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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.

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