Chapter 39: UGI Bleed- Esophageal Variceal Bleeding Flashcards

1
Q

What is it?

A

Bleeding from formation of esophageal varices from back up of portal pressure via the coronary vein to the submucosal esophageal venous plexuses secondary to portal hypertension from liver cirrhosis

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2
Q

What is the “rule of two thirds” of esophageal variceal hemorrhage?

A
  • Two thirds of patients with portal hypertension develop esophageal varices
  • Two thirds of patients with esophageal varices bleed
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3
Q

What are the signs/symptoms?

A
  1. Liver disease
  2. portal hypertension
  3. hematemesis
  4. caput medusa
  5. ascites
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4
Q

How is the diagnosis made?

A

EGD

  • (very important because only 50% of UGI bleeding in patients with known esophageal varices are bleeding from the varices; the other 50% have bleeding from ulcers, etc.)
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5
Q

What is the acute medical treatment?

A

Lower portal pressure with octreotide or vasopressin

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6
Q

What are the treatment options?

A

Sclerotherapy or band ligation via endoscope, TIPS, liver transplant

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7
Q

What is the problem with shunts?

A

Decreased portal pressure, but increased encephalopathy

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