EMQ: 1
Haematemesis and Melaena
a)
Mallory-Weiss tear
b)
Duodenal ulcer
c)
Oesophageal varices
d)
Gastric ulcer
e)
Dieulafoy lesion
f)
Gastric carcinoma
g)
Gastritis
h)
Oesophagitis
i)
Aortoenteric fistula
j)
Barrett’s oesophagus
Select the most likely diagnosis from the list above for
the following clinical scenarios:
1) A middle aged, obese female who has been having
pruritus for a long time presents with haematemesis and melaena. On
examination she has xanthelasma, no signs of chronic hepatocellular failure,
moderate splenomegaly
2) A 75-year-old male with a history of anorexia and
weight loss presents with haematemesis and melaena. On examination he looks
cachectic and on palpation of the abdomen a hard, craggy liver is felt.
3) A 24-year-old male who has been on an alcoholic binge
presents wit haematemesis following a period of prolonged vomiting. On
examination he is inebriated but there is no cardiovascular instability and
his haemoglobin is within normal limits.
4) A 50-year-old sales representative who has been
complaining of abdominal discomfort of several months’ duration .the
discomfort is relieved by meals but wakes him up form his sleep. He presents
with a 3-day history of melaena.
5) A 78-year-old male who has had a repair of an
abdominal aortic aneurysm presents with melaena, tachycardia a fall in blood
pressure and is found to be anaemic.
