Hematemesis

HPI

  • Appearance ( bright red – from esophagus; “coffee grounds” – from lower GI)
  • When? Frequency?
  • How much?
  • What else is happening? – vomiting, illness, etc
  • Pain (ulcer – epigastric)
  • Signs of liver disease (EtOH, hepatitis, jaundice, bruising, ascites, etc)
  • EtOH (gastritis)
  • Epistaxis, hemoptysis, oropharynx
  • GERD (esophagitis)
  • Melena (long duration >12 hours)
  • Anemia – how severe (orthostatic hTN, fatigue, pale, SOB, CP, tachycardia, diaphoresis)
  • Family History



 

Past medical history

  • PUD
    • Risks: NSAIDS, FHx, personal Hx, smoking
  • Prior episodes
  • Alcohol abuse and smoking
  • Hepatic, renal, cardiac, pulmonary or bleeding disorders
  • Systemic illness or major surgery

Medications

  • Predisposing medications (ASA, NSAIDS, anticoagulants

Differential Diagnosis

  • Mallory Weiss tear
  • Varices
  • PUD
  • Gastritis
  • Esophagitis
  • Cancer
  • Trauma
  • Dieulafoy lesion
  • Aorto-duodenal fistula
  • Boerhave’s syndrome (esophageal rupture)

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