Mr Salaa, 63 presents after two days history of vomiting blood. Mr Salaa is of lean build but has not lost any additional weight and there is no family history of cancer.

He is not on any medication, prescription or pharmacy.

On Physical examination he is pale, frail and sweating.

Question 4

Which of the following would you do immediately in the case of Mr Salaa?
(Select as many as you wish)

 a. Check circulation.

b. Resuscitation if required.

c. Perform a careful abdominal examination including digital rectal examination.

d. Restore effective blood volume if required.

e. Establish a diagnosis to allow for correct treatment.

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Answer 4



1. Check circulation.

2. Resuscitation if required.

3. Perform a careful abdominal examination including digital rectal examination.

4. Restore effective blood volume if required.

5. Establish a diagnosis to allow for correct treatment.

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Haematemesis is the vomiting of blood and usually follows bleeding from the oesophagus, stomach and duodenum. Haematemesis is almost always associated with some degree of blood in the stools (memaena). Chronic peptic ulceration accounts for most cases of upper GI haemorrhage.

A sudden loss of 20% or more of circulatory blood volume usually produces signs of shock such as tachycardia, hypotension, faintness and sweating.

All patients with a significant bleed should be admitted to hospital.