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Hematemesis

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Title: Hematemesis  
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Subject: Gastrointestinal bleeding, Upper gastrointestinal bleeding, Bleeding, Portal hypertensive gastropathy, Vomiting
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Hematemesis

Hematemesis
Classification and external resources
ICD-10 K92.0
ICD-9-CM 578.0
DiseasesDB 30745
MedlinePlus 003118
eMedicine med/3565
MeSH C23.550.414.788.400

Hematemesis or haematemesis is the vomiting of blood.[1]:308 The source is generally the upper gastrointestinal tract, typically above the suspensory muscle of duodenum.[1]:308 Patients can easily confuse it with hemoptysis (coughing up blood), although the latter is more common. Hematemesis "is always an important sign".[1]:309 Vomited blood volumes in excess of 5.5 litres could be life-threatening.[1]:309

Contents

  • Causes 1
  • Management 2
    • Minimal blood loss 2.1
    • Significant blood loss 2.2
  • See also 3
  • References 4
  • External links 5

Causes

Causes can be:

Management

Hematemesis is treated as a medical emergency. The most vital distinction is whether there is blood loss sufficient to cause shock.

Minimal blood loss

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.

Significant blood loss

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 esophageal varices patient.) A cuffed endotracheal tube could be a life saving choice.

See also

References

  1. ^ a b c d Interpreting Signs and Symptoms. Nursing. Lippincott Williams & Wilkins. 2007.  

External links

  • "Vomiting blood". Medical Encyclopedia. University of Maryland Medical Center. 2011. 
  • MedlinePlus Encyclopedia Vomiting blood
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