Document Detail

A commonsense approach to variceal bleeding.
MedLine Citation:
PMID:  15562673     Owner:  NLM     Status:  MEDLINE    
A cirrhotic patient with large varices and red color signs at endoscopy, and a portal pressure greater than 12 mmHg, has a high risk of bleeding from those varices in the near future. Prophylactic therapy with a nonselective beta-adrenergic blocking drug or long acting nitroglycerin reduces the risk of developing the first bleed and increases life expectancy. The acute variceal bleed requires prompt resuscitation with volume replacement, early initiation of vasoactive drugs (octreotide, somatosatin, or vasopressin plus nitroglycerin) to reduce portal pressure and decrease splanchnic flow, and early diagnostic endoscopy to determine the cause of bleeding. Variceal banding or sclerotherapy is successful in controlling the acute bleed in up to 90% of cases. Beta-adrenergic blocker therapy should be instituted once the bleed has been controlled and banding/sclerotherapy continued until the varices have been obliterated. In the patient with recalcitrant or recurrent bleeding, TIPS, selective shunt surgery, or liver transplantation may be options depending on the specifics of the particular case.
D R LaBrecque
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Clinics in liver disease     Volume:  1     ISSN:  1089-3261     ISO Abbreviation:  Clin Liver Dis     Publication Date:  1997 May 
Date Detail:
Created Date:  2004-11-25     Completed Date:  2005-02-08     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  9710002     Medline TA:  Clin Liver Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  121-7, xii     Citation Subset:  IM    
Liver Service, Department of Internal Medicine, University of Iowa Hospitals and Clinics Iowa City, Iowa 52242-1081, USA.
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MeSH Terms
Acute Disease
Esophageal and Gastric Varices / complications*,  diagnosis,  therapy
Gastrointestinal Hemorrhage / diagnosis,  etiology,  therapy*
Hemostatics / therapeutic use
Portasystemic Shunt, Transjugular Intrahepatic
Reg. No./Substance:

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