Haematemesis and malaena Flashcards
What is haematemesis
vomiting of blood from the upper GI tract
coffee ground vomit?
good sign
blood is starting to clot
2 most common causes of haematemesis
oesophageal varices
peptic ulcer disease bleed
what is malaena
black tarry stool produced in the presence of UGI bleed
oxidation of iron as it passes through colon
What might you seen if the UGI bleed is severe enough
fresh PR bleed
RF for PUD
>50yo NSAID use H pylori alcohol smoking steroids radiation excess acid production
other causes of haematemesis
Gastritis
Mallory Weiss tear
oesophagitis
vascular abnormalities
what is Boerhaave syndrome
oesophageal rupture secondary to vomiting
SC emphysema
very rare
Scoring systems for haematemesis
Blatchford score - pre-endoscopy, intervention if >0
Rockall - post-endoscopy score
What happens in a major haemorrhage protocol
Call 2222 and state major haemorrhage in ward ‘x’
red cell transfusion
FFP if deranged LFT
platelet transfusion
if patient is on warfarin - prothrombin complex
do you give patients PPI before endoscopy
don’t have to but usually is done
treatment of bleeding PUD at endoscopy
clips +- adrenaline OR
thermocoagulate + adrenaline
Interventional radiology
IV PPI post endoscopy
management of variceal (oesophageal and gastric) bleed at endoscopy
vasopressors - terlipressin
oes varices - band ligation, TIPS
gastric varices - endoscopic injection of n-butyl-N-cyanoacetate, TIPS
do you give antibiotics for any variceal bleed?
yes alongside terlipressin
catastrophic bleed management
balloon tamponade to stop both oes +or gastric varices
what prophylaxis is given for varices
long term prophylactic non-selective B blocker
what is a Mallory Weiss Tear
longitudinal tear at GOJ induced by repetitive and strenuous vomiting
streaks of blood
self limiting
prevention of bleed
eradicate H pylori avoid NSAIDs (use PPI alongside if necessary)
how many classes of shock are there
4
what is the first sign of shock
DBP start to rise and then SBP and DBP drop
young people tolerate blood loss better, true or false
true, better than older people
urea increases in upper/lower GI bleed
upper
initial investigations for haematemesis
FBC - anaemia U+E - AKI LFT - CRP urea amylase G+S coagulation - INR, PT, APTT ECG cannula IV fluid abdominal exam lifestyle PPIs, swap NSAID for paracetamol erect CXR - perforation
when would you give a blood transfusion
<7 and asymptomatic
or if symptomatic and >7
how long do you stop PPI before H pylori test
2 weeks
what lab result will be raised in an UGI bleed
urea
management of H. pylori infection
PPI + amox + clar/met
PPI + clarithromycin + met
