Hematemesis (OSCE)
DDx
[edit | edit source]- peptic ulcer disease
- gastritis/gastropathy (NSAID, alcohol, stress related)
- Mallory-Weiss tear
- variceal rupture
- erosive esophagitis
- foreign object
- vascular malformations (Dieulafoy’s lesion, AVMs, aorto-enteric fistula)
- neoplastic disease (esophageal or gastric)
- other
- systemic bleeding disorder
- epistaxis
- hemoptysis
ABCs
[edit | edit source]- hematemesis can be life threatening
Patient ID, CC
[edit | edit source]Vomiting
[edit | edit source]- onset
- precipitant (coughing, forceful vomiting)
- frequency
- characteristics (dry retching and strenuous, protracted)
Vomitus
[edit | edit source]- volume
- color (bright red, dark red, black)
- properties (coffee grounds - specks of congealed blood, pure blood, mixed with stomach contents)
Accompanying symptoms
[edit | edit source]- non GI source → epistaxis, hemoptysis, bleeding in gums/mouth, bruising, petechiae
- gastritis → GERD
- Mallory Weiss tear → strenuous or protracted vomiting
- PUD → dysphagia, odynophagia, retrosternal/epigastric discomfort
- varices → jaundice, ascites, generalized edema
- melena → bleeding > 12 hour old
- Anemia (ominous signs)
- orthostatic lightheadedness, dyspnea, fatigue, edema
- pallor, headache
Medications
[edit | edit source]- NSAID, ASA
- anticoagulants: warfarin, heparin, clopidegrel
PMHx
[edit | edit source]- prior episodes (diagnosis and outcome)
- PUD → smoking and EtOH
- neoplasm, malnutrition, stress ulcers → systemic illness, recent weight loss, major surgery