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Concept
Hematemesis
Summary
Hematemesis is the vomiting of blood. It can be confused with hemoptysis (coughing up blood) or epistaxis (nosebleed), which are more common. The source is generally the upper gastrointestinal tract, typically above the suspensory muscle of duodenum. It may be caused by ulcers, tumors of the stomach or esophagus, varices, prolonged and vigorous retching, gastroenteritis, ingested blood (from bleeding in the mouth, nose, or throat), or certain drugs.
Hematemesis is treated as a medical emergency, with treatments based on the amount of blood loss. Investigations include endoscopy. Any blood loss may be corrected with intravenous fluids and blood transfusions. Patients may need to avoid taking anything by mouth.
Hematemesis is the vomiting of blood. This is usually vomit that contains bright red blood. Coffee ground vomiting is similar to hematemesis, but is distinct in not involving bright red blood.
Hematemesis must be differentiated from hemoptysis (coughing up blood) and epistaxis (nosebleed). Both of these are more common conditions. These may be difficult to distinguish.
Hematemesis may be caused by:
Peptic ulcer. This may be related to Zollinger–Ellison syndrome, which causes severe disease.
Vascular malfunctions of the gastrointestinal tract, such as bleeding gastric varices or intestinal varices.
Mallory–Weiss syndrome: bleeding tears in the esophagal mucosa, usually caused by prolonged and vigorous retching.
Vomiting of ingested blood after bleeding in the mouth, nose, or throat.
Tumors of the stomach or esophagus.
Irritation or erosion of the lining of the esophagus or stomach.
Radiation poisoning.
Viral hemorrhagic fevers.
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.
Official source
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