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