Flashcards in Haematemesis Deck (15)
Differentials for haematemesis
bleeding peptic ulcer
Scoring systems used for upper GI bleeds
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
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
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?
easy bruising, distended abdomen, puffy ankles, lethargy?
things to consider in drug history
regular NSAIDs, steroids or bisphosphonates
methotrexate, amiodarone - live toxicity
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
palpitation: look for
hepatomegaly - liver disease
splenomegaly - portal hypertension
epigastric tenderness - peptic ulcer disease, gastritis/duodentitis
epigastric mass/virchows node - malignancy
what is malaena?
upper GI haemorrhage and digestion of blood in transit
what is haematochezia?
fresh blood in stools - lower GI haemorrhage
typical blood panel in liver disease
raised liver enzymes - ALT, AST
prolonged clotting times
methods of visualising bleeds
management methods of varices
long term management of portal hypertension
keep BP low, drugs