Ileus

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An ambulance arrives during your shift with a 65-year-old man. He is holding a kidney bowl with approximately 200 mL of vomit with some blood in it. He denies any foregoing trauma and states that he is not allergic and that he is treated for high blood pressure and hypercholesterolemia. He smokes 10 cigarettes a day and drinks alcohol moderately. You will perform basic blood test (FBC, CMP, CRP, LFT, amylase, urea, creatinine and ions). What else are you going to do with your patient?

Surgical revision

Wrong answer

Surgical revision is a good choice when the patient is unstable. Your patient is in stable cardiopulmonary condition so far, therefore you can order other examinations.


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Gastrointestinal endoscopy

Correct answer

The most common cause of haematemesis is bleeding from gastric ulcers (50%), followed by bleeding from oesophageal varices. Gastrointestinal endoscopy is not only a diagnostic method but also a therapeutic one – it allows us to stop the bleeding by electrocoagulation or epinephrine injection.


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Colonoscopy

Wrong answer

Colonoscopy is indicated in case of intense enterorrhagia suspected in aboral parts of GIT. That wouldn’t manifest as haematemesis though. Colonoscopy is also irreplaceable as a prevention of colorectal carcinoma (one of the most common tumors in the Czech Republic).


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Computerised tomography

Wrong answer

CT scan is not indicated as a method of first choice in haematemesis, as it doesn’t allow us to intervene in any way. Most common cause for haematemesis is in the upper parts of GIT (gastric ulcers, oesophageal varices) and we have better diagnostic tests for that.


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Help

FBC – full blood count
CMP – comprehensive metabolic panel
CRP - C reactive protein
LFT – liver function test×
 
RR

19 bpm

HR

80 bpm

SpO2

98 %

BP

136/75 mmHg

ECG

not available

Examination:
The patient is alert and oriented. His abdomen is soft, tender in epigastric region, no peritoneal signs present, positive bowel sounds, no hepatosplenomegaly noted, rectal examination without abnormalities.

Gly

not available

ABG

not available

CBC

not available

biochemistry

not available