Haematemesis

• Vomiting of blood
• Signifies upper GI bleed

Causes

Common Causes

• Gastric / duodenal ulcer
• Gastritis
• Mallory-Weiss tear
• Oesophageal varices
• Portal hypertensive gastropathy
• Drugs
  • NSAIDS
  • steroids
  • thrombolytics
  • anticoagulants

Rare causes

• Haemobilia
• Nose bleeds
• Oesophageal/gastric malignancy
• Oesophagitis
• Angiodysplasia
• Haemangiomas
• Ehler-Danlos or Peutz-Jeghers
• Bleeding disorders

History

• Swift and relevant
• Postural hypotension - IVI needed
• Drugs
• Alcohol abuse
• Previous GI bleed
• peptic ulcer or symptom
• retching/vomiting
• liver disease
• dysphagia
• concomitant disease

Examination

• Vital signs
  • Pulse
  • BP -standing/ sitting, lying
  • JVP
  • urine output
• Assess for shock
• Signs of chronic liver disease
• telangectasia or purpura
• jaundice

Treatment

• Urgent endoscopy
• Octreotide
• sclerotherapy
• banding
• Sengstaken-Blakemore tube
• Surgery
  • Severe bleeding
  • Rockall score >6
  • rebleeding
  • active bleeding during OGD
  • continuing bleeding after transfusion (> 6 units if over 60, >8 unit if <60)
  • Varices
    • Oesophageal transection
    • transthoracic transosophageal ligation
  • Gastric ulcer
    • Under-running
    • Excision
    • Partial gastrectomy

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