Hematemesis means vomiting of blood.
It can be either a frank blood, or altered, coffee-ground coloured blood (altered by digestive enzyme)
The aetiology of hematemesis is usually proximal to the duodenojejunal junction.
1) Swallowed blood
Due to hemoptysis, epitaxis
2) Oesophageal causes
Ruptured oesophageal varices
3) Stomach and duodenum
Peptic ulcer disease
Acute gastric erosions
4) Bleeding disorders
Coagulopathy (due to liver disease)
Connective tissue disorders
History : Important questions
1) Is there any h/o of epitaxis, hemoptysis?
2) Ask for h/o of chronic liver disease
3) Any retrosternal burning chest pain radiating upwards or heartburn?
4) Any h/o of dysphagia, odynophagia, weight lost?
5) Ask for h/o of peptic ulcer disease
6) Any h/o of consumption of large meal and alcohol?
7) Does the hematemesis preceded by severe bouts of vomiting?
8) Ask for h/o of anaemia
9) Any recent h/o of acute pancreatitis? Any head injuries? (Cushing's ulcer) Or Any h/o of burns? (Curling's ulcer)
10) Any h/o of bleeding disorders? In the family, is there any?
11) Any h/o of drug intake?
12) Ask for symptoms of uraemia
1) Depends on the severity of bleeding, does the patients appears to be in shock?
Prolonged capillary filling time
Reduced skin turgosity
Reduced urine output
2) Check around the nose - is there any blood?
3) Examine the chest for any cause of hemoptysis
4) Look for pallor
5) Look for signs of chronic liver disease
6) Any epigastric mass, palpable Left SC nodes?
7) Any epigastric tenderness?
8) Any bruises? Any signs of uremia?
1) Full blood count, ESR
Hb level, platelet count, any raised ESR? (connective tissue disorders)
2) Liver function test
3) Coagulation profile (PT and INR)
4) BUSE (Renal profile)
5) Oesophagogastroduodenoscopy (OGD)