Haematemesis
- Vomiting of blood
- Signifies upper GI bleed
Causes
Common Causes
Rare causes
- Haemobilia
- Nose bleeds
- Oesophageal/gastric malignancy
- Oesophagitis
- Angiodysplasia
- Haemangiomas
- Ehler-Danlos or Peutz-Jeghers
- Bleeding disorders
History
- Swift and relevant
- Postural hypotension - IVI needed
- Drugs
- Alcohol abuse
- Previous GI bleed
- peptic ulcer or symptom
- retching/vomiting
- liver disease
- dysphagia
- concomitant disease
Examination
- Vital signs
- Pulse
- BP -standing/ sitting, lying
- JVP
- urine output
- Assess for shock
- Signs of chronic liver disease
- telangectasia or purpura
- jaundice
Treatment
- Urgent endoscopy
- Octreotide
- sclerotherapy
- banding
- Sengstaken-Blakemore tube
- Surgery
- Severe bleeding
- Rockall score >6
- rebleeding
- active bleeding during OGD
- continuing bleeding after transfusion (> 6 units if over 60, >8
unit if <60)
- Varices
- Oesophageal transection
- transthoracic transosophageal ligation
- Gastric ulcer
- Under-running
- Excision
- Partial gastrectomy
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