S4837 Hematemesis Versus Hemoptysis: Identifying Key Differences to Guide Management in GI Bleeding

Introduction: Hemoptysis is defined as coughing up blood from the respiratory tract while hematemesis is vomiting blood from the gastrointestinal tract. The most common causes of hemoptysis include respiratory infections and bronchiectasis. Hematemesis can be caused by peptic ulcers and gastritis. In general, blood from hemoptysis is usually frothy and bright red while hematemesis is dark red with food particles. Knowing whether a patient is having hemoptysis or hematemesis can help guide management in terms of imaging modalities and invasive scopes. Case Description/Methods: A 58-year-old woman with a past medical history of alcohol use, possible hypertension, not on any medications, presented to the emergency room for altered mental status and vomiting. In the emergency room her blood pressure was 66/44, and she was saturating on 99% on room air. Her initial hemoglobin was 4.1 and she was resuscitated with 2 units of packed red blood cells and fluids. She had a large episode of hematemesis while in the emergency department, for which she was intubated for airway protection and massive transfusion protocol was subsequently initiated. Gastroenterology was consulted. The patient was also started on Levophed and vasopressin due to concern for septic shock. She was initially treated with Ceftriaxone, Flagyl, and Vancomycin for possible sepsis and subsequently transitioned to Zosyn. The patient was admitted to the medical intensive care unit for further management. Computed tomography angiography (CTA) of the abdomen/pelvis ordered in the emergency room was notable for an anterior aortic dissection versus intramural thrombus. Vascular surgery was consulted and they thought it was more of a plaque. Gastroenterology was consulted and their endoscopy was notable for a perforated duodenal ulcer. General surgery was consulted and given patients multi organ failure, they recommended gastroenterology to do a possible suture or clip of the ulcer. GI placed 10 clips to repair the ulcer and interventional radiology placed a drain to collect the blood. After having goals of care discussion with family, they opted for comfort care measures and palliative excavation. The patient died the day after admission. Discussion: Identifying that this patient was having hematemesis originating in her GI tract was important for managing her symptoms. A CTA of the abdomen was helpful to determine whether there was an acute bleed in the abdomen. An endoscopy from GI allowed for a diagnosis of a perforated duodenal ulcer and later, clipping of the ulcer.