Causes of Haematemesis:
- Peptic ulcer disease: most common cause, often epigastric pain a well. Most often due to Helicobacter infection or NSAID use.
- Upper GI malignancy: patient will often have fatigue, weight loss, anorexia and early satiety accompanying symptoms.
- Varices: formed with portal hypertension when blood is trying to find routes to avoid the liver, most commonly with hepatic cirrhosis.
- Mallory-Weiss tear: characteristic history of forceful vomiting with haematemesis following (intial vomiting clear of blood). 90% of these will heal spontaneously.
- Gastritis/Duodenitis: consequence of Alcohol abuse or NSAID overuse. nausea and epigastric pain common.
- Oesophagitis: consequence of GERD. History of heartburn typically.
- Dieulafoy’s lesion: developmental lesion, an unusually large (5-10mm) submucosal artery in the stomach wall. The pulsatility of which causes it to eventually erode through the stomach wall and perforate into the stomach.
- Aorto-duodenal fistula: history of recent aortic surgery.
Management, what to do:
The priority is resuscitation, patients with haematemesis may present in shock. So ABCDEs first. If a patient does present with shock or bright red haematemesis then after they are stabilised they need urgent upper GI endoscopy.
Get urgent CBC, U+E, coag screen, cross match and LFTs
Varices have a high mortality rate and may be suggested by known chronic liver disease or characteristic signs if liver disease.
If patient has characteristic history of a Mallory-Weiss tear then endoscopy is not needed.
If active bleeding is not suspected and patient is stable, then take a full clinical history and exam. Suspect first gastritis, duodenitis or oesophagitis and pay attention to signs of malignancy.
If the diagnosis is not obvious consider inpatient endoscopy.
The priority is resuscitation, patients with haematemesis may present in shock. So ABCDEs first. If a patient does present with shock or bright red haematemesis then after they are stabilised they need urgent upper GI endoscopy.
Get urgent CBC, U+E, coag screen, cross match and LFTs
Varices have a high mortality rate and may be suggested by known chronic liver disease or characteristic signs if liver disease.
If patient has characteristic history of a Mallory-Weiss tear then endoscopy is not needed.
If active bleeding is not suspected and patient is stable, then take a full clinical history and exam. Suspect first gastritis, duodenitis or oesophagitis and pay attention to signs of malignancy.
If the diagnosis is not obvious consider inpatient endoscopy.
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