Upper GI Bleeding

Question 1

Management of acute variceal bleeding

Answer 1

ABC management
IV Vasoactive agent (DOC: IV Terlipressin, but m/c used is IV Octreotide)
IV Antibiotics (Ceftriaxone)
PRB

Upper GI endoscopy
2 options- Band ligation or Sclerotherapy (mc sclerosis agent used is Sodium Tetradecyl sulfate)

Outcomes:
1) Bleeding stops—> monitor 24 hr —> Discharge after prescribing Oral propranolol
2) Bleeding doesn’t stop/Rebleeding —> 2nd trial of endoscopy —> If fails, TIPSS

Question 2

Types of shunt surgeries for portal HTN

Answer 2

1) Non selective shunt (both bowel and splenic blood shunted)
i) Linton (proximal lienorenal)
ii) Eck’s fistula (portacaval)
iii) Mitra shunt (side to side lienorenal)

2) Selective shunt (only splenic blood shunted)
i) Warren shunt (Distal lienorenal)
ii) Inokuchi shunt (Left gastric-vena caval shunt)