$Unique_ID{BRK01985} $Pretitle{} $Title{Hematemesis: Causes and Treatments} $Subject{Hematemesis cause Causes treat treated treatment Treatments liver vomit vomiting blood bleed bleeding stomach ulcer ulcers cancer cancers cancerous irritate irritation irritations gastritis esophagus esophageal varices heart vein veins vessel vessels toxic injury injuries injured damage damaged damages damaging infect infection infections hepatitis chemical chemicals detoxify detoxifying alcohol abuse abusing scar scars scarring fiber fibers fibrous tissue tissues cirrhosis varicose diet diets propranolol medicine medicines medication medications surgery surgeries surgical Sclerotherapy operate operation operations portacaval shunt shunts} $Volume{} $Log{ Normal Fatty and Cirrhotic Livers*0009701.scf What Causes Cirrhosis of the Liver*0009702.scf} Copyright (c) 1993 Tribune Media Services, Inc. Hematemesis: Causes and Treatments ------------------------------------------------------------------------------ QUESTION: I am a faithful reader of your column. I have learned a lot. Would you please write about hematemesis and the architecture of the liver. What causes the problem? What can be done? Thank you for any information you can provide me. ------------------------------------------------------------------------------ ANSWER: The definition of hematemesis is simple, it means "vomiting blood". It may be easy to identify when the vomitus is red, occurring when there is brisk bleeding. In some cases it looks like coffee grounds, for the acid in the stomach changes the color of the blood to black. Such bleeding may result from a stomach ulcer, a cancer in the stomach, acute irritation of the lining of the stomach (gastritis), a tear in the esophagus, or a condition known as esophageal varices. Since you have also asked about the liver, it is this last condition that you are concerned with, for it is a change in the structure of the liver that is the primary cause of the varices, and the bleeding. Normally much of the blood returning to the heart through the veins passes through the liver. There it may be "cleaned", as one of the most important functions of the liver is to chemically change toxic substances so that they can not harm the body. However, when the liver itself has been injured by infection (hepatitis), toxic chemicals, or overworked detoxifying alcohol (alcohol abuse), it reacts by scarring, forming fibrous tissue that changes the shape and structure of the liver. This condition is known as "cirrhosis of the liver". When the scarring becomes extensive, blood no longer flows easily through the liver, and seeks a new path back to the heart. It now flows through veins that run in the wall of the esophagus, stretching them beyond their normal size, creating varices. It is very similar to the condition you can observe in the leg, when the veins there are enlarged and swollen (varicose veins). These distended veins can be easily bruised and damaged by the food passing from the mouth to the stomach, and may rupture and bleed. The escaping blood then passes into the stomach and may be thrown up, and seen as hematemesis. If the damage to the liver can be reversed, it is possible that the normal pathway for the blood can be restored. Treatment depends upon the cause of injury to the liver, by withdrawing the drug or chemical that is responsible for the damage, abstinence from alcohol (when that is the cause) and providing a nutritious diet to the patient. However, if the condition is advanced beyond recovery, there are some treatments that can be tried to reduce the flow through the veins in the esophagus. Some reports reveal that the use of propranolol may reduce the pressure in these veins, and reduce the possibility of bleeding. If medications fail, then there are still some surgical alternatives to turn to. Sclerotherapy consists of injecting a substance in the esophageal veins that cause them to scar, sealing the passage to the flow of blood. There is also an operation that reroutes the blood coming to the liver, to the large vein that leads to the heart. This is called a portacaval shunt, and leads much of the blood around the liver. This is a difficult operation, and is not without its own complication. Be aware that acute hematemesis in the presence of esophageal varices is considered a medical emergency and requires immediate and intensive treatment in a hospital environment. ---------------- The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician. Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.