Bleeding from Mouth (Haematemesis)

 

(This article contain many medical terms and for medical related students and doctors. Free to share. No copy writes. Its my personal study and research.)

ACUTE GASTROINTESTINAL BLEEDING:

It is the most common emergency situation and can cause death of victim within few hours. According to 2006 data, 50-150 admission of hospital per 100 000 of population of United Kingdom came to emergency department for this bleeding. We are going to discuses some golden points about this. According to South African Medical Journal ISSN 0256-9574, the following incidence rate for surgical requirement and its management for Hematemesis is given below

CLINICAL PRESENTATION:

Some doctors believe that it is the treatment which is of more important value compared to engaging patient into diagnostic tests. Clinically diagnosed patient should be treated on major fronts immediately. Those signs and symptoms which every man should know about are given as follows;

1) Haematemesis, may be with clots , bleeding profusely from mouth. Profuse black coffee ground appearance of vomitus is very rare, though more dangerous than the previous one.

2) Black stool or Melena is another common presentation of Gastrointestinal area.

3) Third important sign is >15 points rise of pulse and >20 point down fall of systolic blood pressure on immediately changing the position, called as Orthostasis. It indicates small quantity (15-20%) of blood loss.

MANAGEMENT OF GASTROINTESTINAL BLEEDING:

1) The first step is IV fluid of Ringer Lactate or Normal Saline resuscitation using large bore cannula

2) Check out A,B,C (Airway, breathing, Circulation, Temperature, blood pressure, pulse rate, etc)

3) Send the blood sample for CBC, PT, and in case cross match.

4) Find out any Liver abnormality, stigmata, hepatosplenomegaly, or decompromised cirrhosis.

5) If PT is elevated, immediately start Fresh Frozen plasma. Vitamin K work too slowly in this regard, so less effective.

6) Octreotide is added in treatment to control portal hypertension and developing cirrhosis.

7) Naso-gastric tubing, which is used first for diagnostic purpose can be helpful for therapeutic purpose too e.g. in putting saline solution into the bleeding site.

8) Endoscopy is used only for finding out etiology of disease.

9) Though in more than 85% of patients, spontaneous bleeding resolve by itself, yet Proton Pump Inhibitors and H2- receptor blockers add effectiveness to the treatment plane.

10) Sclerotherapy, emergency endoscopy and TIPS (Trans-jugular Intra hepatic Porto-systemic Shunting) are the surgical techniques to stop bleeding.

11) Black-more Tube to temponade the site of bleeding in stomach or esophagus is rarely used now a days.

12) Beta blockers, propronol is however gaining more and more space in stooping bleeding from varicose.

DIAGNOSIS:

1) Endoscopy, for finding out etiology of bleeding. Endoscopic picture of Gastrointestinal bleeding is as follows

2) Barium studies and Barium Follow through.

3) Biopsy, only after endoscopy.

4) Angiography

5) Nuclear bleeding scan (NBS)

6) Capsual Endoscopy

7) and Virtual Endoscopy of this disease.

ETIOLOGY AND IT PREVENTION:

The most common cause is Peptic Ulcer, both NSAID induced and H.pylori induced.

Gastric Erosion by NSAID, Alcohol.

Oesophagitis

Portal Vein thrombosis

Liver diseases.

Retching (Mallory Weiss tear)

Aortic graft

Vascular malformation.

Adopt healthy Lifestyle to prevent from Peptic Ulcer, avoid spicy things and try to use healthy, controlled and suitable balanced diet. Use of anti-inflammatory repose decrease their values. Recent studies also shows that alcohol use for any thing is also very dangerous.

Mallory Weiss tear uses surgery for control.

REFERENCES:

Davidson book of Medicine, 20th Edition

Medplus website

Atlas of Gastrointestinal bleed.

Principles of Gastrointelligent

International Journal of Royal college for gastrointology

SAJM, JPMA,