HAEMATEMESIS - Means BLOOD VOMITING CAUSES Chronic peptic ulcer (duodenal + gastric) Acute peptic ulcer. Acute erosive gastritis (Steroids, NSAIDs). Oesophageal varices. Mallory-Weiss syndrome Carcinoma stomach Gastric polyps, lymphomas, leiomyomas gastropathy.

1. en love da Homoeopathy
HAEMATEMESIS

2. HAEMATEMESIS

3. HAEMATEMESIS
- Means BLOODVOMITING
CAUSES
• Chronic peptic ulcer
(duodenal + gastric)
• Acute pepticulcer.
• Acute erosive gastritis
(Steroids, NSAIDs).
• Oesophageal varices.
• Mallory-Weisssyndrome
• Carcinoma stomach
• Gastric polyps, lymphomas,
leiomyomas
• gastropathy.

4. • Bleeding disorders.
• Pernicious anaemia.
• Thrombocytopenia
• Gastric antral vascular
ectasia
• It is a rare endoscopically
confirmedcondition which
shows segmenteddilated
vessel meshes in the antral
mucosa(watermelon/tiger
stripe stomach).
• It is oftenassociated with
achlorhydria &
hypergastrinaemia.
• It is common in middle aged
females; common in liver
diseases (25%) and
autoimmune connective tissue
disorders.
• Pathologically it shows
mucosal fibromuscular
hyperplasia and hyalinisation.
• Dieulafoy’s disease
• A gastricarteriovenous
malfor mation whichis
covered by apparently
normal mucosa.

5. • It occurs in proximal
stomachnear OG junction
(within 6 cm) along lesser
curve
• Bleeding often may be
severe and torrential
• Vasculitis or atheroma are
absent in the vessel.
• It is 5%of nonvariceal
upper GI bleed.
• A large 1–3 mm tortuous
abnormal submucosal
artery(AVM) is the cause,
whichdue to its pulsation
erodes themucosa to expose
itself to acidwhich further
erodes the artery causing
bleeding

6. INVESTIGATION
• Endoscopy and
endoscopictherapy or
excision of the lesionis
required.
• Angiography can be
done to confirmthe
diseaseand to do
therapeutic embolisation
using gel foam.
.
• Failure of endoscopic or
angiographic therapy needs
gastrotomy& excisionof
the entire lesion—gastric
wedge resection.
• It canbe done by
open/laparoscopic
approach.
• Prior endoscopictattooing is
mandatory to identify the
lesion during resection

7. TREATMENT
• Evaluation of patient by
measuring BP
• Pulse, respirationlooking for
features of shock
• Oxygensaturation,
• investigatingfor Hb%, blood
grouping
• Blood urea, serumcreatinine
• LFT
• Prothrombintime
• Plateletcount
• Arterial blood gas analysis,
• Gastroscopy.
• Initial treatment is
central line insertion,
fluid and blood
replacement;
catheterisation
• critical care (ICU)
• Antibiotics
• Treatment of
complications like sepsis,
DIC, ARDS.
• Specific treatment—
opensurgeryfor
uncontrolled bleeding
• Ligation of
gastroduodenal artery

8. • Underrunning of ulcer bed
with pyloroplasty
• Gastrectomy
• ligation of varices with
devascularisation.
• Definitive surgeryfor
underlying cause—shunt
surgery; vagotomy and GJ;
• Gastrectomy; splenectomy,
etc.
REFERENCE
1. SRB's Manual of Surgery
by SriramBhat M
2. A Manual on Clinical
Surgeryby Das
3. A Concise textbookof
Surgeryby Das

9. A
Special Thanks
To A Very
Special Doctor