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Flashcards in Haematemesis Deck (15)
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1

Differentials for haematemesis

oesophagitis/gastritis/duodenitis
bleeding peptic ulcer
oesophageal varices
mallory-weiss tear
oesophageal cancer
gastric cancer
arteriovenous malformations
trauma
vascular angiodysplasia

2

Scoring systems used for upper GI bleeds

Blatchford
Rockall

3

What is the blatchford score

used to stratify patients into low and high risk groups, 1 to 6
used in triage to assess management for haematemesis
independent of endoscopy findings

4

what is the rockall score

more comprehensive than blatchford
used to predict risk or re bleeding and mortality
based on age, shock, co-morbidities and endoscopy findings

5

history of haematemesis

how much blood was vomited?
what was the character of the vomit? e.g. fresh blood or not
blood in the stool?
did forceful vomiting trigger the haematemesis?
recent weight loss?
problems swallowing?
easy bruising, distended abdomen, puffy ankles, lethargy?
epigastric pain?

6

things to consider in drug history

anticoagulants
regular NSAIDs, steroids or bisphosphonates
methotrexate, amiodarone - live toxicity
beta-blockers

7

Inspecting the patient: look for

tattoos, track marks, piercings - viral hepatitis
jaundice, palmar erythema, ankle oedema - signs of liver disease
pupura - ITP or liver disease
thoracic-abdominal scar - AAA repair
cachexia - malignancy

8

palpitation: look for

hepatomegaly - liver disease
splenomegaly - portal hypertension
epigastric tenderness - peptic ulcer disease, gastritis/duodentitis
epigastric mass/virchows node - malignancy

9

what is malaena?

upper GI haemorrhage and digestion of blood in transit

10

what is haematochezia?

fresh blood in stools - lower GI haemorrhage

11

typical blood panel in liver disease

macrocytic anaemia
low albumin
raised liver enzymes - ALT, AST
raised bilirubin
raised GGT
prolonged clotting times
raised urea

12

methods of visualising bleeds

endoscopy
angiography
laparotomy

13

management methods of varices

band ligation
sclerotherapy
balloon tamponade
TIPSS
laparotomy

14

long term management of portal hypertension

lifestyle advice
keep BP low, drugs
antibiotics
treat encephalopathy

15

risk factors for peptic ulcer disease

helicobacter pylori infection
smoking and alcohol
NSAIDs
blood group O
hypercalcaemia
physiological stress
burns or brain trauma