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Monday, 2 December 2013

Hemorrhaging: Hematemesis - Management and treatments

Hemorrhaging is also known as bleeding or abnormal bleeding as a result of blood loss due to internal.external leaking from blood vessels or through the skin.
Hematemesis 
Hematemesis is defined as a condition of either upper gastrointestinal tract fresh blood vomiting or altered blood vomiting due to acid on the blood.
Management and treatments
2.1. Severe blood blood and life threatening
In the study of treatment of hematemesis and hematochezia in elderly patients by Department of Internal Medicine (III) Asahikawa Medical College, 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(11). In this case, Fluids and/or blood is administered, preferably by central venous catheter, and the patient is prepared for emergency endoscopy, which is typically done in theatres. Surgical opinion is usually sought in case the source of bleeding cannot be identified endoscopically, and laparotomy is necessary. Securing the airway is a top priority in hematemesis patients, especially those with a disturbed conscious level (hepatic encephalopathy in oesophageal varices patient.) A cuffed endotracheal tube could be a life saving choice(12).

2.2. Blood loss but not life threatening
In this case, certain medication such as Proton-pump inhibitors (PPIs) to reduce gastric acid production and blood transfusion depending to levels of hemoglobin, no eating until endoscopy can be arranged.
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Sources 
(12) http://en.wikipedia.org/wiki/Hematemesis