Case history
Case history #1
A 48-year-old man presents to the ER after several episodes of vomiting blood following periods of forceful retching and vomiting. He had been binge drinking alcohol over the preceding 2 days.
Case history #2
A 64-year-old man presents to the ER after 4 episodes of vomiting over the past 2 days. He describes the appearance of the vomit as resembling coffee grounds. Black, tarry stool was seen during rectal exam; however, no other physical findings were seen.
Other presentations
Typically, hematemesis follows any event that provokes a sudden rise in pressure gradient across the gastroesophageal junction, such as retching, vomiting, coughing, or straining. Other less-common symptoms include melena, hematochezia, syncope, atypical chest pain with interscapular radiation (may indicate tear or rupture of the esophagus), epigastric abdominal pain, and back pain. Rarely, it may present with signs of anemia (pallor, shortness of breath, and/or dyspnea on exertion). Massive upper gastrointestinal bleeding is an unusual presentation. However, massive hemorrhage requiring blood transfusion, and even leading to death, has been described.[3][4][5]
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