Document Detail

The critically ill liver patient: the variceal bleeder.
MedLine Citation:
PMID:  12610853     Owner:  NLM     Status:  MEDLINE    
Esophageal varices develop in patients with cirrhosis once portal pressure, measured by hepatic venous pressure gradient, and exceeds 10 mm Hg. At a portal pressure of 12 mm Hg, variceal bleeding may develop that is associated with a mortality of 30% to 50% per episode. In addition to an elevated portal pressure, other risk factors for the development of variceal hemorrhage include: variceal size, endoscopic features on the variceal wall (i.e., red wales), and Child-Pugh class. In patients with suspected variceal hemorrhage, the treatment of the acute episode includes intravascular volume expansion, hemostasis through the use of pharmacological agents and endoscopy, and the prevention and treatment of potential complications associated with variceal hemorrhage such as aspiration pneumonia, spontaneous bacterial peritonitis and hepatic encephalopathy. Given a high rate of rebleeding, long-term prevention through secondary prophylaxis should be instituted in all patients who have survived an episode of variceal bleeding. Current prophylactic options include: non-selective beta-blockers alone (first line) or in combination with long-acting nitrates (isosorbide mononitrate) and/or endoscopic variceal obliteration achieved through sclerotherapy or preferably, band ligation.
Miguel R Arguedas
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Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Seminars in gastrointestinal disease     Volume:  14     ISSN:  1049-5118     ISO Abbreviation:  Semin. Gastrointest. Dis.     Publication Date:  2003 Jan 
Date Detail:
Created Date:  2003-03-03     Completed Date:  2003-08-22     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  9100391     Medline TA:  Semin Gastrointest Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  34-8     Citation Subset:  IM    
Division of Gastroenterology & Hepatology, UAB Liver Center, University of Alabama at Birmingham, UAB Liver Center, 1918 University Blvd, Birmingham, AL 35294, USA.
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MeSH Terms
Critical Illness
Diagnosis, Differential
Drug Therapy, Combination
Endoscopy, Gastrointestinal
Esophageal and Gastric Varices / diagnosis*,  etiology,  therapy
Hemostatics / therapeutic use*
Hepatitis C, Chronic / complications*
Middle Aged
Nitroglycerin / therapeutic use*
Sclerotherapy / methods*
Vasodilator Agents / therapeutic use*
Vasopressins / therapeutic use*
Reg. No./Substance:
0/Hemostatics; 0/Vasodilator Agents; 11000-17-2/Vasopressins; 55-63-0/Nitroglycerin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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