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6 Cards in this Set
- Front
- Back
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clnica
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sudden onset of upper Gi bleeding( melena/hematemesis)
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association with what
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sigh of cirrhosis- spiderangiomata
hepato megaly spleno megaly asctitis palmar erythema |
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acute management
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1. start ostreotide ( somatostatin analogue)+
I/V ciprofloxacine or cefriaxone ( decrease mortality) 2.upper endoscopy withsclerotherapy or band ligation as soon as posible note-- if endo scopy is delayed- use ballon tamponade to control bleeding |
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if acute tx fails what to do
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transjugular intrahepatic portosystemic shunting (TIPS)
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long term management
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1. endoscopic ligation- superior to sclerotherapy for long term management
2.non selective beta blockers(decrease ty eportal pressure and prevent the variceal bleeding) 3 TIPS if above fail lowers portal pressure --- (could cause to liver failure and )encephalopathy only cure is liver transplant to qualify the candidate should have end stage liver disease be abstinent from drugs for at least 6 months and have not severe cardiopulmonary disease or extensive malignancy |
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Upper GI Bleeding Esophageal Varices
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Upper GI Bleeding Esophageal Varices
Ds – Endoscopy Active Bleeding- No Active Bleeding Iv large bores, OSTREOTIDE Beta Blockers – PROPRANOLOl If this fails- SCLEROTHERAPY if bleeding recurs- ISOSORBIDE Is this fails – BAND LIGATION If cant control- TIPS most common complication- hepatic encephalopathy If TIPS fails - more tubes ( P . is still bleeding) If no effect – SURGERY + give FLUOROQUINALONE for 7-10 days for pneumonia Remember – if patient is active bleeding- this is emergency !!!!! first step is ABC |
