Haematemesis

Question 1

How do you manage haematemesis medically

Answer 1

• Reassure
• Two large-bore cannulas
• Restrictive blood transfusion (Hb 70-80)
  
  • Over transfusion can precipitate rebleed
• Vasopressor
  
  • Terlipressin or octreotide
• IV Abx
• Platelets above 50,000
• Low threshold for critical care

Question 2

What are the aetiologies in portal hypertension

Answer 2

increased resistance

• pre hepatic - portal vein occlusions (extrinsic compression), splenic vein occlusion
• Hepatic
  
  • Sarcoidosis
  • Schistosomiasis
  • Primary biliary cholangitis
  • Idiopathic
  • Cirrhosis
  • Alcoholic hepatitis
  • Veno-occlusive disease
  • Budd chiari
• Post hepatic
  
  • constrictive pericarditis
  • restrictive cardiomyopathy
  • valvular disease

Increased flow

• Portal vein - myeloproliferative disorders
• Hepatic artery - hepatic artery-portal vein fistula

Question 3

What drug is given for prophylaxis against variceal bleeds

Answer 3

Propranolol

• non-selective beta-blocker
• reduces portal pressure