Haematemesis and Melena

Question 1

The dramatic symptom of
haematemesis follows bleeding from the 
1
2
3.

Answer 1

oesophagus,

stomach and duodenum

Question 2

_______ is the vomiting of blood appearing as

fresh blood or ‘coffee grounds’

Answer 2

Haematemesis

Question 3

______ is the passage

of black tarry stools, with 50 mL or more of bloo

Answer 3

Melaena

Question 4

____________accounts for most cases

of upper GI haemorrhage

Answer 4

Chronic peptic ulceration

Question 5

Black stool caused by oral ______ or _____

can cause confusion

Answer 5

iron therapy or bismuth antacid tablets

Question 6

Melaena is generally ______life-threatening than

haematemesis.

Answer 6

less

Question 7

A sudden loss of _______ or more circulatory blood
volume usually produces signs of shock such as
tachycardia, hypotension, faintness and sweating

Answer 7

20%

Question 8

A useful guide is that shock in a previously
well 70 kg man indicates an acute blood loss of at
least________________-.

Answer 8

1000–1500 mL

Question 9

The major cause of bleeding is _____________, accounting

for about half of all cases

Answer 9

chronic peptic

ulceration of the duodenum and stomach

Question 10

In this condition a tear occurs at the lower end of
the oesophageal mucosa (at the oesophagogastric
junction) because of an episode of severe or protracted
vomiting or coughing

Answer 10

Mallory–Weiss syndrome

Question 11

caused by portal hypertension, which

in turn is usually due to cirrhosis of the liver

Answer 11

Gastro-oesophageal varices

Question 12

Prognosis of Gastro-esophageal varices

Answer 12

Mortality is about 30%, despite advances, and 70% for untreated patients

Question 13

Primary prevention of bleeding from varices is

with the use of _____________-.

Answer 13

beta blockers such as propranolol if no

contraindications

Question 14

Other Mx for varices if medical fails

Answer 14

Management includes injection sclerotherapy,
and then intravenous octreotide or terlipressin
if it fails

Question 15

Definitive Mx of varices

Answer 15

Passage of a Sengstaken–Blakemore or Minnesota tube into the oesophagus and stomach to provide tamponade and the radiological procedure of
using a transjugular intrahepatic portosystemic stent are possible options.

Question 16

A coffee grounds vomitus indicates that the blood has been in contact with
_______

Answer 16

gastric acid

Question 17

Drugs associated with gastrointestinal

haemorrhage

Answer 17

Aspirin
Clopidogrel
Other antiplatelet drugs
Heparin/new oral anticoagulants
NSAIDs/COX-2 inhibitors
Prednisolone
SSRI antidepressants
Warfarin

Question 18

Why is Hb level not appropriate guide to need for BT

Answer 18

because haemodilution occurs

gradually over the 24 hours following a severe bleed.

Question 19

Hb level warranting BT

Answer 19

a level below 90 g/L during this period is

usually regarded as an indication for transfusion.

Question 20

______________should be commenced in

most cases especially as 50% of bleeding is from peptic ulceration

Answer 20

Proton pump inhibitors

Question 21

______________is the gold standard for

diagnosis and therapy for acute UGIB

Answer 21

Upper endoscopy