Presentation on theme: "Haematemesis Lent 2007. The case: Mr J O’F 48 year old jockey (divorced, no recent wins). Presents at 2am with a big haematemesis Unable to give a history."— Presentation transcript:
The case: Mr J O’F 48 year old jockey (divorced, no recent wins). Presents at 2am with a big haematemesis Unable to give a history
On examination…… Shocked: b.p. 90/60, P120 Short (5’5”); Thin arms and legs Spider naevi Pale yellow sclerae Veins visible coming out from the navel Liver palpable plus mass in LUQ Abdomen distended with shifting dullness Fetid breath
In adult life: The umbilical arteries- become the obliterated umbilical arteries in the medial umbilical ligaments The umbilical vein- becomes the ligamentum teres in the falciform ligament THIS BECOMES PATENT IN PORTAL HYPERTENSION
Ascites: fluid in the peritoneal cavity May be transudate due to increased portal pressure May be exudate of actively secreted fluid due to inflammation or tumour May be exacerbated by low protein levels due to poor liver function
Prognosis from bleeding varices Patients who have bled once from esophageal varices have a 70% chance of rebleeding Approximately one third of further bleeding episodes are fatal. Risk of death highest during the first few days after the bleeding episode and decreases slowly over the first 6 weeks.