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
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
3
Q
What are the signs/symptoms?
A
- Liver disease
- portal hypertension
- hematemesis
- caput medusa
- ascites
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.)
5
Q
What is the acute medical treatment?
A
Lower portal pressure with octreotide or vasopressin
6
Q
What are the treatment options?
A
Sclerotherapy or band ligation via endoscope, TIPS, liver transplant
7
Q
What is the problem with shunts?
A
Decreased portal pressure, but increased encephalopathy