Hematemesis physical examination

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Hematemesis Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor-In-Chief: John Fani Srour, M.D.

Signs

• Signs of liver disease (ascites, hepatomegaly, telangiectasia, etc)
• Any esopho-gastric symptoms, such as nausea, vomiting, and epigastic tenderness may indicate peptic ulcer disease.
• Dark colored, tar like stools (a condition known as melena). This usually supports upper GI bleed as opposed to lower GI bleed.
• Any significant psychiatric history or symptoms of severe depression or psychosis may indicate iatrogenic upper GI bleed related to pill esophagitis, foreign body ingestion, or munchausen syndrome by proxy (a reason for recurrent haemtemesis in children).
• Vesicular rash of the lips or the oral cavity may indicate esophagitis related to herpes simplex virus infection.
• Oral thrush in combination with dysphagia and/or odynophagia usually indicate candida esophagitis.
• Associated bleeding in other organs ( skin, mucosal bleed, GU, joints, etc) indicates coagulopathy ( ITP, hemophila, heparin, von willebrand disease, etc).
• Signs of associated congential or inherited disease such as mucosal telangiectasias in hereditary hemorrhagic telangiectasia, intestinal duplication, congenital cysts, etc..
• Facial flushing, intermittent diarrhea, and abdominal pain indicate carcinoid syndrome, a rare cause of upper GI bleed.
• Severe and diffuse upper GI ulcerations with chronic diarrhea usually indicate Zollinger Ellison syndrome or gastrenoma.