VARICEAL BLEEDING Clinical features Diagnosis and Treatment

VARICEAL BLEEDING Clinical features Diagnosis and Treatment

VARICEAL BLEEDING

Clinical features,:

VARICEAL BLEEDING Differential diagnosis :

PREDICTIVE FACTORS —

Treatment

  • Blood transfusion Specific interventions
  • Fresh frozen plasma transfusion.
  • Admission to ICU with monitoring of central venous pressure, pulmonary capillary wedge pressure, urine output, mental status.
  • Endoscopy is advised.
  • Vasoconstrictors - somatostatin / octreotide or va­sopressin
  • Endoscopic variceal Iigation (EVL)
    •  is the best method where circular rings are used to ligate the varices.
  • Surgical treatment
    •  is last resort because of high mortality.
    • In TIPS (Trans Jugular Intrahepatic Portosystemic Shunt) a metal stent is used to create a portocaval channel. This is used in refractory bleeding only.
    • Liver transplantation is being increasingly done nowa­days.
    • Gastric fundal bleeding is more difficult to manage.

Prevention of first haemorrhage  :

Prevention of recurrent haemorrhage  :

  • · Endoscopic band ligation
  • · Beta blockers
  • · Portosystemic shunt surgery

Portal hypertensive gastropathy

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