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
Investigations to consider
- creatinine kinase
- creatinine kinase-MB
- troponin
- ECG
- angiography
Treatment algorithm
Contributors
Authors
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
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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