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Case Reports
. 2017 Jul-Sep;43(3):191-200.
doi: 10.12865/CHSJ.43.03.02. Epub 2017 Sep 28.

Diagnosis and Treatment Algorithms of Acute Variceal Bleeding

L A Barbu  1 , N D Mărgăritescu  2 , M V Şurlin  2
Affiliations
Case Reports

Diagnosis and Treatment Algorithms of Acute Variceal Bleeding

L A Barbu et al. Curr Health Sci J. 2017 Jul-Sep.

Abstract

Esophageal varices are about 10%-15% of UGIB. Over 90% of patients with cirrhosis develop portal hypertension (PHT), but not all patients with PHT and liver cirrhosis have esophageal varices. At the time of diagnosis, only 60% of patients with cirrhosis have esophageal varices. In the case of variceal bleeding suspects, vasoactive drugs should be given as soon as possible and before endoscopy. Balloon tamponade is used to obtain temporary hemostasis by direct compression of hemorrhagic varices. The variceal band ligation is already the first place in the treatment and prevention of variceal bleeding, but also in rebleeding prevention. TIPS is used as a rescue therapy after failure of drug and endoscopic therapy. The mortality assigned to the hemorrhagic episode is substantially, estimated at 13-19% of the overall mortality in hepatic cirrhosis. Current recommendations for the treatment of acute variceal bleeding are the use of combination therapy: vasoactive drugs, balloon tamponade, elastic ligation and TIPS, whose staging is done in various diagnosis and treatment algorithms.

Keywords: endoscopy; portal hypertension; variceal bleeding.

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Figures

Figure 1
Figure 1
Endoscopic appearance of esophageal varices (Department of Gastroenterology Craiova)
Figure 2
Figure 2
Variceal elastic band ligation (Department of Gastroenterology Craiova)
Figure 3
Figure 3
Response to conservative therapy
Figure 4
Figure 4
Flow chart showing the management of an AVB episode [75]
Figure 5
Figure 5
Management of acute variceal bleeding [76]
Figure 6
Figure 6
Algorithm of management of acute variceal bleeding [8]
Figure 7
Figure 7
. Algorithm of survival after bleeding [8]
See this image and copyright information in PMC

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