The document discusses the causes and management of haematemesis, or blood vomiting, including conditions such as chronic and acute peptic ulcers, gastritis, and various types of gastric malignancies. It emphasizes the importance of endoscopy for diagnosis and treatment, alongside other investigative procedures and potential surgical interventions for severe cases. Initial management includes stabilizing the patient and addressing complications, with a focus on identifying underlying causes for definitive treatment.

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