tests to assess blood loss and liver function. Treatment options include endoscopic interventions, medications to control acid production, and, in severe cases, blood transfusions or surgery. Factors such as age, nutrition, and pre-existing medical conditions can influence prognosis and mortality rates associated with repeated hematemesis. Preventive measures focus on managing related conditions and addressing risk factors, including lifestyle modifications and proper treatment for infections like Helicobacter pylori.
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Subject Terms
Hematemesis
ALSO KNOWN AS: Vomiting of blood
RELATED CONDITIONS: Esophageal, stomach (gastric), pancreatic, and duodenal ulcers, various metastatic tumors, esophagitis; gastritis; esophageal and stomach varices; melena; Mallory-Weiss tears; Dieulafoy’s lesion; blood-clotting problems; cirrhosis; portal hypertension
DEFINITION: Hematemesis is the vomiting of blood or material that resembles coffee grounds from the upper gastrointestinal (UGI) tract, which includes the mouth, part of the throat, the esophagus, the stomach, and the first part of the small intestine (called the duodenum) up to the ligament of Treitz, a tough fibrous-muscle band tissue supporting the duodenum.
Risk factors: Risk factors for hematemesis include prolonged vomiting, bleeding ulcers, Helicobacter pylori infection, nosebleeds, and use of non-steroidal anti-inflammatory drugs, alcohol, and tobacco.
Etiology and the disease process: Hematemesis and melena (black, tarry stools) are common symptoms of upper gastrointestinal bleeding (UGIB). The most common causes of UGIB include esophagitis, gastritis, peptic ulcer disease, esophagogastric varices, arteriovenous malformations (abnormal blood vessels in the digestive tract), Mallory-Weiss tears (lacerations on the lining of the junction of the esophagus and stomach), tumors (cancers), and nonspecific abnormalities of the upper gastrointestinal lining.
Incidence: Approximately 48 to 160 cases of upper gastrointestinal bleeding occur per 100,000 hospitalizations annually; this bleeding causes hematemesis.
Symptoms: Vomiting of blood is the result of upper gastrointestinal bleeding. Although not all cases can cause a major medical problem, it is necessary to seek medical help immediately. If large quantities of blood are lost, the patient could develop low blood pressure, increased heart rate, and shock.
Screening and diagnosis: A flexible tube extending from the nose or mouth to the stomach and into the duodenum will be inserted to remove blood and prevent blood from going into the lungs. Blood tests will include blood clotting factors, liver function tests, and a complete blood count, which evaluates how much blood was lost. Upper endoscopy will be performed to visualize the upper gastrointestinal tract and to treat the bleeding. If endoscopy fails to identify the site of bleeding, other methods such as angiography (radiographic visualization of blood vessels) and radioactive scan of tagged red blood cells can be employed.
Treatment and therapy: Endoscopic treatments to stop bleeding include injection methods with absolute alcohol, salt solution, or epinephrine, or mechanical methods such as applying heat directly and placing hemoclips (metal clips for grasping blood vessels or surrounding tissues). Bipolar electrocoagulation and band ligation are two additional endoscopic techniques that have come into use. A combination of injections followed by mechanical methods is another treatment modality. Contact and non-contact thermal therapy, anti-ulcer medications, and sandostatin injections are also used. If H. pylori infection is present, the bacteria will be eradicated with antimicrobials, proton pump inhibitors, and acid suppressors. Aspirin and nonsteroidal anti-inflammatory drugs will be stopped. If large volumes of blood are lost, emergency measures may include intravenous fluids, blood transfusions, and medications such as proton pump inhibitors and acid suppressors. Consultations will include a gastroenterologist and a surgeon, who may operate if bleeding does not stop.
Prognosis, prevention, and outcomes: Repeated hematemesis due to upper gastrointestinal tract bleeding increases the mortality rate. Associated factors that increase the mortality rate include age, poor nutrition, and other medical problems and blood-clotting disorders. Related medical conditions such as ulcers should be appropriately treated and risk factors addressed for prevention.
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