Haematemesis Flashcards
1
Q
Most common cause of upper GI bleed
A
- Duodenal or gastric ulceration
- Bleeding from site more common than perforation
2
Q
Differentials for haematemesis
A
- Oesophageal varices
- Peptic ulcer disease
- Mallory weiss tear
- Oesophagitis
- Other - gastric/oesophgeal cancer, angiodysplasia
3
Q
Investigations for haematemesis - bloods
A
- Routine inc clotting
- Group and save with urgent crossmatch
4
Q
Definitive investigation to find cause of haematemesis
A
- Oesophagogastroduodenoscopy (OGD)
- If normal, can do CT angiogram
5
Q
How to know how urgent to do endoscopy?
A
Calculate Glasgow Blatchford score - but everyone should have endoscopy within 24hrs
6
Q
Most common vessel to cause upper GI bleeding in PUD
A
- Gastro-duodenal artery bleeds
- Caused by posterior D1 ulcer erosion
7
Q
Approach of patients with haematemesis
A
- A-E assessment
- If haemodynamically unstable need wide bore access and urgent blood transfusion
- Deranged coag corrected, maybe with FFP +/- platelets
8
Q
Management of peptic ulcer disease
A
- Gastroscopy (OGD) with adrenaline injections and cauterisation at site of bleeding
- Followed by high dose IV PPI
9
Q
Management of oesophageal varices bleeding
A
- Prophylactic abx
- Somatostatin analogues - eg terlipressin to reduce splanchnic blood supply
BOTH OF THESE BEFORE ENDOSCOPY - Endoscopic banding can be done
- Sengstaken Blakemore tube can be used if severe - inflate at varices to tamper bleeding
10
Q
When is surgical intervention required with haematemesis?
A
- If non-responsive to initial management
- Ongoing GI bleeds, unstable, requiring repeated transfusions
- Endoscopic and interventional treatment has failed
11
Q
Surgery for haematemesis
A
Surgical resection eg gastrectomy
12
Q
Further options if bleeding reoccurs with non-variceal bleeds after IV PPI and adrenaline/cauterisation
A
- Surgery
- Interventional radiology
- Repeat endoscopy
13
Q
Options for non responsive variceal bleeding to bang ligation and tube?
A
- TIPS procedure
