Malaena

Question 1

What is malaena

Answer 1

Black tarry stools due to an upper GI bleed

Blood is semi digested and interacts with acid

Question 2

What blood results point to an upper GI bleed

Answer 2

High urea out of proportion to creatinine (also seen following high protein meal)

Question 3

Causes of malaena

Answer 3

Perforated gastric or duodenal ulcer
Varices
Gastric carcinoma

Question 4

What does the Forrest classification predict

Answer 4

Severity of upper GI bleed based on endoscopy findings

Question 5

Treatment for bleeding varices

Answer 5

Endoscopic banding - start inferior due to blood supply of oesophagus
Terlipressin
Start Co-amoxiclav
IV omeprazole

Question 6

What does Rockalls score predict

Answer 6

Mortality and rebleeding risk in upper GI bleeds

Question 7

What does Glasgow-Blatchford predict

Answer 7

Indicates which upper GI bleed patients are low risk and suitable for outpatients

Question 8

Endoscopic treatment of stigmata of recent haemorrhage

Answer 8

Clips +/- adrenaline
Thermal coagulation + adrenaline
Thrombin/fibrinogen injection + adrenaline