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Haematemesis : Definition , Causes and Differential Diagnosis

Haematemesis is a serious symptom that is caused usually by a serious disease and it is considered a medical emergency .

Definition
Vomiting of blood. 

Causes 
I. Oesophageal Causes: 
- Rupture oesophageal varices.
- Oesophageal erosions due to GORD.
- Carcinoma of the oesophagus .
- Mallory-Weiss syndrome: oesophago-gastric tear .

- Rupture of aortic aneurysm into the oesophagus.

II. Gastro-Duodenal Causes: 
-Acute gastritis & acute gastric ulcers especially due to drugs as NSAIDs & cortisone and stress (stress ulcer). 
- Chronic peptic ulcer whether gastric or duodenal.
- Hiatus hernia, if associated with GORD & oesophagitis.
- Cancer stomach & rarely cancer ampulla of Vater. 
- Peutz-Jeghers syndrome: G.l. polyposis & pigmentation.
- Angiodysplasia of the stomach.  

III. Small intestinal causes:
- Angiodysplasia in the small intestine .
- Small intestinal tumors as adenocarcinoma.
- Ulcers complicating prolonged use of NSAIDs.
- Familial adenomatous polyposis.
- Typhoid ulcers..

IV. General Causes: 
- Haemorrhagic blood diseases. 
- Haemorrhagic fevers as Rift valley fever.
- Severe hypertension.

V. False Haematemesis: 
Ingestion of blood after bleeding from the nose, mouth or Pharynx then vomiting of this blood.

Differential Diagnosis 

  •  Differentiation from haemoptysis .
  • Differentiation from false haematemesis by local examination .
  • Differentiation of the cause through:
  1. Good history.
  2. Physical examination.
  3. Oesophago-gastroduodenoscopy .
  4. Enteroscopy.
  5. Capsule endoscopy 
  6. Barium follow-through for small intestirie.
  7. Liver functions & ultrasonography.
  8. Isotope studies & angiography. 
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Tamer Mobarak

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