Last reviewed: April 2018
Last updated: March  2018

Summary

Definition

History and exam

Other diagnostic factors

  • light-headedness/dizziness
  • postural/orthostatic hypotension
  • dysphagia
  • odynophagia
  • pain
  • melaena
  • haematochezia
  • shock
  • signs of anaemia

Risk factors

  • condition predisposing to retching, vomiting, and/or straining
  • chronic cough
  • hiatal hernia
  • retching during endoscopy or other instrumentation
  • significant alcohol use
  • previous instrumentation
  • age 30 to 50 years
  • male sex
  • aspirin or other NSAIDs ingestion
  • hiccups
  • blunt abdominal trauma
  • cardiopulmonary resuscitation
  • primal scream therapy

Diagnostic investigations

1st investigations to order

  • Full blood count (FBC)
  • urea
  • liver function test
  • Prothrombin time/International normalized ratio (PT/INR)
  • Partial thromboplastin time (PTT)
  • Chest x-ray (CXR)
  • oesophagogastroduodenoscopy
  • cross-matching/blood grouping
Full details

Investigations to consider

  • creatinine kinase
  • creatinine kinase-MB
  • troponin
  • ECG
  • angiography
Full details

Treatment algorithm

ACUTE

Contributors

Authors VIEW ALL

Professor of Medicine

Division of Gastroenterology

Department of Internal Medicine

Huntsman Cancer Institute

University of Utah

Salt Lake City

UT

Disclosures

DGA declares that he has no competing interests.

Dr Douglas Adler would like to gratefully acknowledge Dr Shilpa Reddy and Dr Juan Carlos Munoz, the previous contributors to this topic. SR and JCM declare that they have no competing interests.

Peer reviewers VIEW ALL

Professor of Medicine

Department of Medicine and Therapeutics

Director

Institute of Digestive Disease

The Chinese University of Hong Kong

Hong Kong

Disclosures

JS declares that he has no competing interests.

Consultant Gastroenterologist

Sandwell General Hospital

Lyndon

West Bromwich

UK

Disclosures

IM declares that he has no competing interests.

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