Return to Medicines ListShow Learning Points most relevant to Phase 1:

Upper gastrointestinal bleeding

Clinical Discipline(s)/Organ System(s)
Digestive System, Gastroenterology & Hepatology, General Surgery, Emergency Medicine
Progress Test Topic(s)
Digestive, Seriously ill patient
Description
A 45 year old Indian man presents after vomiting blood. He is pale and feels awful. He is rushed to the Emergency Department by ambulance.
Applied Science for Medicine 
   - Anatomy of the upper gastrointestinal tract and vascular supply to the gastrointestinal tract
   - Portal hypertension in liver disease
   - Iron metabolism
   - Mechanisms of haemostasis: platelets and the coagulation cascade
   - Microbiology of Helicobacter pylori
   - Science of blood transfusion
Clinical and Communication Skills 
   - History from a patient with gastrointestinal bleeding
   - Sensitive history taking regarding use of alcohol
   - Perform and record an examination of the abdomen, including rectal examination. Recognise melaena and signs of chronic liver disease
   - Perform measurement of blood pressure
   - Classify hypovolaemic shock according to severity based on clinical signs
   - Differential diagnosis of haematemesis
   - Interpret FBC, electrolytes, creatinine, liver function tests, iron studies and coagulation studies
   - Indications for endoscopy, CT angiography, capsule endoscopy, selective angiography and embolisation
   - Management of severe hypotension
   - Management of upper gastrointestinal tract bleeding: acute and chronic
   - Diagnosis and eradication of H. pylori infection
   - Effectively communicate advice regarding lifestyle
   - Use of blood products and correction of anticoagulated state
   - Role of the haematologist/transfusion medicine specialist in the treatment of massive haemorrhage
Personal and Professional Skills 
   - Explore issues related to blood product use with patient who refuses blood transfusion
   - Self-care in clinical situations involving pressure and urgent management
   - Awareness of communicating across cultures
Hauora Māori 
   - Awareness of differing profiles for Māori (and other disadvantaged populations) presenting with gastrointestinal bleeding compared with non-Māori in New Zealand (hepatitis B, H.pylori, stomach cancer)
   - Inequities in access to health services and quality of medical care for Māori including reduced access to diagnosis, reduced staging (if cancer) and application of this to clinical decision making and management
   - Ensuring a culturally safe environment in occasions when person may die
Population Health 
   - Epidemiology of peptic ulcer disease and chronic liver disease
   - Cost-effectiveness of screening for H. pylori
Conditions to be considered relating to this scenario
Common
peptic ulcer disease, oesophageal varices, oesophageal ulcer, oesophagitis, gastritis, Mallory-Weiss tear
Less common but 'important not to miss'
gastric cancer, vascular malformation, oesophageal carcinoma
Uncommon
angiodysplasia, Dieulafoy (vascular) lesion, Curling's (severe stress/burns) ulcer