The magnitude of acute blood loss and the likely cause of a haematemesis should be determined on clinical grounds. Chronic peptic ulceration accounts for most cases of upper GI haemorrhage. Always check for a history of drug intake, especially aspirin and NSAIDs. Corticosteroids in conventional doses have less influence on GI haemorrhage.
- oesophagitis
- Mallory-Weiss tear
- oesophageal varices
- haemorrhagic gastritis
- peptic ulcer disease
- gastric neoplasms
As a guide, shock in a previously well 70 kg man indicates an acute blood loss of at least 1000–1500 mL (i.e. > 20% of prior circulating blood volume). Initial haemoglobin may be within the reference interval after acute severe haemorrhage.
References
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