Emergency Medicine Emergency Medicine · Gastroenterology · High Yield

Haematemesis Causes

Haematemesis (vomiting blood) indicates upper GI bleeding. Stratifying risk, resuscitating, and achieving endoscopic haemostasis are the priorities.

✦ The Mnemonic

"Peptic Ulcer Leads UGIB — PURE"

Peptic ulcer · Varices · Mallory-Weiss · Oesophagitis · Tumour

P Peptic ulcer Most common cause (35–50%); posterior DU erodes GDA; lesser curvature GU erodes left gastric — may need surgery
V Varices Oesophageal or gastric; portal hypertension; 30–50% mortality per episode; urgent endoscopy + terlipressin
M Mallory-Weiss tear Longitudinal mucosal tear at GOJ from forceful vomiting; usually self-limiting; alcohol common precipitant
O Oesophagitis / Gastritis Erosive disease; NSAIDs, alcohol, H. pylori; acid suppression heals
T Tumour Gastric carcinoma; GIST; Kaposi's sarcoma (HIV); less likely to bleed massively
A Angiodysplasia Vascular ectasias — elderly; telangectasia in HHT; treated endoscopically

📚 Clinical Breakdown

Glasgow-Blatchford score: pre-endoscopy risk stratification. Score 0 = very low risk — can be managed as outpatient. Variables: urea, haemoglobin, systolic BP, pulse, presence of melaena, syncope, hepatic disease, cardiac failure. Score >6 = high risk requiring urgent endoscopy.

Rockall score: post-endoscopy risk scoring. Variables: age, shock, comorbidity, diagnosis, and stigmata of recent haemorrhage. Score 0–1 = low risk, early discharge. Score ≥8 = high risk, rebleed and mortality.

Management: two large-bore IV cannulae, crossmatch 6 units, IV PPI (omeprazole 80 mg bolus + 8 mg/h infusion reduces rebleed from peptic ulcer), urgent endoscopy within 24 hours (within 12 hours for variceal bleeding). Terlipressin + prophylactic antibiotics for variceal bleeding (reduces bacterial translocation and mortality).

Most common UGIB cause Peptic ulcer (35–50%)
Variceal bleeding mortality 30–50% per episode
Pre-endoscopy risk score Glasgow-Blatchford
Post-endoscopy risk score Rockall score

⭐ Clinical Pearl

Dieulafoy's lesion: a large submucosal artery that erodes through the mucosa without an underlying ulcer — causing massive intermittent haemorrhage with normal-looking mucosa between episodes. Difficult to diagnose endoscopically. Treat with endoscopic haemostasis (clips, thermal coagulation) or interventional radiology embolisation.

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