Haematemesis

Question 1

What are the differentials for haematemesis?

Answer 1

Oesophagitis/gastritis/duodenitis

Bleeding peptic ulcer (gastric or duodenal)

Oesophageal varices

Mallory–Weiss tear

Oesophageal cancer

Gastric cancer

Arteriovenous malformations

Bleeding diathesis

Trauma to oesophagus or stomach

Vascular angiodysplasia in oesophagus or stomach

Boerhaave’s oesophageal perforation

Haemobilia

Aorto-enteric fistula

Question 2

What vascular angiodysplasias in the oesophagus/stomach can lead to haematemesis?

Answer 2

Dieulafoy lesion

Scleroderma

Hereditary haemorrhaigc telangiectasia

Question 3

What is the Rockall score?

Answer 3

Score used to predict the risk of rebleeding and mortality in patients with upper GI haemorrhages

Based on age, shock status and comorbidities

Question 4

What techniques are used to stop upper GI bleeding?

Answer 4

Endoscopic band ligation

Endoscopic sclerotherapy

Balloon tamponade

Transjugular intrahepatic portosystemic shunt

Portocaval shunt

Question 5

What is a transjugular intrahepatic portosystemic shunt?

Answer 5

Th is complex procedure involves passing a catheter down the jugular vein and creating a shunt from a hepatic vein to the portal vein to relieve the portal hypertension. If this is not possible, a portosystemic (aka portocaval) shunt can be
placed surgically

Question 6

What is a portocaval shunt?

Answer 6

This surgical technique involves placing a shunt between the portal and systemic circulation, thus bypassing the liver
and reducing the portal hypertension that is causing the oesophageal varices.