Hematemesis, known as bloody vomiting, occurs due to many problems. Bleeding that starts in any part of the digestive system can be life-threatening in a very short time if it cannot be intervened with endoscopy and drugs. For this, it is vital to determine the cause of bloody vomiting. Associate Professor from Memorial Kayseri Hospital Gastroenterology Department. Dr. Mustafa Kaplan gave information about bloody vomiting and treatment methods.
Color indicates the stage of bleeding
Hematemesis is bleeding from the mouth with vomiting. Hematemesis often refers to bleeding originating from the upper gastrointestinal tract, namely the esophagus, stomach and duodenum. Bleeding from the lower small intestine and the large intestine is mostly manifested by red-colored bleeding in the stool. In people with hematemesis, the stage of bleeding can be determined by the color of the vomit. The color of coffee grounds indicates stopped bleeding, which is due to the digestion of blood in the stomach by the effect of hydrochloric acid, dark red vomiting indicates active bleeding, and bright red vomiting indicates a large and rapid bleeding. Bloody vomiting alone may not be significant. Melena is also seen in patients with hematemesis, that is, bloody vomiting. Melena is the name given to the patient's bright or sometimes dull, black and foul-smelling stools, such as tar or coal, as a result of the blood being digested in the intestines.
Peptic ulcer is the most important cause
Peptic ulcer disease may be the most common cause of hematemesis and therefore upper gastrointestinal system (GIS) bleeding. Peptic ulcers are most commonly seen in the first part of the duodenum, and less frequently in the stomach and esophagus. Rarely, injuries to these organs can also cause hematemesis. Cancer is one of the most important causes of hematemesis. Cancers of the stomach, intestines, and esophagus, and in some cases, pancreatic cancers can also cause hematemesis. Bleeding from varices in the esophagus and stomach in patients with cirrhosis is also the cause of serious and life-threatening bleeding. Tears in the esophagus due to severe vomiting and bloody vomiting may occur in pregnant women and people who drink alcohol frequently. Studies have shown that 80% of bleeding stops spontaneously, and 20% of bleeding continues or recurs.
These may be the causes of vomiting blood.
Since 60% of patients with a history of bleeding in the upper gastrointestinal (GIS) system have re-bleeding from the same lesion, patients should be asked about previous bleeding. In addition, the patient's medical history should be strictly reviewed to identify important conditions that may lead to upper GI bleeding or affect the subsequent management of the patient.
Potential causes of bleeding in a patient's medical history to prompt physicians may include:
- Varicose bleeding may occur in a patient with liver disease or a history of alcohol use.
- Bleeding may occur in patients with previous aortic surgery.
- In people with diseases such as kidney disease and aortic stenosis, bleeding due to angioectasia may occur in the stomach and intestines.
- Bleeding due to peptic ulcer disease occurs in a patient with Helicobacter pylori infection, painkiller use, or a history of smoking.
- Bleeding due to gastric-esophageal cancers may occur in patients with a history of smoking and alcohol use or H. Pylori infection.
If there is bloody vomiting, endoscopy should be performed.
Bloody vomiting indicates a serious and urgent situation. These patients should be examined by endoscopy and the source of bleeding should be found. Endoscopy is an important procedure that gives an idea about both diagnosis and treatment and whether the bleeding will recur in the future. Endoscopy is often sufficient to find the source of bleeding, but sometimes these patients are also undergoing examinations such as tomography and ultrasound. Blood values such as blood count and kidney value should also be checked, blood pressure should be monitored and EKG should be taken. Patients in poor condition must be kept under observation in the hospital. Each patient presenting with bloody vomiting should first be given a high dose of drugs that suppress stomach acid. These patients should be kept under observation and these drugs should be continued at high doses for 3-5 days. In patients with nausea and a full stomach, some drugs are given to both stop the nausea and allow the stomach to empty. Patients with varicose bleeding require more specific drugs. Since patients with bloody vomit usually have low blood pressure values, serum therapy should be given to these patients. Because bloody vomiting is a serious condition, these patients are often treated with hospitalization.