EMQs in Clinical Medicine.pdf - Peshawar Medical College

Haematemesis – answers 187
Common bacterial causes of dysentery include Shigella, Campylobacter
and Salmonella spp. and E. coli.
J
G
A 60-year-old man complains of tiredness and significant weight loss.
He notes episodes of rectal bleeding with blood mixed in with the
stool over the last few weeks. There is no diarrhoea.
Colonic carcinoma should always be considered with a history of weight
loss plus blood mixed in with the stool. However, right-sided lesions may
present non-specifically with iron deficiency anaemia.
Risk factors include neoplastic polyps, inflammatory bowel disease
(mainly ulcerative colitis) and a previous history of carcinoma. The
5-year survival rate of adenocarcinoma confined to the bowel wall is
over 90 per cent and so surgery may be curative.
A 21-year-old man presents with a history of constipation and rectal
bleeding. On examination there are numerous dark freckles on the
palm, lips and oral mucosa.
This is a rare condition with the presence of polyps (hamartomas) that
virtually never become malignant. Buccal pigmentation is an important sign.
73 Haematemesis
Answers: A B J E H
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A 50-year-old man who is an alcoholic complains of vomiting blood.
On examination he has signs of chronic liver disease.
Portal hypertension causes the diversion of blood through portosystemic
anastomoses and the development of oesophageal varices. Alcoholic liver
cirrhosis is by far the most common cause of oesophageal varices. The
risk of rupture is particularly high if the patient is still drinking alcohol.
A 55-year-old businessman complains of epigastric pain worse at
night, which is relieved by eating. He has started vomiting small
amounts of blood.
Symptoms of duodenal ulcer are often relieved by eating, drinking milk,
etc., whereas gastric ulcer symptoms are often aggravated by eating.
A 60-year-old woman with a several year history of heartburn presents
with occasional haematemesis. Endoscopy reveals intestinal-type
metaplasia at the distal oesophagus.
Barret’s oesophagus is the term used to describe the presence of specialized
intestinal metaplasia in the oesophagus (squamous to columnar) secondary
to chronic reflux oesophagitis. There is an increased risk of developing
adenocarcinoma of the oesophagus (40-fold increase is often quoted but
the overall risk is still low).