Haematemesis & Melaena
COVID-19 clinical presentation <div class="redbox"> <p style="text-size:12px;">COVID-19 can present with a myriad of symptoms so should probably be on most differential diagnosis lists during the pandemic</p> <li><a href="https://productivemedic.com/covid-remote-assessment/" target="_blank">COVID assessment, DDx and complications</a></li> <li><a href="https://www.google.com/imgres?imgurl=https%3A%2F%2Ff6publishing.blob.core.windows.net%2F2ab0884c-0618-4586-aaf1-41004e6ad656%2FWJCC-8-3956-g002.png&imgrefurl=https%3A%2F%2Fwww.wjgnet.com%2F2307-8960%2Ffull%2Fv8%2Fi18%2F3956.htm&tbnid=I0G0VvXcx_akPM&vet=12ahUKEwj1_43FsrnuAhUH-YUKHSoZAFQQMygYegUIARCwAQ..i&docid=IBDQMbzRItpvKM&w=3307&h=2168&q=covid%2019%20presentation&safe=strict&ved=2ahUKEwj1_43FsrnuAhUH-YUKHSoZAFQQMygYegUIARCwAQ" target="_blank">Clinical presentation summary infographic</a></li> <div>
*Common causes
  • Gastritis
  • Peptic Ulcer Disease
  • Oesophagitis
  • Mallory-Weiss tear <p>Strong indicators</p> <ul> <li>dry retching, vomiting</li> </ul> <p>Typical presentation</p> <ul> <li>abdominal pain or tenderness - vomiting - malaena</li> </ul> <p>Possible presentation</p> <ul> <li>cycles of vomiting - dry retching - haematemesis</li> </ul>
*Must not miss!
*Easily missed
Red flags
  • Shock
  • Dysphagia
  • Persistent vomiting
  • Weight loss
  • Systemic features (fever, night sweats, anorexia)
  • Epigastric mass
  • Chronic liver disease signs (jaundice, ascites etc.)
  • Iron deficiency anaemia
Investigations to consider
  • FBC, CRP/ESR
  • U&Es, LFTs
  • Clotting screen
  • OGD
  • US
  • CXR
  • CT
* DDx list disclaimer: please read
  • These lists could never be comprehensive and remain practical to use during the consultation. We have included conditions that we think will cover the vast majority of primary care presentations for any given symptom. This does not mean other conditions, red flags and investigations should not be considered.
  • Each list is provided as a brief reminder only and is presented in no particular order. The authors have used editorial licence to allow quicker access during the consultation and to prevent duplication.
  • We feel that the "Must not Miss" conditions should always appear at the top of your differential diagnosis list. The consequences of missing a diagnosis from within this category carry significant morbidity and mortality risks to your patient.
  • Many diagnoses are not obvious or apparent at the initial presentation. It may be appropriate to share your diagnostic uncertainty with patient, and also provide specific guidance (safety netting) on when and where patients should seek further advice and follow up.