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Haematemesis (oxford clin cases) Flashcards

1
Q

How is shock defined medically?

A

BP < 90/60 mmHg

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2
Q

How is shock treated medically?

A

Fluid resuscitation

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3
Q

What are the common causes of haematemasis?

A

Oesophagitis/ duodenitis/gastritis
Varices
Bleeding peptic ulcer

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4
Q

What are some other causes of heamatemasis (asides from common causes)

A

Mallory-Weiss tear
Bleeding of upper GI cancer
Ateriovenous malformation

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5
Q

How may someone with gastric cancer present?

A 
Abdominal pain
Haematemesis 
Dysphagia
Weight loss
Lymphadenopathy
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6
Q

In what patients is gastric cancer more common?

A

Age 50-70
Males
Smokers
Those with a family history

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7
Q

What are first line investigations for gastric cancer?

A

First line= upper GI endoscopy with biopsy
Once diagnosis is confirmed= endoscopic ultrasound to stage and Ct abdomen and pelvis/chest x ray to look for mets

Also do bloods to check for anaemia, LFTs/kidney function incase of mets

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8
Q

How is gastric cancer managed?

A

In early stages there should be surgical resection with perioperative chemo and postop chemoradiation
If a patient does not want surgery then chemoradiation
If late stage then chemoradiation and palliative care eg palliative gastrectomy

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9
Q

What are some risk factors for gastric cancer?

A

Pernicious anaemia
H pylori infection
Diet low in fruits and vegetables

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10
Q

What scoring system may be used to calculate risk of patients with haematemesis deteriorating and to help decide the course of treatment?

A

Blatchford or Rockall

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11
Q

What does fresh blood during haematemasis indicate?

A

Upper GI bleed

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12
Q

What does ‘coffee ground’ blood during haematemasis indicate?

A

Blood that has been partially digested by the stomach acid

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13
Q

What does melaena suggest?

A

Upper GI bleed where blood has been digested

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14
Q

What does haematemasis triggered by forceful vomitting suggest could be the problem?

A

Beorhaave’s perforation

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15
Q

What does haematemasis with weight loss suggest?

A

Malignancy

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16
Q

What does haematemasis with dysphagia suggest?

A

Oesophageal malignancy

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17
Q

What is cirrhosis?

A

The pathological end stage of liver disease, it involves the fibrosis and conversion of liver calls into nodules

18
Q

How will someone with cirrhosis present?

A 
Abdominal distention
Jaundice and pruritus 
Haematemesis 
Melaena 
Ascites 
Spider naevi
Palmar erythema
Leukonychia
19
Q

What are first line investigations for cirrhosis?

A 
LFTs
GGTs
Serum sodium
Serum albumin
Prothrombin time
20
Q

How is cirrhosis managed?

A

By treating the underlying cause and complications eg antivirals for hep C, diuretics and low sodium diet for ascites etc

21
Q

What are the causes of cirrhosis?

A

Hep B
Hep C
Alcoholic liver disease
Non alcoholic fatty liver disease

22
Q

What are some symptoms of liver failure?

A 
Haematemesis
Easy bruising 
Distended abdomen
Puffy ankles
Lethargy
23
Q

What are some questions to ask in the history if someone has haematemesis? Why are you asking these questions?

A

How much blood do they vomit?
When do they vomit blood?- eg after forceful vomitting?
What does the blood look like in colour?- is it fresh and red or brown coloured
Is there any blood in the stools?- melaena?
Have they had recent weight loss?- alerts you to carcinoma
Is there dysphagia?- oesophageal cancer
Do they have symptoms of liver failure eg lethargy, puffy ankles, easy bruising, distended abdomen

24
Q

What should you suspect as a cause of haematemesis if someone is on NSAIDs?

A

Peptic ulcer disease

25
What will tattoos/needle track marks/ piercings suggest could be a cause of haematemesis?
Chronic viral hepatitis
26
What is Wernicke's encephalopathy caused by?
Thiamine deficiency
27
How will someone with Wernicke's encephalopathy present?
Confusion Reduced vestibulo-ocular reflexes Mental slowing Impaired concentration
28
Why are alcoholics at risk of Wernicke's encephalopathy?
They usually have a poor diet which causes them to be deficient in thiamine Chronic alcohol use also causes problems absorbing thiamine
29
What investigations are done for Wernicke's encephalopathy?
Therapeutic trial of parentral thiamine Bloods looking at FBC, LFTs, kidney function Serum electrolytes Blood glucose via finger prick test
30
How is Wernicke's encephalopathy managed?
By giving thiamine supplements, magnesium (if they are deficient), and multivitamins
31
How will someone with a bleeding peptic ulcer present?
Haematemesis (blood will be coffee ground coloured usually due to partial digestion by stomach acid) Melaena Tachypnoea Low blood pressure
32
What should you think when someone comes in with haematemesis and takes NSAIDs?
Bleeding peptic ulcer
33
What is the first line investigation for someone with a bleeding peptic ulcer?
Upper GI endoscopy
34
How do you treat a bleeding peptic ulcer?
``` Blood transfusion if needed PPIs H pylori eradication therapy Tell them to stop taking NSAIDs Supportive treatment eg IV fluids ```
35
Why might alcoholics have a higher tendency to bleed?
Damage to the liver means less clotting factors are produced Damage to the liver and fibrosis forces blood to take alternate routes- this leads to the formation of portosystemic anastamoses
36
What score is used to assess severity of liver cirrhosis?
Child-Pugh score
37
What part of the clotting pathway does liver disease affect?
Extrinsic pathway
38
Why is it important to ask if someone who present with haemetemesis is taking beta blockers?
They can mask the effect of shock but slowing the heart rate down
39
What type of anaemia is common in alcoholics? Why?
Macrocytic- the mechanism is unknown
40
What type of anaemia will someone with alcohol abuse likely present with?
Macrocytic | It may also be a mixed picture because if they are iron deficient

Year 3 (104 decks)

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