Gastroenteritis. Gastritis. Chronic viral hepatitis. Hepatic schistosomiasis, or intestinal schistosomiasis. This is caused by the parasite Schistosoma mansoni. Iatrogenic injury (invasive procedure such as endoscopy or transesophageal echocardiography)
Atrio-oesophageal fistula. Yellow fever. Strongyloidiasis. Certain drugs. Plague, most commonly from septicemic plague. Mechanism
The source of vomited blood is usually from the upper gastrointestinal tract. This can include the esophagus, stomach, and parts of the small intestine. This may be the suspensory muscle of duodenum. Hematemesis tends to occur only after significant blood loss. Evaluation
Hematemesis may be investigated with endoscopy of the upper gastrointestinal tract. Barium meal may also be used. Management
Hematemesis is treated as a medical emergency. The most vital distinction is whether there is blood loss sufficient to cause shock. Correct management is required in such conditions. It is required to perform all tests such as endoscopy before medication. A platelet test is also an important test in such conditions. Medicines such as painkillers or antibiotics, e.g. ciprofloxacin, could decrease platelet count which can lead to thrombocytopenia (when the body does not have sufficient platelets in the blood and cannot form clots). In such conditions wrong medication or management could be deadly. Blood transfusion is required in such conditions if the body loses more than 20 percent of body blood volume. Severe loss makes it impossible for the heart to pump a sufficient amount of blood to the body. In such conditions unmaintained blood volume could lead to hypovolemic shock (hypovolemic shock could lead to damage of body organs e.g.
kidney, brain, or gangrene of arms or legs). An untreated patient could develop cerebral atrophy. Minimal blood loss
In cases that do not involve shock, treatment may involve proton pump inhibitors (such as omeprazole) to treat stomach ulcers if they are present. This is given until endoscopy can be arranged. Blood transfusions may be given if the level of hemoglobin in the blood is extremely low, that is less than 8.0 g/dL or 4.5–5.0 mmol/L. A patient may be kept nothing by mouth (or no eating or drinking). Adequate venous access (such as with large-bore cannulas or a central venous catheter) is generally obtained in case the patient develops a further bleed and becomes unstable. Significant blood loss
In a "hemodynamically significant" case of hematemesis, there may be shock. Resuscitation is an immediate priority to prevent death. Intravenous fluids and blood transfusions can be given, preferably by large bore intravenous cannula. The patient is prepared for emergency endoscopy, which is typically done in a operating theatre. Surgical opinion is usually sought in case the source of bleeding cannot be identified endoscopically, and laparotomy is necessary. Securing the airway is a top priority in hematemesis patients, especially those with a disturbed conscious level (hepatic encephalopathy in esophageal varices patient). This may be achieved with a cuffed endotracheal tube. Octreotide may be used if bleeding may be caused by varices. Techniques
Hematemesis, melena, and hematochezia are symptoms of acute gastrointestinal bleeding.