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Haematemesis


Haematemesis is the vomiting of blood. This may be frank blood or blood altered by the action of gastric acid and digestive enzymes, i.e. ‘coffee grounds’. Haematemesis is usually caused by lesions proximal to the duodenojejunal junction.

Causes (all patients with significant haematemesis should be urgently assessed)

Swallowed blood

  • ●

    Epistaxis

  • ●

    Haemoptysis

Oesophagus

  • ●

    Reflux oesophagitis

  • ●

    Oesophageal varices ( Fig. 28 )

    Figure 28, Endoscopic view of oesophageal varices .

  • ●

    Oesophageal carcinoma

Stomach

  • ●

    Peptic ulceration

  • ●

    Acute gastric erosions

  • ●

    Mallory–Weiss syndrome

  • ●

    Carcinoma

  • ●

    Leiomyoma (gastrointestinal stromal tumour – GIST)

  • ●

    Hereditary haemorrhagic telangiectasia

  • ●

    Vascular malformations

Duodenum

  • ●

    Peptic ulceration

  • ●

    Duodenal diverticulae

  • ●

    Aortoduodenal fistulae

  • ●

    Invasive pancreatic tumours

  • ●

    Haemobilia

Bleeding disorders

  • ●

    Liver disease-associated

  • ●

    Thrombocytopenia

  • ●

    Haemophilia

Drugs

  • ●

    Anticoagulants

  • ●

    Aspirin

  • ●

    NSAIDs

  • ●

    Steroids

Others

  • ●

    Uraemia

  • ●

    Connective tissue disorders

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