View source for Hematemesis

{{Infobox_Disease |
  Name           = Hematemesis |
  Image          = |
  Caption        = |
  DiseasesDB     = 30745 |
  ICD10          = {{ICD10|K|92|0|k|92}} |
  ICD9           = {{ICD9|578.0}} |
  ICDO           = |
  OMIM           = |
  MedlinePlus    = |
  eMedicineSubj  = med |
  eMedicineTopic = 3565 |
  MeshName       = Hematemesis |
  MeshNumber     = C23.550.414.788.400 |
}}
'''Hematemesis''' or '''haematemesis''' (see [[American and British English spelling differences#Simplification of ae and oe|American and British spelling differences]]) is the [[vomiting]] of [[blood]]. The source is generally the upper [[gastrointestinal tract]]. Patients can easily confuse it with [[hemoptysis]] (coughing up blood), although the latter is more common.

==Signs==
Signs of the onset of hematemesis may include:
* A history of [[alcohol abuse|excessive alcohol use]] or [[liver disease]]
* Any esophago-gastric symptoms, such as nausea or vomiting
* Brown or black vomit
* Vomit that looks like coffee grounds
* Dark colored, tar-like stools (a condition known as [[melena]])

==Causes==
Causes can be:
* Prolonged and vigorous [[retching]] (may cause a tear in the small blood vessels of the throat or the esophagus, producing streaks of blood in the vomit, and is called [[Mallory-Weiss syndrome]]).
* 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 [[bleeding|hemorrhage]] in the oral cavity, nose or throat
* Vascular malfunctions of the [[gastrointestinal tract]], such as bleeding gastrointestinal [[varices]]
* [[Tumor]]s of the [[stomach]] or esophagus.
* [[Viral hemorrhagic fever|Viral hemorrhagic fevers]]
* [[Gastroenteritis]]
* [[Gastritis]]
* [[Peptic ulcer]]
* Intestinal Schistosomiasis (caused by the parasite "Schistosoma Mansoni" )
* History of [[Smoking]]

==Management==
Hematemesis is treated as a [[medical emergency]]. The most vital distinction is whether there is blood loss sufficient to cause [[Shock (circulatory)|shock]]. 

===Minimal blood loss===
If this is not the case, the patient is generally administered a [[proton pump inhibitor]] (e.g. [[omeprazole]]), given [[blood transfusion]]s (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 [[cannula]]s 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. [[Surgery|Surgical]] opinion is usually sought in case the source of bleeding cannot be identified endoscopically, and [[laparotomy]] is necessary.

== See also ==
* [[Upper gastrointestinal bleeding]]
* [[Shock (circulatory)|Shock]]
* [[Melena]]

==External links==

* [http://www.umm.edu/ency/article/003118.htm]
* [http://www.nlm.nih.gov/medlineplus/ency/article/003118.htm NIH/Medline]
[[Category:Symptoms]]
[[Category:Vomiting]]

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{{Gastroenterology}}

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