SYMPTOMS

What is hematemesis?

Hematemesis refers to the vomiting of blood from the mouth^[1], often caused by diseases. The blood may appear dark red, purplish-red, or brownish like coffee grounds, without foam, and may be mixed with food residue or stomach acid.

Common upper gastrointestinal diseases include reflux esophagitis, esophageal diverticulitis, esophageal cancer, peptic ulcers, acute erosive hemorrhagic gastritis, and gastric cancer. Systemic diseases such as allergic purpura, cirrhosis, epidemic hemorrhagic fever, hemophilia, systemic lupus erythematosus, and leukemia may also cause hematemesis.

What other symptoms may accompany hematemesis?

Hematemesis may occur alone or alongside the following symptoms:

• **Abdominal pain**: Chronic upper abdominal pain, recurrent with a certain periodicity and rhythm, often suggests peptic ulcers^[1]. In middle-aged or elderly individuals, chronic upper abdominal pain without a clear pattern, accompanied by loss of appetite, weight loss, or anemia, may indicate gastric cancer.
• **Hepatosplenomegaly**: Enlarged spleen may suggest cirrhosis^[1]. Liver pain, hepatomegaly with a hard texture, and an irregular or nodular surface often indicate liver cancer.
• **Jaundice**: If accompanied by jaundice, fever, and systemic skin or mucosal bleeding, it may be caused by infectious diseases such as sepsis. Fever, chills, and right upper abdominal colic may suggest biliary tract diseases.
• **Skin or mucosal bleeding**: Often associated with blood disorders or coagulation dysfunction.
• **Dizziness, thirst, blurred vision, cold sweats**: May indicate insufficient blood volume, possibly leading to hemorrhagic shock^[1].
• **Melena**: If accompanied by black stools, it may be caused by gastrointestinal bleeding.

TREATMENT

How to relieve hematemesis?

For minor hematemesis, the following measures can be taken:

• Quit smoking and alcohol promptly to avoid damaging the gastrointestinal mucosa.
• Maintain a positive mindset and avoid excessive stress.
• In cases of heavy bleeding, anti-shock measures and rapid blood volume replenishment are required:
• Stay in bed and ensure smooth breathing; oxygen therapy may be used if there is a sense of suffocation.
• Under a doctor’s guidance, receive intravenous fluids or blood transfusions^[1].

What should hematemesis patients pay attention to in daily life?

• Maintain oral hygiene: Since hematemesis can contaminate the mouth and promote bacterial growth, rinse frequently with warm water.
• Monitor the patient’s condition closely. Seek immediate medical attention if breathing difficulties or confusion occur.
• Patients in the acute phase should fast. After vomiting blood stops, consume liquid foods like porridge or rice soup, while avoiding spicy and irritating foods.

DIAGNOSIS

Under what circumstances should a patient with hematemesis seek medical attention?

If a small amount of hematemesis occurs, prompt medical attention is required.

If a large amount of hematemesis occurs, seek immediate medical attention.

Which department should a patient with hematemesis typically visit?

Gastroenterology.

If the patient experiences significant hematemesis, emergency care is necessary.

What tests are required for a patient with hematemesis?

The diagnosis is based on the patient's symptoms, medical history, and the following examinations:

• Complete blood count and occult blood test: Persistent or recurrent bleeding with an unclear cause after routine endoscopy (including gastroscopy and colonoscopy) can be classified as occult or overt bleeding. The former manifests as recurrent iron-deficiency anemia and positive fecal occult blood tests, while the latter presents as visible bleeding such as hematemesis, melena, or hematochezia.
• Gastroscopy: This allows visualization of the esophagus, stomach, and descending duodenum to identify the bleeding site and determine the cause in 90% of cases. It is the best method for diagnosing upper gastrointestinal bleeding^[2].
• Imaging tests: X-ray barium meal contrast studies help detect lesions missed by endoscopy and bleeding-prone gastrointestinal arteries^[3].
• Biopsy: For lesions identified during endoscopy, a biopsy should be performed when malignancy is suspected, provided the patient's condition permits, to confirm the nature of the lesion.

POTENTIAL DISEASES

What are the possible causes of hematemesis?

There are many causes of hematemesis, the most common being peptic ulcers, cirrhosis complicated by esophageal and gastric variceal rupture, acute erosive hemorrhagic gastritis, and upper gastrointestinal tumors^[3].

• Esophageal diseases: such as esophageal injury, esophageal ulcers, esophageal cancer, esophageal diverticulitis, Mallory-Weiss tears, and aortic aneurysm rupture into the esophagus^[3].
• Gastroduodenal diseases: such as polyps, gastrointestinal stromal tumors, hemangiomas, foreign bodies, and postoperative biliary tract injuries^[3].
• Systemic diseases: Conditions that can affect the entire digestive tract, such as hemophilia, idiopathic thrombocytopenic purpura, leukemia, and Henoch-Schönlein purpura^[3].