Haematemesis Flashcards
What is the most common cause of haematemesis?
Duodenal and gastric ulceration
What is haematemesis?
Vomiting blood - bleeding from upper portion of the GI tract
What are the emergency causes of haematemesis?
Oesophageal Varices
Gastric ulceration
What are non-emergency causes of haematemesis?
Mallory-Weiss tear
Oesophagitis
Gastritis, gastric malignancy, Meckel’s diverticulum or vascular malformations (e.g. Dieulafoy lesion)
What are oseophageal varcies?
Porto-systemic venous anastomoses in the oseophagus with most underlying cause being portal hypertension form alcoholic liver disease.
What is gastric ulceration and what it’s clinical features in the context of haematemesis?
Ulceration usually in lesser curvature or posterior duodenum which leads to erosion into blood vessels supplying the upper GI tract (causing significant haemorrhage).
Known active ulcer disease/H.pylori positive, history of NSAIDs or steroid use, pervious epigastric symptoms.
What is Mallory-Weiss tear?
Tear in the epithelial lining of the oseophagus following episodes of severe or recurrent vomiting which are followed my minor haematemesis.
Often resolve spontaneously but if prolonged or worsening haematemesis the OGD may be required.
What is oseophagitis and what are some of its causes?
Inflammation of the intraluminal epithelial layer of the oseophagus.
Most often due to GORD
Less commonly due to infection (e.g. Candida albicans), medication (e.g. Bisphosphonates), radiotherapy, crohns diseases or ingestion of toxic substances.
What is important to establish in history of haematemesis?
Timing, freq an volume of bleeding
History of dyspepsia, dysphagia or odynophagia
PMH, smoking and alcohol status
Use of steroids, NSAIDs, anticoagulants or Bisphosphonates
What is should be done on examination of pt presenting with haematemesis?
Epigastric tenderness Or peritonism
Potential underlying cause e.g . Varices or liver stigmata
What are the investigations that should be requested in haematemesis?
Routine bloods
VBG
Group and save and cross match if significant blood loss
Oseophagogastroduodenoscopy (OGD) - within 12hrs and also forms part of management in ongoing unstable bleeding.
Erect CXR - perforation? - pneumoperitoneum
What additional investigation can be ordered to assess any active bleeding in an unstable pt esp if endoscopy was unremarkable or patient too unwell to undergo invasive procedure, in haematemesis?
CT abdomen with IV contrast
What scoring system may used to assess the risk of pts admitted with an upper GI bleed?
Glasgow-Blatchford Bleeding score - ≥6 have been associated with >50% risk of needing an intervention.
What is the initial management of haematemesis?
ABCDE - insert two large bore IV cannulas and start fluid resuscitation if needed and cross match blood.
Most case will need OGD
What is the management of peptic ulcer disease if it is the cause of haematemesis?
Injections of adrenaline and cauterisation of the bleeding.
High dose IV PPI therapy (e.g. IV 40mg omeprazole) to reduce acid secretion +/- H.pylori eradication therapy.
Angio-embolisation
