Haematemesis


  • Vomiting of blood
  • Signifies upper GI bleed

Causes

Common Causes

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
 

Home ] Up ]