Significant Blood Loss: In a hemodynamically significant case of hematemesis (e.g., hypovolemic shock), resuscitation is an immediate priority to prevent cardiac arrest. Minimal Blood Loss: In this case, the patient is administered a proton pump inhibitor such as omeprazole, given a blood transfusion, and kept nil per os (Latin, “nothing by mouth”) until endoscopy can be arranged for further investigation. There are many causes for hematemesis, including irritation or erosion of the lining of the esophagus or stomach bleeding ulcer located in the stomach, duodenum, or esophagus vomiting of ingested blood after hemorrhage in the oral cavity, nose, or throat vascular malfunctions of the GI tract and tumors of the stomach or esophagus. This results from upper GI bleeding that has slowed or stopped, with conversion of red hemoglobin to brown hematin by gastric acid. The bleeding is similar to dark brown emesis, with granular material that resembles coffee grounds. It is considered a medical emergency, and the most vital distinction is whether there is blood loss sufficient to cause shock. Upper GI Bleeding: Hematemesis is vomiting of red-colored blood and indicates upper GI bleeding, usually from an arterial source or varix. GI bleeding may also precipitate hepatic encephalopathy (brain and nervous system damage caused by liver failure) or hepatorenal syndrome (kidney failure secondary to liver disease). Chronic liver disease due to excessive use of alcohol can also cause bleeding. Several drugs increase the likelihood of bleeding, including nonsteroidal anti-inflammatory drugs (NSAIDs), warfarin, and heparin. Past medical history should also inquire about previously diagnosed or undiagnosed GI bleeding, inflammatory bowel disease (IBD), bleeding diatheses, and liver disease. These include presence of abdominal discomfort, weight loss, easy bleeding or bruising, previous colonoscopy results, and symptoms of anemia (weakness, fatigue, dizziness). To evaluate the patient, there are a number of symptoms that need to be reviewed after GI bleeding.
Whether blood was passed with initial emesis or only after several nonbloody vomiting episodes could indicate different causes. However, quantity can be difficult to assess because even small amounts (5-10 mL) of rectal bleeding or modest amounts of vomited blood are alarming to a patient. History of present illness should be reviewed to ascertain quantity and frequency of blood passage. Upper endoscopy or colonoscopy are generally considered the best methods to identify the source of bleeding. The manifestations depend on the location and rate of bleeding, from nearly undetectable to acute and life-threatening. GI bleeding has a variety of causes, and a review of patient medical history and a physical examination can distinguish between the macroscopic and microscopic forms. It differs from internal bleeding, where blood leaks from the blood vessels in such a way that the bleeding cannot be seen outside of the body. Gastrointestinal (GI) bleeding can originate anywhere from the pharynx to the rectum and can be occult or overt.
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