Haematemesis and
UGIB
BY SAID MOHAMED ABDILLE
Outline
• Definitions
• Epidemiology
• Etiology
• High Risk individuals
• Diagnosis
• Management
Definition
• The term ‘haematemesis’
describes the vomiting of blood, which may be
bright red and fresh, or altered (commonly described
as ‘coffee grounds’).typically above the suspensory muscle of
duodenum.It can be confused with hemoptysis.
Haematemesis is a symptom that
should be distinguished from
Haemoptysis
Epidemiology
• Haematemesis is a common medical emergency with an incidence of
between – cases per 1000 a year.
• Profuse hematemesis in hospitals still caries an 8%- 14% hospital
mortality.
• Country and regional statistics are not readily accessible
Causes of Haematemesis
The presence of haematemesis
usually means acute bleeding from a source above
the duodenojejunal flexure.
Causes Contd
o Erosive Duodenitis
o Hemorrhagic Erosive Gastritis
o Portal Hypertensive Gastropathy
o Barret’s Esophagus
o Hiatal Hernia
o Atrio oesophageal fistula
o Viral hemorhagic fevers
o Gastroenteritis
o Chronic viral hepatitis
o Intestinal schistomiasis like mansoni type
o Iatrogenic injury like endoscopy
o Zollinger Ellison syndrome
• Among adults, hemorrhage from gastric or duodenal ulceration &
esophageal varices are the most frequent causes:
o Mallory-Weiss tears account for -5-10% of cases
The proportion of patients bleeding from varices varies widely from -5-
40% depending on the population
o Peptic ulcers are the most common cause accounting for -50% of cases
High Risk Individuals
• Elderly
• Those with a history of Chronic Pain
• Alcoholics
• Patients with chronic liver cirrhosis
• Renal failure
• Advanced malignancy
• Clotting disorders
• COPD
• Underlying Peptic ulcer disease
Diagnosis of
hametemesis
1 History taking
2 examination
History
• Ask about previous:
• GI bleeds
• dyspepsia or known ulcers
• Known liver disease
• Alcohol use
• Check drugs
• Is there a serious co-morbididty
Examination
• Look for signs of chronic liver disease
• Poor urine output < 25ml/hr
• Tachycardia
• Hypotensive
Management
• Resuscitation
• Identification of the cause and site
• Definitive management
Resuscitation
• The airway must be protected and Aspiration prevented to prevent cardiac
arrest
• A nasogastric tube may be inserted, adjust posture of an unconscious patient.
• Adequacy of respiration should be assessed if possible with O2 saturation or
blood gas volumes
• Take blood for FBC, PT/INR, cross matching, blood urea, serum electrolytes
and liver function to probably assess for liver pathology.
• Catheterize patient to measure urine output
• Patient should be assessed to estimate the blood loss.
• If patient is not in shock, you may run a 0.9% NaCl
• If patient is in shock, he should receive a rapid infusion of fluid with
the aim of euvolemic resuscitation guided by the urine output of 0.5-1
ml/kg/hr
• If the bleeding is extreme or Hb < 8g/dl, red cell concentrate should
be transfused.
Identification of the cause
• History
• Exam
• Endoscopy
Definitive Managment
1. Use of endoscopic therapy: injection of alcohol or adrenaline to the
bleeding point.
2. Surgery when;
for the case of massive haemorrhage not responding to conservative means
Patients requiring more than 6 units of blood
Elderly patients particularly if a large ulcer is present as they tend to tolerate
blood loss poorly.
Where a second haemorrhage occurs in hospital or there is concern about
persistent on going bleeding.
Give a proton pump inhibitor eg omeprazole,lansoprazole pantoprazole
Refernces
• Brian R. Walker et al. Davidson’s Principles and Practice of Medicine,
22nd Edition,2014
• Denise L. Kasper et al. Harrison’s Principles of Internal Medicine. 19th
Edition, 2015
• Michael Swash et al. Hutchison’s Clinical Methods, 20th Edition, 1995
•
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