Makindo Medical Notes Comprehensive Medical Encyclopedia | Education for Healthcare Professionals

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Causes of Haematemesis

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Causes	Clinical Features	Investigations	Management
Peptic Ulcer Disease (PUD)	Burning epigastric pain, often relieved by food or antacids Nausea and vomiting Haematemesis (vomiting blood) or melena (black tarry stools) History of NSAID use or H. pylori infection	Upper GI Endoscopy: To directly visualize ulcers and determine the source of bleeding. H. pylori Testing: Urea breath test, stool antigen test, or biopsy during endoscopy. Full Blood Count (FBC): To assess for anaemia due to blood loss.	Proton Pump Inhibitors (PPIs): To reduce gastric acid production and promote healing. Eradication of H. pylori: Combination antibiotic therapy if H. pylori is present. Endoscopic Therapy: Haemostasis techniques like clipping, injection therapy, or thermal coagulation for active bleeding. Surgery: Considered if bleeding is refractory to medical and endoscopic treatment.
Esophageal Varices	Severe haematemesis, often massive Signs of chronic liver disease (jaundice, ascites, spider angiomas) History of alcohol abuse or viral hepatitis	Upper GI Endoscopy: To visualize varices and confirm the source of bleeding. Liver Function Tests (LFTs): To assess liver function and underlying cirrhosis. Coagulation Profile: To evaluate clotting status, as coagulopathy is common in liver disease. Ultrasound/Doppler: To assess portal hypertension and liver architecture.	Endoscopic Band Ligation or Sclerotherapy: To control bleeding from varices. Vasoactive Drugs: Such as octreotide or terlipressin to reduce portal pressure. Prophylactic Antibiotics: To prevent bacterial infections in patients with cirrhosis. Transjugular Intrahepatic Portosystemic Shunt (TIPS): Considered in cases of recurrent or uncontrolled variceal bleeding.
Mallory-Weiss Tear	Haematemesis following repeated vomiting or retching History of alcohol use, eating disorders, or severe coughing Epigastric pain or discomfort	Upper GI Endoscopy: To visualize the mucosal tear, usually at the gastr oesophageal junction. CBC: To assess for anaemia if significant blood loss has occurred.	Supportive Care: Including intravenous fluids and blood transfusion if necessary. Endoscopic Therapy: Haemostasis techniques may be required if bleeding persists. Acid Suppression: PPIs to reduce gastric acidity and promote healing.
Gastritis/Gastropathy	Epigastric pain, nausea, and vomiting Haematemesis, especially in severe cases History of NSAID use, alcohol use, or stress (e.g., critically ill patients)	Upper GI Endoscopy: To visualize inflammation, erosions, or bleeding in the stomach lining. CBC: To check for anaemia due to chronic blood loss. H. pylori Testing: To determine if H. pylori infection is present.	Proton Pump Inhibitors (PPIs): To reduce acid production and allow the stomach lining to heal. Discontinuation of NSAIDs: Or switch to a less harmful alternative if NSAIDs are the cause. Eradication of H. pylori: If infection is present. Alcohol Cessation: For alcohol-induced gastritis.
Esophagitis	Heartburn, regurgitation, and dysphagia (difficulty swallowing) Haematemesis, especially in severe or erosive oesophagitis History of gastr oesophageal reflux disease (GERD), ingestion of caustic substances, or pill-induced injury	Upper GI Endoscopy: To evaluate the extent of oesophagitis and identify any bleeding lesions. CBC: To assess for anaemia in cases of significant blood loss. Barium Swallow: Sometimes used to assess swallowing function and oesophageal structure.	Proton Pump Inhibitors (PPIs): To reduce acid reflux and promote healing of the oesophagus. Lifestyle Modifications: Such as dietary changes, elevating the head of the bed, and weight loss for GERD management. Addressing Underlying Causes: Such as switching medications if pill-induced oesophagitis is suspected.
Malignancy (Gastric or Esophageal Cancer)	Progressive dysphagia, weight loss, and early satiety Haematemesis or melena in advanced cases History of smoking, alcohol use, or chronic GERD	Upper GI Endoscopy with Biopsy: To visualize and biopsy suspicious lesions. CT Scan: To assess the extent of disease and metastasis. CBC: To check for anaemia and other blood abnormalities.	Surgical Resection: For localized tumours if feasible. Chemotherapy and/or Radiation: Depending on the stage and type of cancer. Palliative Care: To manage symptoms in advanced or inoperable cases.

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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