| Hematemesis | |
|---|---|
| Classification and external resources | |
| ICD-10 | K92.0 |
| ICD-9 | 578.0 |
| DiseasesDB | 30745 |
| eMedicine | med/3565 |
| MeSH | C23.550.414.788.400 |
Hematemesis or haematemesis 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 latter is more common.
Contents |
Causes can be:
Hematemesis is treated as a medical emergency. The most vital distinction is whether there is blood loss sufficient to cause shock.
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 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.
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. Securing the airway is a top priority in hematemesis patients, especially those with a disturbed conscious level (hepatic encephalopathy in oesophageal varices patient.) A cuffed endotracheal tube could be a life saving choice.