Haematemesis

Last updated 26.09.12

Definition

- Vomiting of blood, may be frank red or coffee ground

Features

- Male > female

Causes

- Epistaxis

- Oesophageal varices

- Mallory-Weiss tears

- PUD (HP, NSAIDs)

- Duodenal ulcer 25%

- Gastric ulcer 20%

- Erosive gastritis or oesophagitis

- Dieulafoy lesion

- Telengiectasia: Osler-Weber syndrome

- Angioectasis

- Venous blebs

- Gastric Ca

- Gastric leiomyoma

DDx

- Haemoptysis

Associated S/S

- Vomiting

- Usually coffee ground vomitus

- Frank blood

- Nausea

- Shock

- Boerhaave syndrome (oesophageal rupture)

- Look for subcutaneous emphysema

- Dyspepsia

- Melena, haematochezia

- Anaemia: IDA

- Peritonism: perforated viscus

Ix

- Vitals: shock

- Postural changes

- FBE: Hb: anaemia

- INR, APTT

- U&E: Urea, Cr: dehydration 

- Urea will elevated w blood in GIT (digestion)

- PR: FOBT

- Gastroscopy

- Mx of acute bleed

- Determine cause

- +/- Colonoscopy

- +/- AXR: pneumopritoneum

Mx

- Shock: IV fluids +/- Blood transfusion

- NBM until stable

- +/- NGT

- Mx as per cause

- PUD

- IV PPI: Pantoprazole 80mg

- Then unfusion 8mg/h for 24-72hrs

References