5. Haematemesis Flashcards
What does each component of the A to E response stand for?
Airway Breathing Circulation Disability: GCS/ AVPU Exposure
List 3 common and 3 rarer differentials for haematemesis?
Oesophagitis
Bleeding peptic ulcer
Oesophageal varices
Mallory weiss tear
Oesophageal cancer
Gastric cancer
What are the blatchford and rockall scores?
Blatchford: stratifies patients presenting to hospital with haematemesis, guides management
Rockall: predicts risk of re-bleeding + mortality
What questions should you ask about the presenting complaint in a patient with haematemesis?
How much blood?
Character of the vomit? (colour of blood)
Blood in stool?
Did forceful vomiting trigger the haematemesis?
Recent weight loss or problems swallowing?
Signs of liver failure? (bruising, distended abdo., puffy ankles)
Epigastric pain?
What 6 features in PMHx are important in a patient with haematemesis?
Previous upper GI haemorrhage Heartburn or epigastric pain History of GORD Aortic repair with grafts (aorto enteric fistula) Bleeding tendency Chronic liver disease
List 8 drugs that are important to ask about in a patient with haematemesis
Anticoagulants Regular NSAIDs Aspirin Clopidogrel Steroids Bisphosphonates Drugs causing liver toxicity: methotrexate, amiodarone B blockers
What are 10 signs of liver disease?
Jaundice Scratch marks Bruising Spider naevi Palmar erythema Dupuytren's contracture Gynaecomastia Ascites Ankle oedema Caput medusa
What measurement defines shock? What are 4 immediate actions to be taken?
BP < 90/60 mmHg
High flow O2 15L/mn
IV Fluid resus. 250ml aliquots crystalloid solution
Send bloods
Give blood if: blood on DRE or shock despite fluid resus.
What process is haematemesis usually due to?
Bleeding in the UPPER GIT
If varices is the suspected cause of haematemesis, what should you include in your initial management? Why?
Terlipressin: ADH agonist causes splanchnic vasoconstriction, reducing mesenteric blood flow
Prophylactic antibiotics
Which patients presenting with haematemesis have indication for emergency endoscopy?
Unstable patients with severe acute upper GI bleeding immediately after resus.
Suspicion of continuing bleed
Blatchford score >,6
Other than OGD which other investigations may be considered for haematemesis?
Chest radiograph- perforated peptic ulcer/ boerhaaves
CT chest/ abdo- in those with aortic graft
What should you establish in a SHx of a patient with haematemesis?
Excess alcohol consumption
Smoking
IV drug use/ tattoos
What 4 features may be present on palpation in haematemesis?
Hepatomegaly: liver disease
Splenomegaly: portal HTN
Epigastric tenderness: PUD/ gastritis
Epigastric mass/ virchows node: malignancy
List 5 treatment strategies for bleeding oesophageal varices
Endoscopic band ligation
Endoscopic sclerotherapy
Balloon tamponade: pressure induces haemostasis
Transjugular intrahepatic portosystemic shunt (TIPS)
Portosystemic shunt
