5. Haematemesis Flashcards
The consultant asks you to calculate Mr Tucker’s Blatchford score. What is the Blatchford score and how does it differ from the Rockall score?
Regarding the presenting complaint and systematic enquiry?
Regarding past medical history, medications, social history?
- General inspection?
- Abdominal palpation?
- DRE?
Mr Tucker is jaundiced and has signs of recent IV drug use, and several tattoos. He is thin, but not cachectic. He has palmar erythema and at least 10 spider neavi over his chest and shoulders. A DRE is unremarkable.
You should arrange for the following investigations:
1. Viral hepatitis and HIV serology: Given Mr Tucker’s tattoos and evidence of IV drug use, he should be screen for viral hepatitis and HIV. He should also be informed you are screening for this.
2. Urinalysis: Mr Tucker has low albumin so you should rule out proteinuria, which would suggest a nephrotic syndrome.
What forms of imaging could be used if endoscopy failed to reveal the source of bleeding? (2)
- Angiography: A femoral catheter is sited and used to inject a constrast agent into the coeliac axis and superior mesenteric artery. In this way, actively bleeding vessels can be visualised.
- Laparotomy: In some cases, especially with posterior peptic ulcers, it is necessary to proceed to laparotomy to visualise and stop the bleeding.
The endoscopy is performed and reveals a bleeding, distended esophageal vein in the distal oesophagus. How will the gastroenterologist manage the bleeding esophageal varix?
Outline the blood supply to the nose?
List 8 risk factors for peptic ulcer disease?
Why are alcoholics particularly vulnerable to haematemesis?
What is the Child-Pugh score used for?
Can you draw a simplified clotting cascade?
3 Indications for packed red cell blood transfusion in adults?
List 10 possible complications of blood transfusions.
