Haematemesis Flashcards
What are the differentials for haematemesis?
Oesophagitis/gastritis/duodenitis
Bleeding peptic ulcer (gastric or duodenal)
Oesophageal varices
Mallory–Weiss tear
Oesophageal cancer
Gastric cancer
Arteriovenous malformations
Bleeding diathesis
Trauma to oesophagus or stomach
Vascular angiodysplasia in oesophagus or stomach
Boerhaave’s oesophageal perforation
Haemobilia
Aorto-enteric fistula
What vascular angiodysplasias in the oesophagus/stomach can lead to haematemesis?
Dieulafoy lesion
Scleroderma
Hereditary haemorrhaigc telangiectasia
What is the Rockall score?
Score used to predict the risk of rebleeding and mortality in patients with upper GI haemorrhages
Based on age, shock status and comorbidities
What techniques are used to stop upper GI bleeding?
Endoscopic band ligation
Endoscopic sclerotherapy
Balloon tamponade
Transjugular intrahepatic portosystemic shunt
Portocaval shunt
What is a transjugular intrahepatic portosystemic shunt?
Th is complex procedure involves passing a catheter down the jugular vein and creating a shunt from a hepatic vein to the portal vein to relieve the portal hypertension. If this is not possible, a portosystemic (aka portocaval) shunt can be
placed surgically
What is a portocaval shunt?
This surgical technique involves placing a shunt between the portal and systemic circulation, thus bypassing the liver
and reducing the portal hypertension that is causing the oesophageal varices.