haematemesis

吐血

関

hematemesis

WordNet

1. vomiting blood (同)haematemesis

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/07/24 18:36:48」(JST)

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Hematemesis
Classification and external resources
ICD-10	K92.0
ICD-9	578.0
DiseasesDB	30745
MedlinePlus	003118
eMedicine	med/3565
MeSH	C23.550.414.788.400

Hematemesis or haematemesis is the vomiting of blood. The source is generally the upper gastrointestinal tract, typically above the suspensory muscle of duodenum. Patients can easily confuse it with hemoptysis (coughing up blood), although the latter is more common. Hematemesis "is always an important sign". Vomited blood volumes in excess of 0.5 litres could be life threatening.

Causes

Causes can be:

• Mallory-Weiss syndrome: bleeding tears in the esophagal mucosa, usually caused by prolonged and vigorous retching.
• Irritation or erosion of the lining of the esophagus or stomach
• Vomiting of ingested blood after hemorrhage in the oral cavity, nose or throat
• Vascular malfunctions of the gastrointestinal tract, such as bleeding gastric varices or intestinal varices
• Tumors of the stomach or esophagus.
• Radiation poisoning
• Viral hemorrhagic fevers
• Gastroenteritis
• Gastritis
• Peptic ulcer
• Chronic viral hepatitis
• Intestinal Schistosomiasis (caused by the parasite schistosoma mansoni )
• History of Smoking
• Iatrogenic Injury (invasive procedure such as endoscopy or transesophageal echocardiography)
• Zollinger-Ellison Syndrome (severe peptic ulcer)
• Atrio-oesophageal fistula
• Yellow fever

Management

Hematemesis is treated as a medical emergency. The most vital distinction is whether there is blood loss sufficient to cause shock.

Minimal blood loss

If this is not the case, the patient is generally administered a proton pump inhibitor (e.g. omeprazole), given blood transfusions (if the level of hemoglobin is extremely low, that is less than 8.0 g/dL or 4.5–5.0 mmol/L), and kept NPO, which stands for "nil per os" (Latin for "nothing by mouth", or no eating or drinking) until endoscopy can be arranged. Adequate venous access (large-bore cannulas or a central venous catheter) is generally obtained in case the patient suffers a further bleed and becomes unstable.

Significant blood loss

In a "hemodynamically significant" case of hematemesis, that is hypovolemic shock, resuscitation is an immediate priority to prevent cardiac arrest. Fluids and/or blood is administered, preferably by central venous catheter, and the patient is prepared for emergency endoscopy, which is typically done in theatres. Surgical opinion is usually sought in case the source of bleeding cannot be identified endoscopically, and laparotomy is necessary. Securing the airway is a top priority in hematemesis patients, especially those with a disturbed conscious level (hepatic encephalopathy in esophageal varices patient.) A cuffed endotracheal tube could be a life saving choice.

See also

• Upper gastrointestinal bleeding
• Shock
• Melena
• Coffee ground vomiting

References

External links

• "Vomiting blood". Medical Encyclopedia. University of Maryland Medical Center. 2011. 
• MedlinePlus Encyclopedia Vomiting blood

UpToDate Contents

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• 1. 成人における急性上部消化管出血へのアプローチ approach to acute upper gastrointestinal bleeding in adults
• 2. 小児における上部消化管出血に対するアプローチ approach to upper gastrointestinal bleeding in children
• 3. 成人における上部消化管出血の主要な原因 major causes of upper gastrointestinal bleeding in adults
• 4. 成人における急性下部消化管出血に対するアプローチ approach to acute lower gastrointestinal bleeding in adults
• 5. 最新の診療アップデート practice changing updates

English Journal

• Computer versus physician identification of gastrointestinal alarm features.

• Almario CV1, Chey WD2, Iriana S3, Dailey F3, Robbins K3, Patel AV3, Reid M4, Whitman C5, Fuller G5, Bolus R6, Dennis B7, Encarnacion R7, Martinez B8, Soares J8, Modi R9, Agarwal N9, Lee A3, Kubomoto S3, Sharma G3, Bolus S6, Chang L10, Spiegel BM11.
• International journal of medical informatics.Int J Med Inform.2015 Dec;84(12):1111-7. doi: 10.1016/j.ijmedinf.2015.07.006. Epub 2015 Jul 26.
• OBJECTIVE: It is important for clinicians to inquire about "alarm features" as it may identify those at risk for organic disease and who require additional diagnostic workup. We developed a computer algorithm called Automated Evaluation of Gastrointestinal Symptoms (AEGIS) that systematically collec
• PMID 26254875

• Trends in upper gastrointestinal diagnosis over four decades in Lusaka, Zambia: a retrospective analysis of endoscopic findings.

• Kayamba V1, Sinkala E2, Mwanamakondo S3, Soko R4, Kawimbe B5, Amadi B6, Zulu I7, Nzaisenga JB8, Banda T9, Mumbwe C10, Phiri E11, Munkonge P12, Kelly P13,14.
• BMC gastroenterology.BMC Gastroenterol.2015 Oct 6;15(1):127. doi: 10.1186/s12876-015-0353-8.
• BACKGROUND AND AIMS: There a shortage of robust information about profiles of gastrointestinal disease in sub-Saharan Africa. The endoscopy unit of the University Teaching Hospital in Lusaka has been running without interruption since 1977 and this 38-year record is largely intact. We report an anal
• PMID 26444265

• Spontaneous Paraesophageal Hematoma.

• Yan J1, Walker C1, Chalasani P2.
• ACG case reports journal.ACG Case Rep J.2015 Oct 9;3(1):29-30. doi: 10.14309/crj.2015.91. eCollection 2015.
• Spontaneous paraesophageal hematoma (SPH) likely shares a common etiology with spontaneous intramural esophageal hematoma (IEH). Patients with IEH typically present with hematemesis or melena leading to early detection and management, but patients with SPH do not have overt gastrointestinal bleeding
• PMID 26504872

Japanese Journal

• 穿孔性腹膜炎を契機に発見され消化管出血をきたした壁外発育型胃ＧＩＳＴの１例

• 佐野 文,国枝 克行,松橋 延壽,田中 千弘,長尾 成敏,河合 雅彦
• 日本臨床外科学会雑誌 70(7), 1981-1986, 2009
• GISTの予後不良因子に，腫瘍径，転移，臓器浸潤，腫瘍破裂，播種，不完全切除などがあげられる．われわれは穿孔，出血をきたした肝転移を伴う胃GISTの1例を経験したので報告する．症例は69歳，男性．2007年7月頃から心窩部不快感を自覚していたが，11月末に心窩部痛，コーヒー残渣様嘔吐を認め，当院に紹介された．腹部CTにて少量の腹腔内遊離ガス像，胃壁外に17cm大の腫瘍性病変，多発肝転移を認めた．胃 …
• NAID 130004517321

• Hamartoma of Brunner's glands causing massive haematemesis

• KOURAKLIS G
• Scand J Gastroenterol 29, 841-843, 1994
• NAID 30030704671

• 肝細胞癌と悪性リンパ腫併存の1例:―悪性リンパ腫胃転移の経過観察例―

• 岩波 栄逸,松村 暢之,山口 直行,八橋 弘,井上 長三,古賀 満明,矢野 右人
• 日本消化器内視鏡学会雑誌 33(5), 956-961_1, 1991
• 症例は63歳,男性.1989年6月1日肝腫瘤とAFP高値の精査を目的に当科入院となった.基礎疾患に肝硬変が存在し,腹部CTおよび肝動脈血管造影の所見は多発性肝細胞癌を示したので,肝動脈内SMANCS注入療法を2回施行した.しかし,後日遠隔転移をきたし効果は不良であった.9月18日胃の小潰瘍から出血し吐血をみたが,内視鏡上同潰瘍は急速に増大,中心陥凹を伴う粘膜下腫瘍の形態(牛眼像)に至るとともに,周 …
• NAID 130004253159

Related Links

• Hematemesis - Wikipedia, the free encyclopedia

Hematemesis or haematemesis is the vomiting of blood. The source is generally the upper gastrointestinal tract. Patients can easily confuse it with hemoptysis ( coughing up blood), although the latter is more common.

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