Gastrointestinal haemorrhage

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Haematemesis (vomiting of blood) can be difficult to recognize. While fresh red blood is easily identified by clients, digested blood is typically a particulate, brown material resembling ‘coffee grounds’ that is not appreciated as blood. Therefore, not explaining the appearance of digested blood is inviting the client to give an inaccurate history. Haematemesis can be due to: lesions in the oesophagus, stomach or duodenum; ingestion of blood from the mouth, nose or lower respiratory tract; coagulopathy. The chapter observes clinical features, diagnosis and treatment of haematemesis, as well as Melaena, Haematochezia and Anaemia and hypovolaemia.

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11.1 Typical appearance of digested blood that has been vomited. Note the ‘coffee-grounds’-like appearance.
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11.2 Flecks of partially digested blood can be detected in vomit due to disruption of mucosal vessels. This disruption was caused by repeated, vigorous vomiting.
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11.3 Vomited material that contains substantial amounts of red blood as well as partially digested blood. Note black material in centre.
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11.4 Basic diagnostic approach to the patient with haematemesis and melaena. ACT = activated clotting time (not available in the UK); ACTH = adreno-corticotropic hormone; aPTT = activated partial thromboplastin time; CBC = complete blood count; NSAID = non-steroidal anti-inflammatory drug; PT = prothrombin time.
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11.5 Normal faeces covered with black digested blood (melaena). Note the red colour as the faecal fluid diffuses out from the faeces.

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