HEMATEMESIS

Definition

Hematemesis is the vomiting of blood or coffee ground-like material.

Types

• Upper gastrointestinal bleeding (UGIB)
• Lower gastrointestinal bleeding (LGIB)
• Massive bleeding
• Overt bleeding
• Occult bleeding
• Chronic bleeding

Pathology

• Upper GI bleeding is due to:
  • Peptic ulcer disease (PUD)
  • Erosive gastritis
  • Gastroesophageal varices
  • Gastric cancer
  • Duodenal ulcer
• Lower GI bleeding is due to:
  • Diverticular disease
  • Angiodysplasia
  • Inflammatory bowel disease (IBD)
  • Colon cancer
  • Ischemic colitis

Clinical Features

• Vomiting of blood or coffee ground-like material
• Hematemesis
• Melena
• Abdominal pain
• Nausea and vomiting
• Rapid heart rate
• Low blood pressure
• Tachycardia
• Restlessness
• Confusion

Investigations

• Complete blood count (CBC)
• Electrolyte panel
• Blood chemistry panel
• Coagulation studies
• Endoscopy
• Radiographic studies (e.g., CT scan, X-ray)

Complications

• Hemodynamic instability
• Respiratory failure
• Cardiac arrest
• Shock
• Renal failure
• Sepsis

Management

• Resuscitation
• Fluid replacement
• Blood transfusion
• Endoscopic control of bleeding
• Surgery
• Angiographic embolization

Emergency Management

1 → Stabilize the patient with fluids and blood transfusions 2 → Perform endoscopy to control the bleeding 3 → Consider surgery or angiographic embolization if endoscopic control fails

Endoscopic Methods of Control

• Thermal coagulation
• Band ligation
• Injection of sclerosing agents
• Mechanical hemostasis
• Endoscopic clipping

Homoeopathic Therapeutics

• Aconitum napellus: for sudden onset of hemorrhage
• Arsenicum album: for bleeding with burning pain
• Belladonna: for bleeding with intense heat
• China officinalis: for chronic bleeding
• Ferrum phosphoricum: for bleeding with chilliness
• Ignatia amara: for bleeding with anxiety