[PEMPHIGUS TREATED BY CORTICOIDS: HEMATEMESIS. ACTION OF INTRAVENOUS CORTICOTHERAPY ON THE HEMATEMESIS. ACTION OF SODIUM OXYFERRISCORBONE ON THE PEMPHIGUS].
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2,3-Diketogulonic Acid↗
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[HEMATEMESIS OF RARE CAUSES, OF DIFFICULT DIAGNOSIS, AND CRYPTOGENETIC HEMATEMESIS].
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Diagnosis, Differential↗
[Severe repeated hematemesis during chronic pancreatitis; gastrectomy as last resort; cure of the hematemesis].
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Gastrectomy↗
[Hematemesis. Extramural emergency].
Hematemesis is the cardinal sign of upper gastrointestinal bleeding. It is a sign related to numerous affections, with a prognosis depending on the underlying lesion, the degree of bleeding, the accompanying disease and other risk factors. Mortality rates are generally close to 10%, although if hematemesis is secondary to variceal bleeding, as high as 30%. 65% of hemorrhages subside spontaneously, but 25% bleed recurrently (after initial cessation) and in 10% bleeding persists. Three quarters of all renewed bleeding occurs within two days after the initial hemorrhage. If hematemesis occurs outside a hospital, rapid evaluation is required to assess the necessity of emergency transport and treatment. In the case of severe to moderate bleeding, life-support measures and rapid transport to the nearest hospital are of primary importance and all measures complicating diagnosis and treatment in the hospital should be avoided. Patients with mild hematemesis, stable cardiovascular parameters and no risk factors can be investigated and, if appropriate, treated, on an out-patient basis. If the cause of hematemesis cannot be found, aggressive, inpatient investigations are required at the first sign of second bleed. Endoscopy is the primary investigative procedure for hematemesis. The success rate is highest if endoscopy is performed within the first 36 hours of the onset of bleeding. There are indications that aggressive diagnosis and therapy, including endoscopic hemostatic interventions, can reduce hematemesis mortality.
Adult↗
Usefulness and validity of diagnostic nasogastric aspiration in patients without hematemesis.
STUDY OBJECTIVE: We estimate the test characteristics of nasogastric aspiration to diagnose upper gastrointestinal tract hemorrhage in patients without hematemesis. METHODS: In this retrospective cohort study, medical records from patients admitted to 2 urban hospitals between 1997 and 2002 for gastrointestinal tract bleeding without hematemesis were reviewed. Positive nasogastric aspiration results were classified by the severity of hemorrhage, and negative results were classified by the presence or absence of bile. The reference standard for nasogastric aspiration was the source of bleeding-upper versus non--upper gastrointestinal tract--from the hospital discharge summary. Confidence intervals (CIs) for proportions and likelihood ratios (LRs) were calculated. RESULTS: Of 333 eligible patients, 235 were offered nasogastric aspiration, and 220 accepted the test. Results of 220 attempts were distributed as follows: negative, 158 (72%), including 9 (4%) with bile; nasogastric aspiration aborted, 13 (6%); and positive, 49 (23%), including 4 (2%) that were strongly positive (> or =450 mL red blood). Test characteristics of nasogastric aspiration to detect upper gastrointestinal tract bleeding in 213 patients with a reference standard diagnosis were as follows: sensitivity 42% (95% CI 32% to 51%), specificity 91% (95% CI 83% to 95%), negative predictive value 64% (95% CI 56% to 71%), and positive predictive value 92% (95% CI 79% to 97%). The nasogastric aspiration accurately predicted the source of bleeding in 66% of patients (95% CI 59% to 72%). The likelihood ratio of a positive nasogastric aspiration was 11 (95% CI 4 to 30), and the likelihood ratio of a negative nasogastric aspiration was 0.6 (95% CI 0.5 to 0.7). CONCLUSION: In patients without hematemesis, a positive nasogastric aspiration, seen in 23%, indicates probable upper gastrointestinal tract bleeding (LR+ 11), but a negative nasogastric aspiration, seen in 72%, provides little information (LR- 0.6).
Aged↗
Hepatitis and hematemesis complicating nicotinic acid use.
Nicotinic acid has a proven efficacy in the treatment of hypercholesterolemia. Therapeutic use of this water-soluble B vitamin has resulted in a survival benefit among patients enrolled in the Coronary Drug Project. Conversely, nicotinic acid has been associated with a high side-effect profile when used at therapeutic doses. Nevertheless, there are no previously reported cases of hematemesis temporally associated with nicotinic acid use. The authors report the case of a previously healthy 20-year-old man who developed hematemesis and hepatitis 1 week after self-initiating the daily consumption of 6 g of nicotinic acid. Supportive therapy and discontinuing nicotinic acid resulted in rapid clinical improvement in this patient. The clinical circumstances suggest a possible causal relationship between nicotinic acid consumption and his presenting problems. The use of large doses of nicotinic acid may be rapidly complicated by hematemesis and hepatitis.
Adult↗
[Treatment of hematemesis and hematochezia in elderly patients].
Hematemesis and hematochezia (melena) in elderly patients are serious symptoms which should be carefully handled since they can lead to death without suitable treatment. In elderly patients the advance of arteriosclerotic changes throughout the body decreases blood flow and function in various organs. When these arteriosclerotic changes become prominent in the gastric vascular structure, bleeding from gastric ulcers tends to easily occur and it can be difficult to stop. A large amount of bleeding can cause irreversible shock due to the decreased cardiopulmonary function, and diminished hepatorenal capacity would also be a decisive factor in determining the outcome of the state of shock. Once hemorrhage happens, it is of great importance to properly evaluate the general conditions of the patient and to perform adequate measures with special emphasis on the pathophysiological characteristics of elderly patients. In recent years the causes of bleeding in the gastrointestinal (GI) tract have changed, and various new medical methods to control hemorrhage, such as endoscopic sclerotherapy, have been developed and widely applied in elderly patients. The present lecture describes clinical aspects, including these up-to-date topics, which are closely based on daily practices. During the past 6 years (from 1984 through 1989) we have experienced in our affiliated hospitals, 1,611 patients who developed hematemesis or/and hematochezia, out of which 554 patients were aged more than 65. The pathogenesis, treatment and outcome of these patients were analyzed in detail. With regard to the cause of hematemesis in elderly patients, gastric ulcer ranked top (47%).(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
[A case of juvenile esophageal cancer with hematemesis].
We here report a case of juvenile esophageal cancer which developed with a chief complaint of hematemesis. The case was a 36-year-old male patient who was admitted to the hospital because of dysphagia and repeated hematemesis episodes. Through various imaging studies, the patient was diagnosed as having advanced esophageal carcinoma. Since it was considered to be impossible to perform a curable surgical treatment, we tried, using a Laser apparatus, to alleviate the stenosis of the esophageal lumen and to control the bleeding from the cancerous lesion. However, an operation was finally performed after observing that the Laser therapy had not been so effective. Hematemesis is an uncommon symptom among primary complaints of esophageal cancer. The present case developed a protuberant cancerous mass which considerably obstructed the esophageal lumen. It is speculated that the patient repeatedly vomited blood which had gradually originated from ruptured capillary vessels in the tumor and had accumulated in the esophageal lumen. The histological type of the cancer was poorly-differentiated squamous cell carcinoma which partially contained an undifferentiated element. This histological nature might have accelerated the growth of the esophageal cancer in the present case.
Adult↗
Esophageal tuberculosis: a rare presentation with massive hematemesis.
A 43-year-old female presented with massive hematemesis. Esophagoscopy showed an ulcer 22 to 25 cm from the incisor with active bleeding. A thoracotomy and primary closure of the ulcer was performed. Massive hematemesis recurred 8 days later, resulting in hypovolemic shock. The thoracic esophagus was resected and histological examination showed granuloma with central caseous necrosis. Combined chemotherapy was given for 10 months. At 6 months after the subtotal esophagectomy, the esophagus was reconstructed using the right-side colon.
Adult↗
Esophagitis in infants with hypertrophic pyloric stenosis: a source of hematemesis.
This study was undertaken to clarify the source of blood in the vomitus of patients with hypertrophic pyloric stenosis (HPS). Twenty-one infants with HPS were examined. Hematemesis was noted in 14 infants. Esophagogastric endoscopy showed a 100% incidence of esophagitis and in one patient gastric erosion was also observed. Histological study of the esophageal mucosa showed evidence of esophagitis in 18 patients (85.7%). Preoperative pH monitoring showed gastroesophageal reflux (GER) in all infants. Excessive acid exposure (> or = 7%) was significantly correlated with the grade of esophagitis and the incidence of hematemesis, whereas acid exposure time was shorter in the cases without histological esophagitis. These results suggested that the source of bleeding in HPS is the esophageal mucosa affected by esophagitis secondary to excessive acid reflux. Although there is obvious massive gastroesophageal reflux in HPS, it is too difficult to evaluate the lower esophageal sphincter function in HPS.
Esophagitis, Peptic↗
[AIDS and non Hodgkin's malignant lymphoma disclosed by massive hematemesis].
A 40-year-old man was admitted for a major haemorrhage from the upper gastro-intestinal tract. An emergency gastrectomy was performed to control the bleeding. The histopathological study revealed a non-Hodgkinian lymphoma associated with an AIDS, which had remained unknown. The postoperative period was complicated by several infections. The patient died 2 1/2 months after the hematemesis. Such major haemorrhage from the upper gastro-intestinal tract as the presenting symptom of AIDS is very rare, although this has been described during the course of the disease. This case illustrates the importance in reminding operating theater staff (anaesthetists, surgeons, nurses) of the risk of viral contamination when treating a young patient with hematemesis and the necessity of wearing gloves, face masks and glasses.
Acquired Immunodeficiency Syndrome↗
Primary malignant melanoma of the esophagus presenting with massive hematemesis.
A 66-year-old Japanese man was admitted to our hospital, presenting with massive hematemesis. Emergency endoscopy revealed a bleeding tumor at the esophagogastric junction. The endoscopic appearance of the tumor was that of a Borrmann 2-like tumor, with a brownish-black discoloration. Bioptic histology confirmed the diagnosis of malignant melanoma. Atypical melanocytes with junctional changes were also found at a small pigmented patch in the lower esophagus, separate from the gross tumor. Melanocytosis was noted in the adjacent esophageal epithelium in the resection specimen following surgery. No primary lesion was found elsewhere, even in the patient's skin. These pathologic findings support the possibility of multicentric occurrence of malignant melanoma in esophageal melanocytosis. The patient is alive 11 months later, with multiple liver metastases. Massive hematemesis is an unusual presentation of primary malignant melanoma of the esophagus.
Aged↗
Epistaxis as a cause of hematemesis and melena.
Epistaxis was diagnosed in 10 patients with apparent upper gastrointestinal bleeding, comprising a 0.55% incidence of hematemesis and melena in the population studied. A sufficient amount of blood can be swallowed during epistaxis to cause hematemesis and melena. Recent facial trauma or epistaxis, absence of a history of chronic dyspepsia, and impairment of blood coagulation emerge as strong indicators of the diagnosis and should lead to a careful examination of the nose and nasopharynx for the source of bleeding.
Adult↗
Mediastinal bronchial artery aneurysm with hematemesis.
Mediastinal bronchial artery aneurysm is a rare condition which can lead to potentially fatal hemorrhage. In most cases it presents respiratory symptoms due to rupture into pleural parenchyma. But when it develops mediodorsally and compresses the esophagus, it may cause dysphagia or hematemesis. Here we report a case of mediastinal bronchial artery aneurysm which presented with hematemesis. Computed tomography and endoscopic ultrasound showed what seemed to be a submucosal tumor on the esophagus. We were able to correctly diagnose the aneurysm using magnetic resonance imaging and probe thoracoscopy, and were able to successfully treat with transluminal artery embolization.
Aneurysm, Ruptured↗
Fibronectin, platelet factor 4 and beta-thromboglobulin in endemic hepatosplenic schistosomiasis: relation to acute hematemesis.
Some platelet alpha-granule contents were assessed in parallel with other markers of hemostatic imbalance in 50 patients with hepatosplenic schistosomiasis (15 patients with compensated hepatosplenomegaly, 15 patients with advanced hepatic fibrosis and ascites and 20 patients during an acute attack of hematemesis from ruptured esophageal varices). Platelet factor 4 (PF4), beta-thromboglobulin (beta-TG), fibronectin (FN), prothrombin fragment 1 + 2, thrombin-antithrombin (TAT) complexes, fibrin degradation products (FbDP) and D-dimer were assessed in schistosomal patients compared to controls (15 healthy subjects). A significant increase in both thrombin (high TAT and prothrombin fragment 1 + 2 levels) and plasmin (high FbDP and D-dimer levels) generation was detected in decompensated patients establishing the presence of a steady state of low-grade disseminated intravascular coagulation, with and without overt bleeding, in these patients. A decrease in plasma FN concentration was found in diseased groups compared to controls. The reduction in plasma levels of FN paralleled the defective liver function and matched the relative decrease in tissue FN in liver specimens of decompensated patients suggesting that FN levels can be used to evaluate the pathological staging of the disease. A significant increase in beta-TG and PF4 levels was noted in decompensated patients with ascites and/or acute hematemesis compared both to controls and compensated patients reflecting platelet alpha-granule release and consequently increased in vivo platelet activation which may initiate and/or perpetuate the pathophysiological mechanisms of the hemostatic imbalance underlying the hemorrhagic diathesis in hepatosplenic schistosomiasis.
Acute Disease↗
Hematemesis in infants induced by cow milk allergy.
This study was conducted in order to analyze the clinical manifestations, the endoscopic findings, the histology of the gastrointestinal mucosa, the treatments and the clinical course in infants who had hematemesis induced by cow milk allergy. The medical records were reviewed retrospectively. The criteria for the diagnosis of CMA included elimination of cow milk formula resulting in improvement of symptoms, specific endoscopic and histologic findings as well as the exclusion of other causes. Twenty-three infants with a diagnosis of hematemesis were analyzed, which included 20 infants with CMA and 3 infants with gastroesophageal reflux disease (GERD). In the CMA group were 12 girls and 8 boys whose ages were 4.3 +/- 1.4 months. The onset of vomiting after starting cow milk formulas was 70.6 +/- 48.9 days. Gastroduodenoscopy was performed on 15 patients showing erythema, erosion and friability of the gastric mucosa in all patients and lymphoid hyperplasia in the duodenal bulb in 7 patients. Eight patients had mild to moderate eosinophilic infiltration and 5 patients had eosinophilia. Cow milk formulas were changed to other formulas: two children were initially given extensively hydrolyzed casein formulas and later followed by a soy formula, 14 were given a soy formula and 4 were given partially whey hydrolyzed formulas. All patients showed clinical signs of improvement a few days later. Patients that were able to tolerate cow milk were 1.5 +/- 0.9 years old. During the follow-up period (2.6 +/- 1.8 years after treatment) 4 patients were diagnosed with asthma, 4 patients with chronic respiratory symptoms, 4 patients with constipation and 2 others with food allergies. CMA induced gastritis in infancy may not be classified as eosinophilic gastritis because of the low level of eosinophilic infiltration. The elimination of cow milk and subsequent substitution with a soy formula is the proper management.
Animals↗
Duodenal atresia presenting as hematemesis in a premature infant with Down syndrome. Case report and review of the literature.
Congenital duodenal obstruction, a common complication of Down syndrome, most often presents as neonatal bilious vomiting. We report the first premature infant with Down syndrome whose duodenal atresia presented with a massive hematemesis secondary to duodenitis. Since a plain radiograph of the abdomen is diagnostic in the case of duodenal obstruction, it should be included in the diagnostic workup of hematemesis in newborn infants.
Down Syndrome↗
The Bouveret syndrome: an unusual cause of hematemesis.
Gallstones are usually silent. Less commonly, patients with cholelithiasis develop symptoms and/or complications; biliary fistula occurs in 3% to 5% of the cases. When a large stone is passed and occludes the duodenum, gastric outlet obstruction (the Bouveret syndrome) may result. In reported cases, the stones are usually larger than 2.5 cm. The usual presenting symptoms are those of bowel obstruction: abdominal pain, nausea, and vomiting. Less commonly, the patients experience melena and, rarely, hematemesis. We describe a patient who had the largest stone reported to cause hematemesis rather than bowel obstruction and to be diagnosed endoscopically. The 5 X 4 X 3 cm stone was extracted surgically. Endoscopic diagnosis and extraction of stones up to 3 cm in size has been reported, avoiding the need for surgery.
Aged↗