Upper Gastrointestinal Haemorrhage DDx
Overview
Upper gastrointestinal haemorrhage is classically bleeding from above the ligament of Trietz (the suspensory muscle of duodenum that connects to the diaphragm), can is characterised by haemetemesis and melaena.
Causes
More common
- Chronic peptic ulcer: duodenal ulcer (40%), gastric ulcer
- Acute peptic ulcer (erosions)
Less common
- Mallory-Weiss syndrome (tear at the gastro-oesophageal junction)
- Oesophageal and/or gastric varices
- Erosive or ulcerative oesophagitis
- Gastric carcinoma, polyp, other tumours
- Dieulafoy lesion (single defect that involves an ectatic submucosal artery)
- Watermelon stomach (antral vascular ectasias)
- Aortoenteric fistula (usually aortoduodenal and after aortic surgery) Don’t miss this!
- Vascular anomalies
— angiodysplasia
— AVMs
— blue rubber bleb naevus syndrome
— hereditary haemorrhagic telangiectasia
— CRST syndrome - Pseudoxanthoma elasticum, Ehlers-Danlos syndrome
- Amyloidosis
- Vasculitis
- Ménétrier disease
- Bleeding diathesis
- Pseudohaematemesis (nasopharyngeal origin)
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Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
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