Haematemesis Flashcards
Differentials for haematemesis
oesophagitis/gastritis/duodenitis bleeding peptic ulcer oesophageal varices mallory-weiss tear oesophageal cancer gastric cancer arteriovenous malformations trauma vascular angiodysplasia
Scoring systems used for upper GI bleeds
Blatchford
Rockall
What is the blatchford score
used to stratify patients into low and high risk groups, 1 to 6
used in triage to assess management for haematemesis
independent of endoscopy findings
what is the rockall score
more comprehensive than blatchford
used to predict risk or re bleeding and mortality
based on age, shock, co-morbidities and endoscopy findings
history of haematemesis
how much blood was vomited?
what was the character of the vomit? e.g. fresh blood or not
blood in the stool?
did forceful vomiting trigger the haematemesis?
recent weight loss?
problems swallowing?
easy bruising, distended abdomen, puffy ankles, lethargy?
epigastric pain?
things to consider in drug history
anticoagulants
regular NSAIDs, steroids or bisphosphonates
methotrexate, amiodarone - live toxicity
beta-blockers
Inspecting the patient: look for
tattoos, track marks, piercings - viral hepatitis
jaundice, palmar erythema, ankle oedema - signs of liver disease
pupura - ITP or liver disease
thoracic-abdominal scar - AAA repair
cachexia - malignancy
palpitation: look for
hepatomegaly - liver disease
splenomegaly - portal hypertension
epigastric tenderness - peptic ulcer disease, gastritis/duodentitis
epigastric mass/virchows node - malignancy
what is malaena?
upper GI haemorrhage and digestion of blood in transit
what is haematochezia?
fresh blood in stools - lower GI haemorrhage
typical blood panel in liver disease
macrocytic anaemia low albumin raised liver enzymes - ALT, AST raised bilirubin raised GGT prolonged clotting times raised urea
methods of visualising bleeds
endoscopy
angiography
laparotomy
management methods of varices
band ligation sclerotherapy balloon tamponade TIPSS laparotomy
long term management of portal hypertension
lifestyle advice
keep BP low, drugs
antibiotics
treat encephalopathy
risk factors for peptic ulcer disease
helicobacter pylori infection smoking and alcohol NSAIDs blood group O hypercalcaemia physiological stress burns or brain trauma
