Hematemesis: Symptoms, Causes, Diagnosis, and Treatment

Hematemesis is a medical term for vomiting blood, a serious symptom that often indicates a potentially life-threatening condition. The blood may appear bright red, indicating active bleeding, or dark and coffee-ground-like, suggesting that the blood has been partially digested. Hematemesis should never be ignored, as it usually signifies gastrointestinal bleeding that requires immediate medical attention.

In this blog, we will explore the symptoms, causes, diagnosis, and treatment options for hematemesis.

Symptoms of Hematemesis

The primary symptom of hematemesis is the presence of blood in vomit. The quantity and appearance of blood can vary depending on the underlying cause:

1. Bright red blood: Indicates active, fresh bleeding.
2. Dark, coffee-ground-like vomit: Suggests that the blood has been in the stomach for some time, indicating older bleeding.
3. Additional Symptoms:
   • Nausea and abdominal discomfort
   • Fatigue and weakness (often due to blood loss)
   • Dizziness or lightheadedness
   • Low blood pressure or fainting (in severe cases)
   • Black, tarry stools (melena), which indicate the presence of digested blood in the stool

These symptoms vary based on the severity of bleeding and the underlying condition responsible for hematemesis.

Causes of Hematemesis

Hematemesis is generally caused by gastrointestinal bleeding, which can result from various conditions. Below are some common causes:

1. Peptic Ulcers: One of the most common causes of hematemesis is peptic ulcers, which occur when the lining of the stomach or duodenum is damaged by stomach acid. These ulcers can bleed, causing blood to be vomited.
2. Esophageal Varices: Esophageal varices are swollen veins in the lower part of the esophagus, often resulting from liver cirrhosis. If these veins rupture, significant bleeding can occur, leading to hematemesis.
3. Gastritis: Inflammation of the stomach lining, often caused by excessive alcohol consumption, stress, or the use of nonsteroidal anti-inflammatory drugs (NSAIDs), can result in bleeding and hematemesis.
4. Mallory-Weiss Tear: A tear in the lining of the esophagus near the junction with the stomach, caused by severe vomiting or retching, can lead to hematemesis. This is more common in individuals with alcoholism or eating disorders.
5. Esophagitis: Inflammation of the esophagus, often caused by acid reflux (GERD), can sometimes cause bleeding.
6. Cancer: Cancers of the stomach or esophagus can cause bleeding that leads to hematemesis, especially in later stages of the disease.
7. Anticoagulant Use: Blood-thinning medications, such as warfarin, can increase the risk of gastrointestinal bleeding, especially in individuals with existing ulcers or other gastrointestinal conditions.
8. Trauma: Physical trauma or surgery affecting the gastrointestinal tract can result in internal bleeding and hematemesis.

Diagnosis of Hematemesis

Diagnosing hematemesis involves a combination of clinical evaluation, laboratory tests, and imaging studies. The goal is to identify the source of bleeding and determine its severity.

1. Medical History and Physical Examination: The physician will begin by asking about symptoms, medical history, and any medications the patient is taking. A physical examination will focus on signs of anemia (paleness, fatigue), abdominal pain, and blood pressure to assess the degree of blood loss.
2. Blood Tests:
   • Complete Blood Count (CBC): Measures hemoglobin levels and hematocrit to assess the extent of blood loss.
   • Liver Function Tests: Help detect liver disease, which may be responsible for conditions like esophageal varices.
   • Coagulation Profile: Evaluates how well the blood clots, particularly important if the patient is taking anticoagulant medications.
3. Endoscopy: An upper gastrointestinal (GI) endoscopy is the most definitive diagnostic tool for hematemesis. During this procedure, a thin, flexible tube with a camera (endoscope) is inserted through the mouth to examine the esophagus, stomach, and duodenum. It helps locate the source of bleeding and assess its severity.
4. Imaging Studies: In some cases, imaging tests such as an abdominal ultrasound, CT scan, or X-ray may be used to identify other causes of bleeding, especially if the endoscopy is inconclusive.
5. Nasogastric Tube Lavage: A nasogastric tube may be inserted through the nose into the stomach to determine whether active bleeding is occurring. This can also help remove blood and stomach contents, which makes further diagnostic testing easier.

Treatment of Hematemesis

The treatment for hematemesis focuses on stopping the bleeding, stabilizing the patient, and treating the underlying cause. The approach may involve a combination of medical, endoscopic, and sometimes surgical interventions.

1. Immediate Stabilization:
   • Fluid Resuscitation: Patients with significant blood loss may require intravenous fluids to maintain blood pressure and circulation.
   • Blood Transfusion: If there is severe blood loss, a blood transfusion may be necessary to restore the patient’s blood volume.
   • Oxygen Therapy: Supplemental oxygen may be provided to improve oxygen levels in the blood, particularly if the patient is experiencing shortness of breath or low blood pressure.
2. Endoscopic Treatment: Endoscopy is not only a diagnostic tool but also a key method for treating bleeding sources:
   • Clipping: Small clips may be applied to bleeding vessels or ulcers to stop the bleeding.
   • Sclerotherapy: A chemical solution can be injected into bleeding varices to cause them to shrink and stop bleeding.
   • Banding: In the case of esophageal varices, rubber bands can be placed around the veins to cut off blood flow and stop bleeding.
3. Medications:
   • Proton Pump Inhibitors (PPIs): These medications reduce stomach acid production and help treat ulcers and gastritis, reducing the risk of further bleeding.
   • Octreotide: Often used for bleeding from esophageal varices, this medication reduces blood flow to the gastrointestinal tract.
   • Antibiotics: If the bleeding is related to an infection, such as H. pylori in peptic ulcers, antibiotics may be prescribed.
4. Surgical Intervention: Surgery may be required if endoscopic treatment is unsuccessful or if the bleeding is life-threatening. Surgical options include:
   • Ligation or Removal of Varices: If esophageal varices are the source of bleeding, they may need to be surgically tied off or removed.
   • Ulcer Repair: Peptic ulcers that do not respond to medication may need to be surgically repaired to prevent further bleeding.
5. Treating the Underlying Cause: Addressing the underlying condition causing hematemesis is essential for long-term management. For instance:
   • Liver Cirrhosis: If esophageal varices are caused by liver disease, managing cirrhosis through lifestyle changes, medications, or liver transplantation may be necessary.
   • Avoiding NSAIDs: For patients with ulcers or gastritis, stopping the use of NSAIDs or finding alternative medications is crucial to prevent further bleeding.

Prevention of Hematemesis

Preventive measures depend on the underlying causes but may include:

• Managing chronic conditions like GERD, peptic ulcers, or liver disease.
• Limiting the use of NSAIDs and alcohol, both of which can damage the stomach lining.
• Taking prescribed medications, such as PPIs, to prevent ulcers or control stomach acid production.
• For individuals with liver disease, regular screening for esophageal varices may be recommended to catch and treat varices before they rupture.

Conclusion

Hematemesis is a medical emergency that can indicate a serious underlying health condition. Early diagnosis and treatment are crucial to prevent life-threatening complications. If you or someone you know experiences vomiting blood, seeking immediate medical care is essential. Effective treatment will depend on accurately diagnosing the source of the bleeding and addressing any underlying conditions.