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Year 3 > Haematemesis (oxford clin cases) > Flashcards

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
Q

What will tattoos/needle track marks/ piercings suggest could be a cause of haematemesis?

A

Chronic viral hepatitis

26
Q

What is Wernicke’s encephalopathy caused by?

A

Thiamine deficiency

27
Q

How will someone with Wernicke’s encephalopathy present?

A

Confusion
Reduced vestibulo-ocular reflexes
Mental slowing
Impaired concentration

28
Q

Why are alcoholics at risk of Wernicke’s encephalopathy?

A

They usually have a poor diet which causes them to be deficient in thiamine
Chronic alcohol use also causes problems absorbing thiamine

29
Q

What investigations are done for Wernicke’s encephalopathy?

A

Therapeutic trial of parentral thiamine
Bloods looking at FBC, LFTs, kidney function
Serum electrolytes
Blood glucose via finger prick test

30
Q

How is Wernicke’s encephalopathy managed?

A

By giving thiamine supplements, magnesium (if they are deficient), and multivitamins

31
Q

How will someone with a bleeding peptic ulcer present?

A

Haematemesis (blood will be coffee ground coloured usually due to partial digestion by stomach acid)
Melaena
Tachypnoea
Low blood pressure

32
Q

What should you think when someone comes in with haematemesis and takes NSAIDs?

A

Bleeding peptic ulcer

33
Q

What is the first line investigation for someone with a bleeding peptic ulcer?

A

Upper GI endoscopy

34
Q

How do you treat a bleeding peptic ulcer?

A 
Blood transfusion if needed
PPIs
H pylori eradication therapy
Tell them to stop taking NSAIDs
Supportive treatment eg IV fluids
35
Q

Why might alcoholics have a higher tendency to bleed?

A

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
Q

What score is used to assess severity of liver cirrhosis?

A

Child-Pugh score

37
Q

What part of the clotting pathway does liver disease affect?

A

Extrinsic pathway

38
Q

Why is it important to ask if someone who present with haemetemesis is taking beta blockers?

A

They can mask the effect of shock but slowing the heart rate down

39
Q

What type of anaemia is common in alcoholics? Why?

A

Macrocytic- the mechanism is unknown

40
Q

What type of anaemia will someone with alcohol abuse likely present with?

A

Macrocytic

It may also be a mixed picture because if they are iron deficient

Year 3 (104 decks)

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