Hematemesis occurs in which of the following disease?

UPPSC 2023

Medical Surgical Nursing

Easy

Appeared in: UPPSC 2023

Explanation

Hematemesis is the vomiting of blood, indicating bleeding from an upper gastrointestinal (GI) source, such as the esophagus, stomach, or duodenum.
A peptic ulcer is an open sore on the inner lining of the stomach or the upper part of the small intestine (duodenum).
These ulcers can erode into underlying blood vessels, leading to bleeding.
The accumulated blood in the stomach acts as an irritant, triggering vomiting, which results in hematemesis.
The appearance of the vomited blood can be bright red (fresh bleeding) or like 'coffee grounds' (partially digested blood).

Option A: Bleeding associated with lung cancer originates in the respiratory tract and is coughed up, a condition known as hemoptysis, not vomited.
Option B: Tuberculosis of the small intestine typically affects the lower GI tract (ileocecal region). Bleeding from this area presents as melena (dark, tarry stools) or hematochezia (fresh blood in stool), not hematemesis.
Option D: Similar to lung cancer, bleeding from lung tuberculosis originates in the airways and is expectorated (coughed up) as hemoptysis.

Clinical Relevance

Nursing practice connection: Knowing Differential diagnosis of gastrointestinal and respiratory bleeding helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
A nurse's primary responsibility is to quickly differentiate hematemesis from hemoptysis, as this determines the entire course of emergency management, from patient positioning to diagnostic tests (endoscopy vs. bronchoscopy).
For a patient with hematemesis, the nurse must immediately assess for signs of hypovolemic shock (e.g., tachycardia, hypotension, pallor) and establish large-bore IV access for fluid resuscitation.
What if? If the patient had a history of alcoholism and presented with massive hematemesis, the most likely cause would be bleeding esophageal varices, a life-threatening emergency requiring immediate intervention with vasoactive drugs and endoscopy.

How to Approach the Question

First, define the key term 'hematemesis' as the vomiting of blood.
Recall that the source of hematemesis is the upper gastrointestinal (GI) tract (proximal to the ligament of Treitz).
Evaluate each option based on its anatomical location.
Peptic Ulcer is a condition of the stomach/duodenum (upper GI tract) and is a classic cause of bleeding.
Eliminate Lung Cancer and Lung T.B. as they are respiratory conditions; bleeding from the lungs is coughed up (hemoptysis).
Eliminate Small Intestinal T.B. as it affects the lower GI tract, so bleeding would appear in the stool (melena/hematochezia).

Concept Tested & Keywords

Concept Tested: Differential diagnosis of gastrointestinal and respiratory bleeding
Stem keywords: Hematemesis, disease
Lead-in keywords: occurs in

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