hematemesis

Hemateme sis is the vomiting of blood or blood-tinged material, originating from the upper part of the gastrointestinal tract, typically above the ligament of Treitz. The appearance can be bright red or dark and coagulated depending on the duration of contact with gastric acid.

Presentation and evaluation begin with stabilization. Patients may report abrupt onset of hematemesis with dizziness, syncope, or signs of volume depletion. Physical examination focuses on hemodynamic status and potential sources of chronic illness, such as liver disease. Initial management includes securing the airway if needed, establishing two IV lines, and monitoring vitals. Laboratory studies typically include complete blood count, coagulation tests, blood type and crossmatch, and assessments of renal and liver function. Endoscopy is usually performed within 24 hours after resuscitation to identify the source and provide therapeutic hemostasis.

Common causes include peptic ulcers and other nonvariceal upper GI bleeding, esophageal or gastric varices due to portal hypertension, gastritis or esophagitis, Mallory-Weiss tears, malignancy, and vascular lesions.

Management depends on the cause. Nonvariceal bleeds are treated with proton pump inhibitor therapy and endoscopic hemostasis. Variceal bleeds require vasoactive medications (such as octreotide or terlipressin), antibiotic prophylaxis in the setting of cirrhosis, and endoscopic therapy (band ligation or sclerotherapy); refractory cases may need radiologic embolization or surgical intervention. Transfusion decisions are guided by clinical status and ongoing blood loss.

Prognosis varies with the etiology and patient comorbidities; bleeding from varices or ongoing hemorrhage in cirrhotic patients is associated with higher mortality. Prevention focuses on addressing risk factors such as NSAID use, Helicobacter pylori infection, and portal hypertension when appropriate.