Introduction

Haematemesis, also known as vomiting blood, is a medical condition characterized by the presence of blood in vomit. It is a potentially serious symptom that may indicate an underlying medical condition^[1]. The aim of this guide is to provide a comprehensive overview of the diagnostic steps, possible interventions, and patient education related to haematemesis.

Codes

• ICPC-2 Code: D14 Haematemesis/vomiting blood


• ICD-10 Code: K92.0 Haematemesis

Symptoms

• Vomiting blood: The presence of blood in vomit, which may range from bright red to dark and coffee-ground-like in appearance^[2].


• Nausea and vomiting: Feeling of nausea and recurrent episodes of vomiting^[3].


• Abdominal pain: Discomfort or pain in the abdominal region^[4].


• Weakness and fatigue: Feeling weak and tired^[5].


• Pale skin: Skin appears pale due to decreased blood volume^[6].

Causes

• Peptic ulcers: Open sores that develop on the lining of the stomach or upper part of the small intestine^[7].


• Esophageal varices: Enlarged veins in the lower part of the esophagus, usually caused by liver cirrhosis^[8].


• Mallory-Weiss tear: Tear in the lining of the esophagus or stomach, often caused by severe vomiting or retching^[9].


• Gastritis: Inflammation of the stomach lining^[10].


• Gastroesophageal reflux disease (GERD): Chronic acid reflux that causes irritation and inflammation of the esophagus.


• Esophagitis: Inflammation of the esophagus, often caused by acid reflux or infections.


• Gastric or duodenal ulcers: Open sores that develop on the lining of the stomach or upper part of the small intestine.


• Cancer: Tumors in the esophagus, stomach, or other parts of the gastrointestinal tract.


• Medications: Certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or blood thinners, may increase the risk of haematemesis.

Diagnostic Steps

Medical History

• Gather information about the patient’s symptoms, including the frequency and duration of haematemesis episodes.


• Inquire about any previous medical conditions, such as peptic ulcers, liver disease, or gastrointestinal disorders.


• Assess the patient’s medication history, including the use of NSAIDs or blood thinners.


• Ask about any recent trauma or injury to the abdominal region.

Physical Examination

• Perform a thorough physical examination, including vital signs, abdominal palpation, and assessment of the gastrointestinal system.


• Look for signs of anemia, such as pale skin or conjunctiva.


• Check for signs of liver disease, such as jaundice or enlarged liver.


• Assess for signs of gastrointestinal bleeding, such as melena (dark, tarry stools) or hematochezia (bright red blood in the stool).

Laboratory Tests

• Complete blood count (CBC): To assess for anemia and evaluate the blood cell counts.


• Liver function tests: To evaluate liver function and assess for liver disease.


• Coagulation profile: To assess the blood’s ability to clot and rule out bleeding disorders.


• Electrolyte levels: To evaluate the patient’s fluid and electrolyte balance.


• Blood type and crossmatch: To prepare for potential blood transfusion if needed.

Diagnostic Imaging

• Upper gastrointestinal endoscopy: A flexible tube with a camera is inserted through the mouth to visualize the esophagus, stomach, and upper part of the small intestine.


• Abdominal ultrasound: To assess the liver and other abdominal organs for abnormalities.


• CT scan or MRI: To obtain detailed images of the gastrointestinal tract and identify any tumors or structural abnormalities.

Other Tests

• Stool occult blood test: To check for the presence of blood in the stool.


• Helicobacter pylori testing: To determine if the bacteria H. pylori is present, which is associated with peptic ulcers.


• Esophageal manometry: To measure the pressure and movement of the esophagus.


• Capsule endoscopy: A small capsule with a camera is swallowed to visualize the entire gastrointestinal tract.

Follow-up and Patient Education

• Schedule a follow-up appointment to discuss the results of the diagnostic tests and determine the appropriate treatment plan.


• Educate the patient about the importance of adhering to prescribed medications and lifestyle modifications.


• Provide information on potential complications and when to seek immediate medical attention.


• Encourage the patient to maintain regular follow-up appointments for monitoring and further evaluation.

Possible Interventions

Traditional Interventions

Medications:

Top 5 drugs for haematemesis/vomiting blood:

1. Proton pump inhibitors (e.g., Omeprazole, Pantoprazole):
   
   
   
   • Cost: Generic versions can be $10-$50/month.
   
   
   • Contraindications: Hypersensitivity to the medication.
   
   
   • Side effects: Headache, diarrhea, abdominal pain.
   
   
   • Severe side effects: Severe allergic reactions, liver problems.
   
   
   • Drug interactions: Clopidogrel, methotrexate, digoxin.
   
   
   • Warning: Long-term use may increase the risk of fractures and certain infections.
   
   
   
   


2. H2 receptor blockers (e.g., Ranitidine, Famotidine):
   
   
   
   • Cost: Generic versions can be $10-$30/month.
   
   
   • Contraindications: Hypersensitivity to the medication.
   
   
   • Side effects: Headache, dizziness, constipation.
   
   
   • Severe side effects: Rare, but may include blood disorders or liver problems.
   
   
   • Drug interactions: Warfarin, phenytoin, theophylline.
   
   
   • Warning: Rare cases of allergic reactions or anaphylaxis have been reported.
   
   
   
   


3. Antacids (e.g., Aluminum hydroxide, Magnesium hydroxide):
   
   
   
   • Cost: Over-the-counter options are available at a low cost.
   
   
   • Contraindications: Hypersensitivity to the medication.
   
   
   • Side effects: Constipation or diarrhea, stomach cramps.
   
   
   • Severe side effects: Rare, but may include kidney problems or electrolyte imbalances.
   
   
   • Drug interactions: Tetracycline, quinolone antibiotics.
   
   
   • Warning: Long-term use may lead to metabolic alkalosis or kidney stones.
   
   
   
   


4. Antiemetics (e.g., Ondansetron, Metoclopramide):
   
   
   
   • Cost: Generic versions can be $10-$50/month.
   
   
   • Contraindications: Hypersensitivity to the medication, gastrointestinal obstruction.
   
   
   • Side effects: Headache, dizziness, drowsiness.
   
   
   • Severe side effects: Rare, but may include movement disorders or serotonin syndrome.
   
   
   • Drug interactions: Serotonergic medications, dopamine antagonists.
   
   
   • Warning: Use caution in patients with a history of seizures or cardiovascular disease.
   
   
   
   


5. Vitamin K:
   
   
   
   • Cost: Over-the-counter options are available at a low cost.
   
   
   • Contraindications: Hypersensitivity to the medication.
   
   
   • Side effects: Rare, but may include allergic reactions or injection site reactions.
   
   
   • Severe side effects: Rare, but may include anaphylaxis or severe allergic reactions.
   
   
   • Drug interactions: Anticoagulant medications.
   
   
   • Warning: Use under the guidance of a healthcare professional.
   
   
   
   

Alternative Drugs:

• Tranexamic acid: An antifibrinolytic medication that helps prevent bleeding.


• Octreotide: A medication that reduces blood flow to the gastrointestinal tract.


• Esomeprazole: A proton pump inhibitor similar to omeprazole.


• Sucralfate: A medication that forms a protective coating over ulcers.

Surgical Procedures:

• Endoscopic therapy: Involves using an endoscope to treat bleeding ulcers or varices.


• Transjugular intrahepatic portosystemic shunt (TIPS): A shunt is placed to redirect blood flow in the liver and reduce pressure in the portal vein.


• Surgical repair: In cases of severe bleeding or structural abnormalities, surgery may be necessary to repair or remove the affected area.

Alternative Interventions

• Acupuncture: May help reduce nausea and improve overall well-being. Cost: $60-$120 per session.


• Herbal supplements: Certain herbs, such as ginger or chamomile, may help alleviate symptoms of nausea and promote digestion. Cost: Varies depending on the specific supplement.


• Hypnotherapy: Can help manage stress and anxiety, which may contribute to symptoms of haematemesis. Cost: $100-$200 per session.


• Mind-body techniques: Practices such as meditation or yoga may help reduce stress and improve overall well-being. Cost: Varies depending on the specific practice.


• Dietary modifications: Avoiding spicy or acidic foods, eating smaller meals, and avoiding alcohol and caffeine may help reduce symptoms. Cost: Varies depending on individual food choices.

Lifestyle Interventions

• Smoking cessation: Smoking can worsen symptoms and delay healing. Cost: Varies depending on