HAEMETEMESIS(BLOOD VOMITINGS)
The endoscopist controls the bleeding by injecting a sclerosing agenton the ulcer bed or banding the esophageal varices or laser is used sometimes to control the bleeding.
Haemetemesis is the vomiting of blood. The source is generally the upper gastro-intestinal tract. Patients can easily confuse it with hemoptysis (coughing up blood).
The causes are esophageal tears secondary to prolonged retching/vomitings,peptic ulcer with vascular erosion,tumours in esophagus/stomach,esophageal varices,vascular malformations, portal hypertension, some drugs like aspirin,anti-coagulants,blood dyscrasias ,chronic alcoholism etc.
Hematemesis is treated as a medical emergency. The most vital distinction is whether there is blood loss sufficient to cause shock.The blood may be bright red or coffee ground in colour(blood mixed with gastric juice).If there is associated tarry stools it suggests there is significant GI bleed.
The patient is started on antacids,i.v.drugs like omeprazole,and given blood transfusions (if the level of Hb is extremely low, that is less than 8.0 g/dL.He is kept NBM which stands for Nothing By Mouth.He will be planned for Upper GI Endoscopy for accurate diagnosis and simultaneous treatment in most of the cases.A ryles tube is usually inserted into the stomach through nose for any medicines or monitor the stomach fluids for blood.
If a person starts vomiting blood along with symptoms like confusion,nausea,fainting,rapid shallow breathing and cold clammy limbs, it is a sign of impending shock and needs ICU admission.
In a "hemodynamically significant" case of hematemesis, that is hypovolemic shock, resuscitation is an immediate priority and patient is prepared for emergency endoscopy, which is typically done in theatres under anaesthesiologist care and support.
The endoscopist controls the bleeding by injecting a sclerosing agenton the ulcer bed or banding the esophageal varices or laser is used sometimes to control the bleeding.
Surgeons opinion is sought in case the source of bleeding cannot be identified endoscopically, and laparotomy is necessary to control the bleeding . Securing the airway is a top priority in hematemesis patients, especially those with a disturbed conscious level (hepatic encephalopathy in bleeding esophageal varices) .A cuffed endotracheal tube to secure the airway from aspirating the bloody vomitus.
MORE IN BLOG
MORE IN BLOG
- THROMBOSED,PAINFUL PILESACUTE TUBULAR NECROSISPARAPHIMOSISTESTICULAR TORSIONTRAUMARENAL COLICPRIAPISMACUTE URINE RETENSIONSEVERE PALLORABSCESSANIMAL BITESPOISONINGBURNSSEIZURESPARALYTIC STROKEANY PREGNANCY RELATED EVENTSUDDEN LOSS OR IMPAIRMENT OF VISIONSUDDEN HEAD ACHE AND VOMITINGHIGH GRADE FEVERNON-RESPONSIVENESSVIOLENT BEHAVIOURSUDDEN CALF PAINSEVERE BREATHLESSNESS
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