HEMATEMESIS

HEMATEMESIS: Excerpt from Algorithmic Diagnosis of Symptoms and Signs

Ask the Following Questions:

1. Is there fever? The presence of fever should suggest scarlet fever, measles, malaria, leptospirosis, yellow fever, and other acute and chronic infectious diseases.
2. Is there a history of ingestion of poison, drugs, or alcohol? Poison, many drugs, and alcohol may cause acute gastritis, gastric ulcer, and corrosive esophagitis.
3. Is there associated abdominal pain? Abdominal pain associated with the hematemesis suggests the possibility of gastric or duodenal ulcer, a hiatal hernia, and esophagitis or carcinoma of the stomach. Of course, any of these conditions may occur without abdominal pain.
4. Was the hematemesis preceded by blood-free vomitus? If in the initial stages of vomiting the vomitus was blood-free, one should consider Mallory-Weiss syndrome, which is a tear of the distal esophagus due to severe vomiting.
5. Is there hepatomegaly or splenomegaly? Hepatomegaly would suggest cirrhosis of the liver, whereas a portal vein thrombosis may occur without hepatomegaly but almost certainly is associated with splenomegaly. Splenomegaly should suggest Banti's syndrome with depression of platelets, leukocytes, and anemia. Splenomegaly also suggests other blood dyscrasias.
6. Is there a positive tourniquet test or IVY skin bleeding time? These tests may indicate thrombocytopenia and other blood dyscrasias. If these tests are negative and there is no hepatomegaly, splenomegaly, or abdominal pain, one should consider hereditary hemorrhagic telangiectasia, an aortic aneurysm, and pseudoxanthoma elasticum.

DIAGNOSTIC WORKUP

Hematemesis, no matter how small, is a clear indication for immediate consultation with a gastroenterologist and esophagoscopy, gastroscopy, and duodenoscopy. To delay this while ordering an upper GI series and other diagnostic tests may place the patient in serious jeopardy. The clinician would be prudent to order a CBC and coagulation profile, type, and cross-match of several units of blood while waiting for the gastroenterologist to see the patient. If endoscopy fails to locate the site of bleeding, arteriography may do so. A technetium-99m bleeding scan may be ordered to detect suspected bleeding but will not locate the exact site of bleeding. Liver function tests should be ordered to rule out cirrhosis in all cases.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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