Vomiting of Blood (Hematemesis): Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body weight, height; further:
    • Inspection (viewing).
      • Skin, mucous membranes and sclerae (white part of the eye) [accompanying symptom: pallor (anemia)].
      • Abdomen (abdomen)
        • Shape of the abdomen?
        • Skin color? Skin texture?
        • Efflorescences (skin changes)?
        • Pulsations? Bowel movements?
        • Visible vessels?
        • Scars? Hernias (fractures)?
    • Auscultation of the lungs [due todifferential diagnosis (leading to upper gastrointestinal hemorrhage): hemoptysis (coughing up blood)]
    • Examination of the abdomen (abdomen)
      • Auscultation (listening) of the abdomen [vascular or stenotic sounds?, bowel sounds?]
      • Percussion (tapping) of the abdomen.
        • Ascites (abdominal fluid): phenomenon of fluctuation wave. This can be triggered as follows: if you tap against one flank a wave of fluid is transmitted to the other flank, which can be felt by placing the hand (undulation phenomenon); flank attenuation.
        • Meteorism (flatulence): hypersonoric tapping sound.
        • Attenuation of the tapping sound due to enlarged liver or spleen, tumor, urinary retention?
        • Hepatomegaly (liver enlargement) and/or splenomegaly (spleen enlargement): estimate liver and spleen size.
        • Cholelithiasis (gallstones): tapping pain over the gallbladder region and the right lower ribcage.
      • Palpation (palpation) of the abdomen (abdomen) (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, renal bearing knocking pain?) [Leading symptoms: hematemesis (vomiting blood)] [due todifferential diagnoses (lead to upper gastrointestinal bleeding):
        • Gallstone perforation (rupture of the external bile ducts as a result of a gallstone leading to wall damage, with or without passage of the same) of the duodenum (duodenum).
        • Esophageal varices – varicose veins in the esophagus, usually due to cirrhosis of the liver.
        • Peptic ulcer (ulcer in the gastrointestinal tract caused by hydrochloric acid):
          • Ulcus ventriculi (gastric ulcer).
          • Duodenal ulcer (duodenal ulcer)
          • Ulcus pepticum jejuni (jejunum (empty intestine; one of the three sections of the small intestine; connects to the duodenum (duodenum)).
        • Acute mesenteric ischemia (AMI) or mesenteric infarction – acute occlusion of the blood vessels supplying the intestine]
    • Digital rectal examination (DRU): examination of the rectum (rectum) and adjacent organs with the finger by palpation.
  • Cancer screening

Square brackets [ ] indicate possible pathological (pathological) physical findings.