Model Answer
0 min readIntroduction
Hematemesis, the vomiting of blood, is a clinical manifestation indicative of bleeding within the gastrointestinal tract. The color and characteristics of the vomited material can provide clues to the site and severity of the bleeding. Bright red hematemesis usually suggests proximal bleeding (esophagus, stomach), while coffee-ground emesis indicates older, partially digested blood, often from higher up in the GI tract or a slower bleed. Accurate identification of the underlying cause is paramount for effective management and prevention of complications like hypovolemic shock. This answer will enumerate the various causes of hematemesis, categorized by anatomical location.
I. Esophageal Causes
The esophagus is a frequent site of bleeding leading to hematemesis.
- Esophageal Varices: These are enlarged veins in the esophagus, commonly caused by portal hypertension secondary to cirrhosis. They are a major cause of hematemesis, often presenting with massive bleeding.
- Mallory-Weiss Tears: Longitudinal tears in the mucosa of the esophagus, typically caused by forceful vomiting or retching. Often associated with alcohol abuse.
- Esophagitis: Inflammation of the esophagus, which can be caused by acid reflux (GERD), infection (e.g., Candida, Herpes), or medications.
- Esophageal Cancer: Squamous cell carcinoma or adenocarcinoma can cause bleeding, though often presents with other symptoms like dysphagia.
- Esophageal Ulcers: Less common, but can occur due to infections or medications.
II. Gastric Causes
The stomach is another common source of hematemesis.
- Peptic Ulcers: Gastric and duodenal ulcers are a significant cause, often associated with Helicobacter pylori infection or NSAID use.
- Gastritis: Inflammation of the gastric mucosa, which can be acute (e.g., due to NSAIDs, alcohol) or chronic (e.g., autoimmune gastritis).
- Gastric Cancer: Similar to esophageal cancer, gastric cancer can cause bleeding, often with other symptoms.
- Gastric Varices: Less common than esophageal varices, but can occur in patients with portal hypertension.
- Erosive Gastropathy: Superficial erosions of the gastric mucosa, often associated with NSAID use or stress.
III. Duodenal Causes
Bleeding from the duodenum can also manifest as hematemesis, especially if brisk.
- Duodenal Ulcers: As mentioned above, duodenal ulcers are a common cause of upper GI bleeding.
- Celiac Disease: Inflammation of the small intestine can lead to mucosal damage and bleeding.
- Duodenitis: Inflammation of the duodenum, similar to gastritis.
- Crohn's Disease: Inflammatory bowel disease affecting the duodenum can cause bleeding.
IV. Less Common Causes
These causes are less frequent but should be considered.
- Vascular Malformations: Angiodysplasia, arteriovenous malformations.
- Dieulafoy's Lesion: A large, abnormally positioned artery in the stomach wall that erodes through the mucosa.
- Aortoenteric Fistula: Rare, but serious, abnormal connection between the aorta and the gastrointestinal tract.
- Blood Dyscrasias: Conditions affecting blood clotting (e.g., thrombocytopenia, hemophilia) can increase the risk of bleeding.
- Medications: Anticoagulants, antiplatelet agents.
V. Diagnostic Approach
Differentiating between these causes requires a thorough diagnostic workup.
- Endoscopy: The gold standard for diagnosing and treating upper GI bleeding. Allows direct visualization of the esophagus, stomach, and duodenum.
- Blood Tests: Complete blood count (CBC), coagulation studies, liver function tests, H. pylori testing.
- Imaging: CT scan may be useful in certain cases to identify vascular lesions or aortoenteric fistulas.
Conclusion
Hematemesis is a serious symptom with a wide range of potential causes, ranging from common conditions like peptic ulcers and esophageal varices to rarer entities like Dieulafoy’s lesion. A systematic approach to diagnosis, utilizing endoscopy as the primary tool, is crucial for identifying the source of bleeding and initiating appropriate treatment. Prompt and accurate diagnosis and management are essential to prevent complications and improve patient outcomes. Further investigation into patient history (NSAID use, alcohol consumption, liver disease) is vital for narrowing the differential diagnosis.
Answer Length
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