Haematemesis

Question 1

What are oesophageal varies? What is the most common cause for these?

Answer 1

Dilatations of the porto-systemic venous anastomoses in the oesophagus.
These dilated veins are swollen, thin walled and prone to rupture, with potential to cause a catastrophic haemorrhage.

Caused by portal hypertension resulting from alcoholic liver disease.

Question 2

What is responsible for most cases to haematemesis?

Answer 2

Gastric ulceration

Question 3

Where do ulcers commonly occur?

Answer 3

Lesser curve of the stomach or posterior duodenum

Question 4

What are clues for peptic ulcer disease?

Answer 4

H. pylori positive, hx of NSAID or steroid use, previous epigastric symptoms

Question 5

What is a Mallory Weiss tear?

Answer 5

Episodes of severe or recurrent vomiting followed by minor haematemesis
Forceful vomiting causes a tear in the epithelial lining of the oesophagus resulting in a small bleed.
Most cases are benign and will resolve spontaneously

Question 6

What is oesophagi’s?

Answer 6

Inflammation of the intraluminal epithelial layer of the oesophagus, most often due to GORD… or infections, medication - bisphosphonates, radiotherapy, Crohn’s

Question 7

List causes of haematemesis

Answer 7

Oesophageal varices rupture
PUD
Mallory Weiss tear
Oesophagitis
Gastritis
Gastric malignancy
MEckel's diveriticulum

Question 8

What questions should you ask about haematemesis?

Answer 8

Timing, frequency, volume of bleeding
History of dyspepsia (indigestion), dysphagia, odynophagia (pain swallowing)
PMH, smoking and alcohol
Use of steroids, NSAIDs anticoagulants, bisphosphonates

Question 9

What investigations for haematemesis?

Answer 9

Routine bloods (FBC, U&E, LFT, clotting)
VBG
G&S, X match in significant blood loss

Oesophagogastroduodenoscopy (OGD)

Erect CXR if PUD perforation suspected - for penumoperitoneum

Question 10

How is bleeding PUD treated?

Answer 10

Injections of adrenaline and cauterisation of the bleeding
High dose IV PPI to reduce acid secretion ± H. pylori eradication therpay

Actively bleeding patient can be treated with angio-embolism 0 bleeding vessel is embolism.
Gastro-duodenal artery eroded into by ulcer at back of first part of duodenum

Question 11

How are oesophageal varices treated?

Answer 11

Endoscopic banding
Prophylactic antibiotic therapy
Vasopressors to reduce splanchnic blood flow and reduce bleeding