Etiology

Peptic ulcer, esophagogastric varices, angiodyysplasia, arteriovenous malformation, tumor, esophageal (Mallory-Weiss) tear

Hematemesis (vomiting blood) can result from various causes, ranging from mild to life-threatening conditions. Here are the primary categories and their causes:

1. Gastrointestinal (GI) Causes

  • Upper GI Bleeding:

    • Peptic ulcer disease (gastric or duodenal ulcers, often due to H. pylori infection or NSAID use).
    • Esophageal varices (due to portal hypertension, commonly in liver cirrhosis).
    • Mallory-Weiss tear (tear in the mucosa at the gastroesophageal junction, often after severe vomiting).
    • Gastritis or gastropathy (due to alcohol, NSAIDs, or stress).
    • Esophagitis (from GERD or infections in immunocompromised individuals).
    • Dieulafoy lesion (abnormal artery in the stomach wall that can bleed).

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2. Liver Disease and Portal Hypertension

  • Esophageal or Gastric Varices: Enlarged veins that bleed massively.
  • Portal hypertensive gastropathy: Diffuse gastric mucosal bleeding due to increased portal pressure.

3. Trauma or Iatrogenic

  • Trauma to the esophagus or stomach (e.g., endoscopic procedures or ingestion of sharp objects).
  • Complications of surgery or other medical interventions.

4. Systemic Disorders

  • Coagulopathies (e.g., due to liver disease, anticoagulant therapy, or inherited disorders like hemophilia).
  • Disseminated intravascular coagulation (DIC).
  • Severe thrombocytopenia.

5. Malignancies

  • Gastric cancer.
  • Esophageal cancer.
  • Rare tumors (e.g., gastrointestinal stromal tumors, Kaposi sarcoma in HIV).

6. Infections

  • Severe cases of H. pylori-induced ulcers.
  • Fungal or viral esophagitis (e.g., Candida, CMV, or HSV in immunocompromised individuals).

7. Vascular Abnormalities

  • Angiodysplasia (abnormal, fragile blood vessels).
  • Aortoenteric fistula (rare but serious, often secondary to abdominal aortic aneurysm repair).

8. Drug or Toxin-Related

  • NSAIDs or aspirin (causing ulcers or gastritis).
  • Alcohol abuse (causing gastritis, varices, or Mallory-Weiss tears).
  • Corrosive ingestion (acid or alkali).

9. Miscellaneous

  • Severe vomiting leading to mucosal injury (e.g., Boerhaave syndrome).
  • Swallowed blood (e.g., from epistaxis or dental procedures).

Key Considerations:

  • Severity and Color: Bright red blood suggests active bleeding, while "coffee-ground" emesis indicates partially digested blood, often from slower bleeding.
  • Immediate Concerns: Hematemesis can lead to hypovolemic shock and requires urgent evaluation and stabilization.
  • Diagnosis: Upper endoscopy is often the first-line diagnostic tool.

If you or someone you know experiences hematemesis, it is crucial to seek immediate medical attention to determine the underlying cause and begin appropriate treatment.

 

 

 

Hematemesis

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