5. Haematemesis

Question 1

What does each component of the A to E response stand for?

Answer 1

Airway, breathing, circulation, disability, exposure

Question 2

What are the main differentials for haematemesis?

Answer 2

Oesophagitis, bleeding peptic ulcer, oesophageal varices

Less common causes- mallory weiss tear, oesophageal cancer, gastric cancer, arteriovenous malformations

Question 3

What are the blatchford and rockall scores?

Answer 3

Blatchford- stratifies patients presenting to hospital with haematemesis

Rockall- predicts the risk of rebleeding and mortality

Question 4

What questions should you ask about the presenting complaint in a patient with haematemesis?

Answer 4

How much blood?
What was the character of the vomit?
Any blood in the stool?
Did vomiting trigger the haematemesis?
Any recent weight loss or problems swallowing?
Any signs of liver failure
Any epigastric pain?

Question 5

What features in PMHx are important in a patient with haematemesis?

Answer 5

Previous upper GI haemorrhage, heartburn or epigastric pain, any history of GORD, any aortic repair with grafts (aorto enteric fistula), bleeding tendency, chronic liver disease

Question 6

What drugs are important to ask about in a patient with haematemesis?

Answer 6

Anticoagulants, regular NSAIDs, aspirin, clopidogrel, steroids or bisphosphonates

Drugs causing liver toxicity- methotrexate, amiodarone

Question 7

What are signs of liver disease?

Answer 7

jaundice, scratch marks, bruising, spider naevi, palmar erythema, dupuytren’s contracture, gynaecomastia, ascites, ankle oedema, caput medusa