HAEMATEMESIS CLINACLE FEATURE MANAGEMENT DIAGNOSIS INVESTIGATION

HAEMATEMESIS

   IT IS BLOOD IN VOMITING .IT MAY BE BRIGHT RED OR LIKE COFFEE GROUND .THERE MAY BE PRESENT MELAENA  FOR EXAMPLE  BLACK LIKE TAR COAL  SO CALLED TARRY BLACK COLORED STOOL WITH CHARACTERISTIC SMELL STOOL ARE SEMI SOLID FOLLOWING ARE THE CAUSES OF THE HAEMATEMESIS 

1 PEPTIC ULCER 

2 GASTRIC ERROSIONS 

3 INTAKE OF DRUG FOR EXAMPLE ASPRINE STEROIDS AND NASID

4 ESOPHAGEAL VAR ICES

5 CARCINOMA OF STOMACH 

6 MALLORY WEISS SYNDROME 

7 DOUYDINITIS AND ESOPHAGEAL 

8 BLEEDING DISORDER 

CLINICAL FEATURE      

1 PATIENT LOOK PALE 

2 HE MAY BE SWEATING PROFUSELY COOL AND CLAMMY SKIN 

3 PULSE IS FAST MORE THEN 100/MM AND THREADY 

4 BP MAY BE LOW LESSER THAN 100 MM HG

5 EXCESSIVE BLEEDING MAY LEAD TO SHOCK 

6 URINE OUT PUT IS DECREASES LESSER THAN 30ML/HR 

7 IF BLEEDING IS FROM OSEOPHAGEAL VARICES FEATURE OF LIVER CIRRHOSIS FOR EXAMPLE ASCITES AND SPLENOMEGALY ARE PRESENT 

8 PRESENCE OF MASS EPIGASTRIUM IS SUGGESTIVE  OF CARCINOMA OF STOMACH MAY BE WITH SECONDARY IN LIVER 

9 BOARD LIKE RIGIDITY OF ABDOMEN AND SHOCK LIKE CONDITION IS SUGGESTIVE OF PERITONITIS OR PERFORATED PIPTIC ULCER

MANAGEMENT    

IRRESPECTIVE OF THE  CAUSE FOLLOWING STEP ARE IMMEDIATELY TAKEN 

1 FOOT END OF THE BED IS ELEVATED 

2 IV LINE IS MAINTAINED 

3 BLOOD PLASMA PLASMA EX PANDER NORMAL SALINE OR 5% DEXTROSE DRIP IS IMMEDIATELY STARTED 

4 INJ TRANEXAMIC ACID IGM /6 HR IV FOR 48HR 

5 ANTIEMETIC INJECTION MAXALON OR PLASIL IS GIVEN 

6 ASPIRATION TO ASSESS WEATHER BLEEDING IS GOING ON OR NOT AND TO CLEAR THE STOMACH FROM BLOOD CLOTS 

7 NASOGASTRIC TUBE IS PASSED 

8 VITAL SIGN FOR EXAMPLE BP PULSE AND RESPIRATION IS CHEEKED HALF HR .INCREASED PULSE RATE . MORE THEN 100/MIN  INCREASED RESPIRATORY RATE AND FALLING OF SYSTOLIC B.P LESS THEN 100/MIN HG IS SUGGESTIVE OF CONTINUOUS BLEEDING .

9 OXYGEN MAY BE GIVEN TO CHECK CEREBRAL ANOXIA 

10 IF DESIRED PATIENT CAN BE GIVEN LIQUID OR SEMI SOLID DIET FOR EXAMPLE CHILLED MILK ICE CREAM PUDDING CUSTARD ETC 

11 DEHYDRATION IS AVOIDED BY GIVING IV FLUID .AFTER COMBATING WITH ACTIVE BLEEDING AND SHOCK FOLLOWING STEP ARE TAKEN TO ESTABLISHED THE DIAGNOSIS 

DIAGNOSTIC     POINTS 

1 H/O INTAKE OF ASPRIN NASID AND STEROID IS SUGGESTIVE OF PIPTIC ULCER 

2 H/O INTAKE OF ALCOHOL IS SUGGESTIVE OF GASTRIC LIVER CIRRHOSIS AND PANCREATITIS 

3 PAIN IN EPIGASTRIUM WITH DYSPEPSIA  HEART BURN AND RETROSTERNAL BURNING FOLLOWING INTAKE OF FOOD IS SUGGESTIVE OF PIPTIC ULCER 

INVESTIGATION 

FOLLOWING INVESTIGATION ARE DONE TO ESTABLISH THE DIAGNOSIS 

1 EMERGENCY ENDOSCOPY  IS DONE TO SEE THE SOURCES OF BLEEDING FOR EXAMPLE PEPTIC ULCER ESOPHAGEAL VARIES OR  MALIGNANCY BIOPSY IS TAKEN IF MALIGNANCY IS SUSPECTED 

2 X RAY BARIUM MEAL FOLLOW THROUGH 

3 LIVER FUNCTION TESTES