General: Haematemesis

Question 1

Describe the pathophysiology of haematemesis

Answer 1

Vomiting blood

Bleeding from the upper portion of the GI tract

Question 2

What are the possible causes of haematemesis

Answer 2

Oesophageal varices = dilations of the porto-systemic venous anastomoses in the oesophagus, prone to rupture, underlying cause of portal hypertension (common alcoholic liver disease)

Gastric ulceration = lesser curve of the stomach (splenic artery), posterior duodenum (gastroduodenal artery), H,pylori, NSAIDs

Mallory-Weiss Tear = forceful vomiting causes a tear in the epithelial lining of the oesophagus

Oesophagitis = inflam of intraluminal epithelial layer of the oesophagus, most often due GORD

Question 3

What are the key features to ascertain from a Hx with regards to haematemesis?

Answer 3

Timing, frequency, and the volume of bleeding

History of dyspepsia, dysphagia, or odynophagia

Past medical history and smoking and alcohol status

Use of steroids, NSAIDs, anticoagulants, or bisphosphonates

Question 4

What investigations should be performed for haematemesis?

Answer 4

Bloods = FBC, U+Es, LFTs, and clotting

VBG

Group and save, cross match 4 units

Oesophagogastroduodenoscopy (OGD)

eCXR = if perforated ulcer is suspected

CT abdo with IV contrast = assess any active bleeding in an unstable pt

Question 5

Outline the management for haematemesis

Answer 5

A-E assessment = 2 large bore cannulas, IV fluids

Peptic ulcer disease = adrenaline, cauterisation of bleeding, high dose PPI, H.pylori eradication

Oesophageal varices = endoscopic banding, prophylactic Abx, terlipressin (reduce splanchnic blood flow)

Question 6

What are the possible complications of haematemesis

Answer 6

shock