Haematemesis and malaena

Question 1

What is haematemesis

Answer 1

vomiting of blood from the upper GI tract

Question 2

coffee ground vomit?

Answer 2

good sign

blood is starting to clot

Question 3

2 most common causes of haematemesis

Answer 3

oesophageal varices

peptic ulcer disease bleed

Question 4

what is malaena

Answer 4

black tarry stool produced in the presence of UGI bleed

oxidation of iron as it passes through colon

Question 5

What might you seen if the UGI bleed is severe enough

Answer 5

fresh PR bleed

Question 6

RF for PUD

Answer 6

>50yo 
NSAID use 
H pylori 
alcohol 
smoking 
steroids 
radiation 
excess acid production

Question 7

other causes of haematemesis

Answer 7

Gastritis
Mallory Weiss tear
oesophagitis
vascular abnormalities

Question 8

what is Boerhaave syndrome

Answer 8

oesophageal rupture secondary to vomiting
SC emphysema
very rare

Question 9

Scoring systems for haematemesis

Answer 9

Blatchford score - pre-endoscopy, intervention if >0

Rockall - post-endoscopy score

Question 10

What happens in a major haemorrhage protocol

Answer 10

Call 2222 and state major haemorrhage in ward ‘x’
red cell transfusion
FFP if deranged LFT
platelet transfusion
if patient is on warfarin - prothrombin complex

Question 11

do you give patients PPI before endoscopy

Answer 11

don’t have to but usually is done

Question 12

treatment of bleeding PUD at endoscopy

Answer 12

clips +- adrenaline OR
thermocoagulate + adrenaline
Interventional radiology
IV PPI post endoscopy

Question 13

management of variceal (oesophageal and gastric) bleed at endoscopy

Answer 13

vasopressors - terlipressin
oes varices - band ligation, TIPS
gastric varices - endoscopic injection of n-butyl-N-cyanoacetate, TIPS

Question 14

do you give antibiotics for any variceal bleed?

Answer 14

yes alongside terlipressin

Question 15

catastrophic bleed management

Answer 15

balloon tamponade to stop both oes +or gastric varices

Question 16

what prophylaxis is given for varices

Answer 16

long term prophylactic non-selective B blocker

Question 17

what is a Mallory Weiss Tear

Answer 17

longitudinal tear at GOJ induced by repetitive and strenuous vomiting
streaks of blood
self limiting

Question 18

prevention of bleed

Answer 18

eradicate H pylori 
avoid NSAIDs (use PPI alongside if necessary)

Question 19

how many classes of shock are there

Answer 19

4

Question 20

what is the first sign of shock

Answer 20

DBP start to rise and then SBP and DBP drop

Question 21

young people tolerate blood loss better, true or false

Answer 21

true, better than older people

Question 22

urea increases in upper/lower GI bleed

Answer 22

upper

Question 23

initial investigations for haematemesis

Answer 23

FBC - anaemia
U+E - AKI 
LFT - 
CRP 
urea 
amylase
G+S 
coagulation - INR, PT, APTT
ECG 
cannula IV fluid 
abdominal exam 
lifestyle 
PPIs, swap NSAID for paracetamol 
erect CXR - perforation

Question 24

when would you give a blood transfusion

Answer 24

<7 and asymptomatic

or if symptomatic and >7

Question 25

how long do you stop PPI before H pylori test

Answer 25

2 weeks

Question 26

what lab result will be raised in an UGI bleed

Answer 26

urea

Question 27

management of H. pylori infection

Answer 27

PPI + amox + clar/met

PPI + clarithromycin + met