VARICEAL BLEEDING Clinical features Diagnosis and Treatment

VARICEAL BLEEDING Clinical features Diagnosis and Treatment

VARICEAL BLEEDING

• It results from portal systemic venous collaterals when portal hypertensionPortal Hypertension Clinical Features Symptoms Diagnosis and Treatment. Read more ... » is more than 12 mmHg.

Clinical features,:

• There is painless hematemesis, tachycardiaHyperglycemic Hyperosmolar State (HHS) Acute Complication Of DM. Read more ... » and even shockShock Presentation Risk Factors Pathogenesis Management Treatment. Read more ... ».

VARICEAL BLEEDING Differential diagnosis :

• Peptic ulcer and gastritis. Endoscopy is done for proper diagnosisCommon atrioventricular canal defect or complete atrioventricular septal defect. Read more ... ».
• Variceal bleeding is serious emergency
• patients with varices will develop variceal hemorrhage, a major cause of morbidity and mortality in patients with cirrhosis

VARICEAL BLEEDING ClinicalCommon atrioventricular canal defect or complete atrioventricular septal defect. Read more ... » features Diagnosis and TreatmentCommon atrioventricular canal defect or complete atrioventricular septal defect. Read more ... »

PREDICTIVE FACTORS —

• Numerous clinical and physiologic factors are useful in predicting the risk of variceal hemorrhage in patients with cirrhosis.
• These include:
• Location of varices
• Size of varices
• Appearance of varices
• Clinical featuresPulmonary Thromboembolism Pathophysiology Clinical Features with Treatment. Read more ... » of the patient
• Variceal pressureChronic Long-term Complications Of Diabetes Mellitus. Read more ... »

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
  • Vasopressin is given 0.1 to 0.4 units / min. in IV infu­sion.
  • Bleeding often recurs after stoppage of infusion. Side effects of vasopressin are acuteCommon atrioventricular canal defect or complete atrioventricular septal defect. Read more ... » renalDiabetic Nephropathy and Renal complications of DM (Diabetes Mellitus). Read more ... » failure, hyponatremia and coronary ischemia.
  • Somatostatin is splanchnic vasoconstrictor. It is given 250IJg bolus followed by 250 IJg / hour.
  • Octreotide is given 50 – 100 IJg/hour. These are pre­ferred to vasopressin.
  • Nitroglycerin drip or isosorbide-di-nitrate are given to prevent side effects.
  • Balloon tamponade is done to stop bleeding Endoscopic ligation or sclerotherapy of varices may be done to check and pevent bleeding.
• 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  :

• · Beta blockersHeart Failure Treatment Heart Failure GENERAL PRINCIPLES. Read more ... »
• · Banding of oesophageal varices

Prevention of recurrent haemorrhage  :

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

Portal hypertensive gastropathy

• · A congestive gastropathy occurs due to venous hypertensionThyrotoxic crisis or Thyroid storm. Read more ... ».
• · Mucosa becomes friable.
• · Beta blockers and proton pump inhibitors are given.