Variceal H

Question 1

what vasoactive agent do you give

Answer 1

terlipressin

Question 2

terlipressin moa

Answer 2

synthetic vasopressin analogue with relative specificity for the splanchnic circulation where it causes vasoconstriction in these vessels with a reduction in portal pressure.

Question 3

what else should you give alongside terlipressin

Answer 3

IV abx - quinolones

Question 4

before endoscopy what should be given and made sure of

Answer 4

ABC
pt is resuscitated before endoscopy
both terlipressin and IVabx given
clotting ordered - FFP, vit k , platelet transfusion
blood transfusion may be required

Question 5

last resort for haemorrhage

explain what it does

Answer 5

TIPS connects hepatic vein to portal vein

this is after enoscopic variceal band ligation or endoscopy slerotherapy tried
uncontrolled h - sengstaken blakemore tube could work

Question 6

main blood supply to liver

Answer 6

portal vein - 80%
hepatic artery - 20%

Question 7

how does propranolol act as prophylaxis for variceal h

Answer 7

reduced rebleeding and mortality

Question 8

what other things can you do for proph

Answer 8

endoscopic band ligation - 2 weekly. intervals to irradicate with PPI cover