Exam III: Acute Variceal Bleeding

Question 1

Acute Variceal Bleeding is responible for what percentage of cirrhotic related deaths?

Answer 1

33%

20-40% of cirrhotics develop variceal bleeding

Question 2

Variceal Bleeding is a risk factor for _____.

Answer 2

Spontaneous bacterial peritonitis.

Question 3

What are the supportive care measures for managing variceal bleeding?

Answer 3

1. IV fluids
2. Packed red blood cells (<8)
3. Oxygen therapy

Question 4

What is the mainstay of treatment for variceal bleeding?

Answer 4

Octreotide + Endoscopic Variceal Ligation

Question 5

What is the mecahnism of octreotide.

Answer 5

Somatostatin Analog —> Inhibits glucagon leading to vasoconstriction of splanchic vessels.

Question 6

How is octreotide administered?

Answer 6

IV bolus, then infusion.

Question 7

Who should receive SBP prophylaxis?

Answer 7

Anyone who had bleeding

Question 8

What is used for SBP prophylaxis in patients with acute variceal bleeding?

Answer 8

3rd Gen Cephalosporins for 7 days.

Ex) Ceftriaxone IV

Question 9

When should non-selective beta-blockers be used in patients with acute variceal bleeds?

Answer 9

Once the bleed stabilizes.