hematemese

Hematemesis is the vomiting of blood or blood-stained material, usually arising from the upper gastrointestinal tract. The blood can be bright red or have a coffee-ground appearance if it has been partially digested by stomach acid. Hematemesis is a medical emergency when accompanied by signs of major blood loss or ongoing bleeding.

Clinical evaluation centers on stabilizing the patient and determining the likelihood of significant upper GI bleeding. Symptoms such as dizziness, syncope, or hypotension may indicate substantial blood loss. Initial management emphasizes airway protection and rapid fluid resuscitation, with blood transfusion considered for marked anemia or ongoing hemorrhage. Laboratory workup typically includes a complete blood count, coagulation studies, blood type and crossmatch, and metabolic panels. An urgent endoscopic examination is often indicated for diagnosis and hemostasis, and imaging may be used to assess complications or alternative sources when endoscopy is not immediately feasible.

Common causes in adults include peptic ulcer disease (gastric or duodenal ulcers), esophageal or gastric variceal bleeding related to portal hypertension, gastritis or esophagitis, Mallory-Weiss tears from forceful retching, Dieulafoy lesions, and malignant lesions. Less frequent but critical sources include aortoenteric fistula and arteriovenous malformations. Medications such as nonsteroidal anti-inflammatory drugs, anticoagulants, or antiplatelet agents can exacerbate bleeding or contribute to ulcer formation.

Diagnosis combines history, physical examination, laboratory testing, and endoscopy, which also offers therapeutic options such as injection, clipping, or cauterization. Management is etiology-specific, with proton pump inhibitors for suspected peptic ulcers, vasoconstrictors and antibiotics for suspected variceal bleeds, and urgent endoscopic or surgical intervention as needed. Prognosis varies with cause, severity, and comorbidities.