Varices and variceal bleed resident survival guide: Difference between revisions
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{{familytree | | | | | | | | | G01 | | G02 | | G03 | | G04 | | | | | | | | | | | | | | | | | | | | |G01=Non selective beta blockers|G02=Non selective beta blockers can be used (long tern benefits not established)|G04= Non selective beta blockers preferred (propanolol, nadolol), EVL in case of contraindication or intolerance to beta blockers |G03=Non selective beta blockers (propanolol,nadolol) or EVL}} | {{familytree | | | | | | | | | G01 | | G02 | | G03 | | G04 | | | | | | | | | | | | | | | | | | | | |G01=Non selective beta blockers|G02=Non selective beta blockers can be used (long tern benefits not established)|G04= Non selective beta blockers preferred (propanolol, nadolol), EVL in case of contraindication or intolerance to beta blockers |G03=Non selective beta blockers (propanolol,nadolol) or EVL}} | ||
{{familytree/end}} | {{familytree/end}} | ||
Algorithm according to American Association for the Study of Liver Diseases (AASLD) practice guidelines. <ref name="pmid17879356">{{cite journal| author=Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W, Practice Guidelines Committee of the American Association for the Study of Liver Diseases. Practice Parameters Committee of the American College of Gastroenterology| title=Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. | journal=Hepatology | year= 2007 | volume= 46 | issue= 3 | pages= 922-38 | pmid=17879356 | doi=10.1002/hep.21907 | Algorithm according to American Association for the Study of Liver Diseases (AASLD) practice guidelines. <ref name="pmid17879356">{{cite journal| author=Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W, Practice Guidelines Committee of the American Association for the Study of Liver Diseases. Practice Parameters Committee of the American College of Gastroenterology| title=Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. | journal=Hepatology | year= 2007 | volume= 46 | issue= 3 | pages= 922-38 | pmid=17879356 | doi=10.1002/hep.21907| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17879356}}</ref> | ||
Revision as of 20:40, 29 December 2013
Approach to varices in a cirrhotic patient
| Patient diagnosed with cirrhosis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| No active bleeding | Active bleeding | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Screening EGD | See below | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| No varices | Esophageal varices | Gastric varices | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Compensated cirrhosis | De-compensated cirrhosis | Small(<5mm) | Medium/Large(>5mm) | Cyanoacrylate or EVL | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Repeat EGD in 3 years | Repeat EGD annually | High risk of hemorrhage† | Not at high risk of hemorrhage‡ | High risk of hemorrhage† | Not at high risk of hemorrhage‡ | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Non selective beta blockers | Non selective beta blockers can be used (long tern benefits not established) | Non selective beta blockers (propanolol,nadolol) or EVL | Non selective beta blockers preferred (propanolol, nadolol), EVL in case of contraindication or intolerance to beta blockers | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Algorithm according to American Association for the Study of Liver Diseases (AASLD) practice guidelines. [1]
- ↑ Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W, Practice Guidelines Committee of the American Association for the Study of Liver Diseases. Practice Parameters Committee of the American College of Gastroenterology (2007). "Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis". Hepatology. 46 (3): 922–38. doi:10.1002/hep.21907. PMID 17879356.