Haematemesis other

Question 1

Haematemesis management for a patient waiting for endoscopy (5)

Answer 1

Regular observation, NBM, fluids, Pro-kinetic (empties the stomach), thiamine if malnourished to prevent wernickes encephalopathy.

Question 2

Haematemesis other forms of imaging?

Answer 2

Angiography; Active bleeding vessels can be visualised.

Laparotomy; To visualise peptic ulcers.

Question 3

Haematemesis methods for stopping oesophageal varices?

Answer 3

Endoscopic band ligation, Endoscopic sclerotherapy, Balloon tamponade, Transjugular intrahepatic portosystemic shunt (TIPS, relieves portal hypertension).

Question 4

Haematemesis long term management?

Answer 4

Lifestyle advice: stop smoking and drinking.

Lower BP: minimise the chance of oesophageal varices, propranolol or isosorbide mononitrates (if asthma)

Antibiotics: 1 week e.g. ciprofloxacin for liver cirrhosis with upper GI bleeding.

Treat encephalopathy.

Question 5

Haematemesis peptic ulcer disease risk factors?

Answer 5

H. Pylori, smoking, alcohol, NSAIDs and aspirin, hypercalcaemia, stress.