Tumour-like growth of small blood vessels in and beneath the skin, nearly always found in children. There are three main kinds: the strawberry mark or naevus, capillary haemangioma and cavernous haemangioma. Strawberry marks almost always occur on the face or the neck, are present at birth and result from severe dilation of the capillaries, causing a pale to dark pink patch not raised above the skin; they can cover a large area. Unfortunately little can be done about them. Surgery or radiation leaves ugly scars; the only possibility is camouflage with make-up. A capillary haemangioma is also made up of dilated capillaries, but occurs after birth as a small red swelling which in a short time can become several centimetres across, and then usually starts to shrink spontaneously. By the age of five 80 per cent of tumours of this sort have disappeared, sometimes leaving a small scar. Thus the only treatment is to wait; otherwise the remarks about strawberry marks apply. A cavernous haemangioma is a cluster of severely dilated veins or arteries under the skin, forming a large, bluish spongy swelling which can occur anywhere on the body. They do not disappear spontaneously, and the only treatment is to remove them in their entirety by surgery. Haematemesis (vomiting blood) Associated with a condition in the upper part of the alimentary tract, usually the oesophagus, stomach or duodenum. It is important to differentiate between vomiting blood and coughing blood (haemoptysis). In vomiting the blood is almost always partly digested and looks brown. It is bright red only in the case of a sudden, severe haemorrhage. A possible difference can be that in haematemesis acid gastric juices are mixed with the blood, whereas if it comes from the lungs it is often foaming. Also in haematemesis the quantity is usually greater than if the blood comes from the lungs. In a condition of the alimentary tract blood is often visible in the faeces. The most important causes of haematemesis are haemorrhage of the stomach or duodenum, usually when an existing stomach ulcer eats its way into a larger blood vessel, or damage to the wall of the stomach by drugs such as aspirin, particularly if used in conjunction with alcohol. The disorder is less commonly the result of cancer of the stomach or oesophagus, or varicose veins of the oesophagus, and is very occasionally associated with conditions unconnected with the alimentary tract, such as defective blood clotting. The location and cause of the haemorrhage can usually be established by endoscopy (examination with a flexible tube attached to a light source). Treatment is usually by waiting until the haemorrhage is over, often in hospital to ensure thorough observation and the availability of blood transfusions. It can be decided only later if an operation is necessary.

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