Hematemsis

Question 1

45 year old male patient alcoholic, presented with 3 times of hematemesis, Low BP, tachycardia& altered mental status .

Q1: what is the differentials?

Answer 1

Rapture eso. Varices, Mallory Weiss syndrome, borheave syndrome, Bleeding peptic ulcer disease.

Question 2

Q2: What are the specific concerns about this patient ?

Answer 2

Bleeding will lead to hypovolemia /
Complications; Hepatic encephalopathy, AKI, Hepatorenal $

Question 3

Q3: How will you address immediately the hemorrhage in this patient

Answer 3

According to CCrISP protocol
Resus. / O2 15 L per reservoir bag / Venous access 2 wide pore Cannulas, blood for grouping and Crossmatching / Involve hematologist for transfusion , start volume replacements / prepare for emergency endoscopy (band ligation) / meds; somatostatisn analogues vasopressors

Question 4

Q4: Explain the Role of endoscopy?

Answer 4

Sclerotherapy / adrenaline injection / Band ligation
Given the following lap results
↓↓Hb , ↑↑FDP

Question 5

Q5: What is your Diagnosis?

Answer 5

DIC

Question 6

Q6: What is massive transfusion protocol? What is the Ratio used ?

Answer 6

Giving 50% of his blood volum in 4 hrs or whole blood volume in 24 hrs
Packed RBCs : FFP : Platlets 1:1:1

Question 7

Q7: what is the cause of Ascites in this patient?

Answer 7

Hypo albumin / retention of water / release of anti-diuretic hormons

Question 8

Q8: Blood findings in patient abusing alcohol?

Answer 8

Macrocytic anemia / Thrombocytopenia

Question 9

Q9: Cause of thrombocytopenia in this case?

Answer 9

DIC / Bleeding / Liver Dysfunction / Hypersplenism / Hemodilution

Question 10

Q10: what is the indication of platelet transfusion?

Answer 10

Platelet count less than 10 000 / and as a part of massive hge protocol

Question 11

Q11: Explain portal hypertension in alcoholic patient ?

Answer 11

Cirrhosis from alcoholism will lead to increase of portal vascular resistance of in liver as portal pressure = flow × Resistance this will increase pressure – > development of varices to bypass pressure
Gastro-Esoph – btw lt gastic V. and Azygos V
periUmblical – btw inf. Gastric V and lig. Teres V.
Upper Anal Canal – btw Sup R. V and Mid/Inf. R Vs

Question 12

Q12: Patient with macrocytic anemia, what could be the cause?

Answer 12

Alcoholism / Vit B12 and folate Deficiency

Question 13

Q13: Other than drugs what therapeutic maneuvers to reduce portal hypertension ?

Answer 13

TIPSS / Stabled esophageal transection / Liver Transplantation

Question 14

Q14 what is sangstaken tube and how is it used ?

Answer 14

Double tamponad tube
Explain;It has three lumens: one for inflating a balloon in the stomach, another for inflating a balloon in the esophagus, and a third for gastric aspiration. The inflated balloons compress the varices to control bleeding.

Question 15

Q15: what is the indication for using it ?

Answer 15

Life threating bleeding not responding medical ttt and also endoscopy is not available

Question 16

Q16: what is Minnesota tube ? when to use it ?

Answer 16

Modified type of sangstaken tube with an extra port for suction of Esophageal content

Question 17

Q. Pt is misusing alcohol. What features of indications?

Answer 17

Raised MCV / Low platelet counts