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Flashcards in 5. Haematemesis Deck (15)
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1

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

Airway
Breathing
Circulation
Disability: GCS/ AVPU
Exposure

2

List 3 common and 3 rarer differentials for haematemesis?

Oesophagitis
Bleeding peptic ulcer
Oesophageal varices

Mallory weiss tear
Oesophageal cancer
Gastric cancer

3

What are the blatchford and rockall scores?

Blatchford: stratifies patients presenting to hospital with haematemesis, guides management
Rockall: predicts risk of re-bleeding + mortality

4

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

How much blood?
Character of the vomit? (colour of blood)
Blood in stool?
Did forceful vomiting trigger the haematemesis?
Recent weight loss or problems swallowing?
Signs of liver failure? (bruising, distended abdo., puffy ankles)
Epigastric pain?

5

What 6 features in PMHx are important in a patient with haematemesis?

Previous upper GI haemorrhage
Heartburn or epigastric pain
History of GORD
Aortic repair with grafts (aorto enteric fistula)
Bleeding tendency
Chronic liver disease

6

List 8 drugs that are important to ask about in a patient with haematemesis

Anticoagulants
Regular NSAIDs
Aspirin
Clopidogrel
Steroids
Bisphosphonates
Drugs causing liver toxicity: methotrexate, amiodarone
B blockers

7

What are 10 signs of liver disease?

Jaundice
Scratch marks
Bruising
Spider naevi
Palmar erythema
Dupuytren's contracture
Gynaecomastia
Ascites
Ankle oedema
Caput medusa

8

What measurement defines shock? What are 4 immediate actions to be taken?

BP < 90/60 mmHg
High flow O2 15L/mn
IV Fluid resus. 250ml aliquots crystalloid solution
Send bloods
Give blood if: blood on DRE or shock despite fluid resus.

9

What process is haematemesis usually due to?

Bleeding in the UPPER GIT

10

If varices is the suspected cause of haematemesis, what should you include in your initial management? Why?

Terlipressin: ADH agonist causes splanchnic vasoconstriction, reducing mesenteric blood flow
Prophylactic antibiotics

11

Which patients presenting with haematemesis have indication for emergency endoscopy?

Unstable patients with severe acute upper GI bleeding immediately after resus.
Suspicion of continuing bleed
Blatchford score >,6

12

Other than OGD which other investigations may be considered for haematemesis?

Chest radiograph- perforated peptic ulcer/ boerhaaves
CT chest/ abdo- in those with aortic graft

13

What should you establish in a SHx of a patient with haematemesis?

Excess alcohol consumption
Smoking
IV drug use/ tattoos

14

What 4 features may be present on palpation in haematemesis?

Hepatomegaly: liver disease
Splenomegaly: portal HTN
Epigastric tenderness: PUD/ gastritis
Epigastric mass/ virchows node: malignancy

15

List 5 treatment strategies for bleeding oesophageal varices

Endoscopic band ligation
Endoscopic sclerotherapy
Balloon tamponade: pressure induces haemostasis
Transjugular intrahepatic portosystemic shunt (TIPS)
Portosystemic shunt