Haematemesis

Question 1

Gastric Causes

Answer 1

Peptic Ulcer
Inflammation: gastritis
Gastric Ca

Question 2

Oesophageal Causes

Answer 2

Oesophageal Varicies
Mallory Weiss Tear
Oesophageal Ca
Oesophagitis

Question 3

Haematology Causes

Answer 3

HHT (osler-weber - rendu)

Question 4

Vascular Causes

Answer 4

Aorto-enteric Fistula
Dieulafoy lesion (erosion of arteriole)

Question 5

Iatrogenic Causes

Answer 5

Anticoagulants

Question 6

Other

Answer 6

Peutz-Jegher Syndrome

Question 7

Upper GI bleed Mx

Answer 7

ABCDE Approach

Question 8

Bedside

Answer 8

Obs: low BP, high HR, sgns of hypovolaemia

ECG

ABG: quick idea of Hb level

Question 9

Bloods

Answer 9

FBC, UEs, LFTs, CRP, Amylase, Clotting

Crossmatch, G+S, INR if warfarin

Question 10

Imaging

Answer 10

AXR and erect CXR (perforation)

Question 11

Risk Scoring Systems

- Rockall

Answer 11

Risk of rebleeding (contains diagnosis)
< 3 = low risk
>8 = need for surgery

Question 12

Risk Scoring Systems

- Glasgow Blatchford

Answer 12

Need for Endoscopy

0-1 and stable = low risk, routine OGD

> 2 and stable = intermediate, OGD 24hrs, discuss gastro reg

> 2 and unstable/varices
= urgent reg review, emergency OGD

Question 13

Special Tests

Answer 13

Gastroscopy

- diagnostic and therapeutic

Question 14

RED FLAGS

Answer 14

Hypovolaemia, signs of volume loss