Hematemesis:

 Vomiting blood, or hematemesis, is the regurgitation of stomach contents mixed with blood, or the regurgitation of blood only. Vomiting blood can be a concerning, but in some cases, minor causes may trigger it. This includes swallowing blood from a mouth injury or a nosebleed..



Causes can be:


Several symptoms may be present along with vomiting blood. These symptoms include, but are not limited to:

Vomiting blood can indicate a serious medical emergency. Call 911 if you experience any of these symptoms:

How is the cause of hematemesis diagnosed?

Your healthcare provider will ask about your symptoms. Tell him when the vomiting started and how long it lasted. Describe the amount of blood you vomited, and if it was bright red or looked like coffee grounds. Tell him about any recent illness you had, or if you have a chronic medical condition. Tell him if you recently took NSAIDs or aspirin, and how much you took. He may also ask if you drink alcohol regularly.

  • Blood tests may be used to check your oxygen and iron levels. The tests can also show how well your blood clots.
  • Endoscopy is a procedure used to examine your upper GI. Your healthcare provider will use a scope (thin, bendable tube with a light on the end). He will move the scope down your throat and into your stomach. He may also take a tissue sample to be tested.
  • A bowel movement sample may be tested for blood.
  • CT or x-ray pictures may show the source of the bleeding. The pictures may show a tear, obstruction, or tumor that is causing you to vomit blood.

Mahagement:

Hematemesis is treated as a medical emergency. The most vital distinction is whether there is blood loss sufficient to cause shock. Correct management is required in such conditions. It is required to perform all tests such as endoscopy before medication. A platelet test is also an important test in such conditions. Medicines such as painkillers or antibiotics eg. ciprofloxacin, could decrease platelet count which can lead to thrombocytopenia (when the body does not have sufficient platelets in the blood and cannot form clots). In such conditions wrong medication or management could be deadly. Blood transfusion is required in such conditions if the body loses more than 20 percent of body blood volume. Severe loss makes it impossible for the heart to pump a sufficient amount of blood to the body. In such conditions unmaintained blood volume could lead to Hypovolemic Shock (hypovolemic shock could lead to damage of body organs eg. kidney, brain, or gangrene of arms or legs). Note that an untreated patient could suffer cerebral atrophy

Minimal blood loss

In cases that do not involve shock, 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 NPO, which stands for "nil per os" (Latin for "nothing by mouth", or no eating or drinking) 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.[citation needed] Fluids and/or blood is administered, preferably by large bore intravenous cannula, 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. Securing the airway is a top priority in hematemesis patients, especially those with a disturbed conscious level (hepatic encephalopathy in esophageal varices patient.) A cuffed endotracheal tube could be a life saving choice.

Techniques

Hematemesis, melena, and hematochezia are symptoms of acute gastrointestinal bleeding. Bleeding that brings the patient to the physician is a potential emergency and must be considered as such until its seriousness can be evaluated. The goals in managing a major acute gastrointestinal hemorrhage are to treat hypovolemia by restoring the blood volume to normal, to make a diagnosis of the bleeding site and its underlying cause, and to treat the cause of the bleeding as definitively as possible. 


The history should be directed toward 

(1) confirming the presence of bleeding; 

(2) estimating its amount and rapidity; 

(3) identifying the source and potential specific causes; and 

(4) eliciting the presence of serious associated diseases that might adversely affect the outcome. 


The information obtained is especially helpful in identifying situations that require aggressive management.


Choking, or aspiration, is one of the main complications of vomiting blood. This can lead to blood collecting in the lungs, impairing your ability to breathe properly. Aspiration of blood in the vomit, although rare, can be life-threatening if not treated immediately.

People who are at risk for aspiration of stomach contents include:

  • older adults
  • people with a history of alcohol misuse
  • people with a history of stroke
  • people with a history of disorders affecting their ability to swallow

Depending on the cause, vomiting blood may cause additional health complications.

Anemia is another complication of excessive bleeding. It’s a deficiency of healthy red blood cells. It occurs particularly when the blood loss is rapid and sudden.

However, people with conditions that progress slowly, such as gastritis, or people with chronic NSAID use may develop anemia over several weeks to months. In this case, anemia may remain without symptoms until their hemoglobin, or blood count, is very low.

Vomiting blood caused by excessive bleeding can also lead to shock. The following symptoms are indicators of shock:

  • dizziness upon standing
  • rapid, shallow breathing
  • low urine output
  • cold, pale skin

If not treated immediately, shock can lead to a decrease in blood pressure followed by coma and death. If you experience any symptoms of shock, have someone take you to the

Depending on the amount of blood lost, you may need a blood transfusion. A blood transfusion replaces your lost blood with donor blood. The blood is fed into your vein through an IV line.

You might also require fluid to be given through an IV to rehydrate your body. Your doctor may prescribe medication to stop the vomiting or to decrease stomach acid. If you have an ulcer, your doctor will prescribe medications to treat it.

In certain more severe cases of upper GI bleeding, your doctor may refer you to a gastroenterologist.

The gastroenterologist may perform an upper endoscopy to not only diagnose but also treat the source of the bleeding. In severe cases, such as stomach or bowel perforation, surgery may be needed. Severe cases may also include a bleeding ulcer or internal injuries.

Some foods and beverages increase the likelihood of vomiting blood. These include but are not limited to highly acidic foods and alcoholic beverages. If you regularly consume these foods or beverages, your doctor can help you create a special diet to decrease this risk.


Hematemesis is the vomiting of blood, which may be obviously red or have an appearance similar to coffee grounds. Melena is the passage of black, tarry stools. Hematochezia is the passage of fresh blood per anus, usually in or with stools.