Varices and variceal bleed resident survival guide: Difference between revisions
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==Overview== | ==Overview== | ||
==Approach to | ==Approach to Varices in a Cirrhotic Patient== | ||
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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}} | ||
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Algorithm | Algorithm as per practice guidelines approved by American Association for the Study of Liver Diseases (AASLD) and American College of Gastroenterology (ACG). <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> | ||
==Management of | ==Management of Actively Bleeding Varices== | ||
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Algorithm as per practice guidelines approved by American Association for the Study of Liver Diseases (AASLD) and American College of Gastroenterology (ACG). |
Revision as of 23:29, 29 December 2013
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Twinkle Singh, M.B.B.S. [2]
Overview
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 as per practice guidelines approved by American Association for the Study of Liver Diseases (AASLD) and American College of Gastroenterology (ACG). [1]
Management of Actively Bleeding Varices
Suspected acute variceal hemorrhage
❑ Patient with known cirrhosis and/ | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
General measures: ❑Admit the patient to ICU | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Prophylactic antibiotics
❑ Oral norfloxacin (400mg BID)OR | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacologic therapy:
❑ Vasopressin (IV infusion 0.2 to 0.4 units/min up to 0.8 units/min)+ Nitroglycerine (IV 40 μg/min can be increased up to 400 μg/min) OR | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Endoscopic therapy
❑ Early EGD recommended for diagnosis and treatment (with in 12 hours of admission) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Algorithm as per practice guidelines approved by American Association for the Study of Liver Diseases (AASLD) and American College of Gastroenterology (ACG).
- ↑ 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.