Management of oesophageal variceal haemorrhage

Haemorrhage from oesophageal varices is potentially life-threatening and occurs unpredictably. Risk reduction can be achieved by identifying varices in cirrhotic patients and employing a surveillance strategy for low-risk cases, or pharmacological prophylaxis in higher-risk cases. This chapter sets out a summary of current national/international guidelines and includes detailed recommendations for management of acute haemorrhage including terlipressin, endoscopic EVL/sclerotherapy and Sengastaken tube therapy and TIPS.

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Sudden death due to ruptured oesophageal varices – autopsy-based case report

Medico-Legal Journal ◽

10.1177/0025817220926929 ◽

2020 ◽

Vol 88 (4) ◽

pp. 189-191

Author(s):

Nagendra Singh Sonwani ◽

Navneet Ateriya ◽

Arvind Kumar ◽

Anil Kohli ◽

Kalyan Kumar Banerjee

Keyword(s):

Chronic Alcoholism ◽

Medical Emergency ◽

Oesophageal Varices ◽

High Morbidity ◽

Forensic Pathologist ◽

Threatening Condition ◽

Life Threatening ◽

Cirrhotic Patients ◽

Acute Haemorrhage

Acute haemorrhage from ruptured oesophageal varices is a serious consequence of portal hypertension in cirrhotic patients. It represents a medical emergency with a high morbidity and mortality rate. Studies over the years have shown a direct link with chronic alcoholism in the development of such complications. Although the gastrointestinal system accounts for a few numbers of sudden deaths, bleeding through ruptured varices represent a life-threatening condition. The role of forensic pathologist is vital in dealing with sudden deaths. Here, we report a case of a 46-year-old man who died suddenly following the rupture of oesophageal varices.

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Predicting the outcome of transhepatic embolisation to control life-threatening haemorrhage from oesophageal varices

Clinical Radiology ◽

10.1016/s0009-9260(89)80348-4 ◽

1989 ◽

Vol 40 (6) ◽

pp. 639

Keyword(s):

Oesophageal Varices ◽

Life Threatening

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Acute Asthma in Adults: Controversies and Best Practice

Acute Medicine Journal ◽

10.52964/amja.0224 ◽

2009 ◽

Vol 8 (1) ◽

pp. 10-16

Author(s):

Maren Schuhmann ◽

◽

Fraser Brims ◽

Anoop J Chauhan ◽

◽

...

Keyword(s):

Emergency Care ◽

Best Practice ◽

Care Setting ◽

Acute Asthma ◽

British Thoracic Society ◽

International Guidelines ◽

Life Threatening

Asthma in the emergency care setting is common and may be life-threatening. Last year the British Thoracic Society updated their guidelines for the management of asthma, however some treatments remain controversial and there is variation in adherence to these and other national and international guidelines.

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Blood Ammonia level : Is it a Clue for the Presence of Oesophageal Varices in Cirrhotic Patients ?

Afro-Egyptian Journal of Infectious and Endemic Diseases ◽

10.21608/aeji.2017.16284 ◽

2017 ◽

Vol 7 (4) ◽

pp. 169-176

Author(s):

A.H Lashin ◽

H. M El feky ◽

M.M Elbehisy ◽

M.E Nada

Keyword(s):

Ammonia Level ◽

Oesophageal Varices ◽

Blood Ammonia ◽

Blood Ammonia Level ◽

Cirrhotic Patients

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Noninvasive assessment of oesophageal varices presence and size in patients with liver cirrhosis using right liver lobe/serum albumin concentration

Vojnosanitetski pregled ◽

10.2298/vsp0707453a ◽

2007 ◽

Vol 64 (7) ◽

pp. 453-457

Author(s):

Tamara Alempijevic ◽

Vladislava Bulat ◽

Nada Kovacevic ◽

Rada Jesic ◽

Srdjan Djuranovic ◽

...

Keyword(s):

Liver Cirrhosis ◽

Portal Hypertension ◽

Oesophageal Varices ◽

Digestive Endoscopy ◽

Liver Lobe ◽

Albumin Ratio ◽

Cirrhotic Patients ◽

The Mean ◽

Upper Digestive Endoscopy ◽

The Right

Background/Aim. Liver cirrhosis is a chronic, progressive disease and it is usually accompanied by portal hypertension. The development of oesophageal varices (OV) is one of the major complications of portal hypertension. Cirrhotic patients should be screened for the presence of OV when portal hypertension is diagnosed. In order to reduce the increasing burden that endoscopy units have to bear, some studies have attempted to identify parameters for noninvasive prediction of OV presence. The aim of our study was to evaluate the value of biochemical and ultrasonography parameters for prediction of OV presence. Methods. This study included 58 cirrhotic patients who underwent a complete biochemical workup, ultrasonography examination and upper digestive endoscopy. Right liver lobe diameter/albumin ratio was calculated and its correlation to the presence and degree of OV, and Child-Pugh score of liver cirrhosis explored. Results. The mean age of the patients included in the study was 53.07?13.09 years; 40 were males and 18 females. In the Child-Pugh class A were 53.4% patients, class B 39.7%, whereas 6.9% were in the class C. In 24.1% of the patients no OV were identified by upper digestive endoscopy, 19% had OV grade I, 34.5% grade II, 20.7% grade III, and 1.7% OV grade IV. The mean value of the right liver lobe diameter/ albumin ratio was 5.43?1.79 (range of 2.76?11.44). Statistically significant correlation (p < 0.01) was confirm by Spearman's test between OV grade and calculated index (? = 0.441). Conclusion. The right liver lobe diameter/albumin ratio is a noninvasive parameter which provides an accurate information pertinent to the determination of OV presence and their grading in patients with liver cirrhosis. .

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Immature Platelet Fraction as a Non-Invasive Marker for Esophageal Varices

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2021/v33i330821 ◽

2021 ◽

pp. 55-64

Author(s):

Alyaa Marzouk Soliman ◽

Sherief Mohamed Abd-Elsalam ◽

Amal Saeid ALBendary ◽

Osama El. Sayed Negm

Keyword(s):

Esophageal Varices ◽

Significant Positive Correlation ◽

Oesophageal Varices ◽

P Value ◽

Positive Correlation ◽

Non Invasive ◽

Immature Platelet Fraction ◽

Significant Difference ◽

Cirrhotic Patients ◽

Group 1

Background: All cirrhotic patients should be screened for oesophageal varices (OV) at the time of diagnosis. The development of a non-invasive method for the detection of OV is a vital issue in subjects with cirrhosis to decrease the need for invasive endoscopic procedures that can be costly. This work aimed to evaluate immature platelet fraction (IPF) as a non-invasive marker and predictor of OV. Methods: This cross-sectional study was carried out on 80 cirrhotic patients with esophageal varices diagnosed by upper endoscopy. They were divided into Group (1): 40 patients with cirrhosis with esophageal varices and Group (2): 40 patients with cirrhosis and without esophageal varices. All patients were subjected to the complete history taking, physical examination, routine laboratory investigations (Complete blood count, IPF, C-reactive protein, Liver and kidney function tests, Bone marrow aspiration for some cases, Ascetic sample analysis when applicable), Pelvic-Abdominal ultrasonography, Child Pugh score assessment, Upper GIT endoscopy. Results: There was a significant difference between the studied groups regarding IPF (p<0.001). At cutoff >12 IPF had (AUC= 0.993) with sensitivity of 97.5% and specificity of 97.5% for detection of esophageal varices. There was a significant negative correlation between IPF and platelets count (p- value < 0.001). There was a significant positive correlation between IPF and Child Pugh score (p- value <0.001). There was a highly significant positive correlation between IPF and CRP (p value <0.001). There was significant difference between the two groups as regards splenic longitudinal diameter (p<0.001). As regards platelet count, there was a significant difference between the two groups (p<0.001). It was significantly lower in Group 1. Conclusions: IPF is elevated in cirrhotic patients with naive esophageal varices than in cirrhotic patients without varices. IPF could be used as a noninvasive, easy to measure method for detection of the presence of esophageal varices at a cutoff level of >12.

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Abstract 17369: Addressing Missed Opportunities for Cardiometabolic Primary Prevention of Veterans Referred for Stress Testing

Circulation ◽

10.1161/circ.142.suppl_3.17369 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Ysanne Johnson ◽

Sheila M Mattei ◽

Matthew Burg ◽

Judith L Meadows

Keyword(s):

Risk Reduction ◽

Stress Testing ◽

Stress Test ◽

Standard Of Care ◽

Low Risk ◽

Stress Tests ◽

Missed Opportunities ◽

Presenting Symptoms ◽

Reduction Strategies ◽

Risk Reduction Strategies

Introduction: Patients presenting to stress testing have a high prevalence of cardiometabolic risk factors (RF) which are not at guideline supported goals. Referral to stress testing is often a patient’s first presentation to CV care and represents a missed opportunity for delivery of risk reduction strategies. Hypothesis: Implementation of a cardiometabolic prevention initiative for cardiology-naïve patients referred to stress testing will result in improved delivery of guideline-directed prevention care. Methods: A consecutive prospective cohort of patients who underwent stress testing (12/1/2019-1/31/2020) after implementation of a linked cardiometabolic prevention referral for those with low risk stress tests was compared to a retrospective standard of care (SOC) cohort (9/1/2019-10/1/2019) from a single center Veterans Hospital. Outcomes assessed were change in CV risk reduction care at 90 days following stress test. Results: Of 181 patients, 62.5% were naïve to cardiology specialty care, had >1 CV risk factor not meeting guideline goals, 6% had typical angina as presenting symptoms, and greater than 70% of stress tests were normal or low risk. Baseline CV RF were common and failed to reach goals in SOC and intervention cohorts respectively with LDL above goal (40 vs. 33%), stage 1 or greater hypertension (67 vs 81%), Diabetes with HgA1c > 7 (48 vs. 21%), overweight or obese (68 vs. 79%), current tobacco (11 vs. 12%), and elevated mean 10-year ASCVD risk (32 vs.20%). At 90 days, 28% of SOC cohort had intensification of CV prevention care as compared to 76% of intervention cohort (X 2 26.8, p<0.05). Conclusions: A stress testing setting represents a valuable opportunity to deliver cardiometabolic prevention care. Integration of risk reduction strategies is imperative to shift from cardiac disease management to patient centered health promotion.

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Should preoperative showering or cleansing with chlorhexidine gluconate (CHG) be part of the surgical care bundle to prevent surgical site infection?

Journal of Infection Prevention ◽

10.1177/1757177417714873 ◽

2017 ◽

Vol 18 (6) ◽

pp. 311-314 ◽

Cited By ~ 5

Author(s):

Charles E Edmiston ◽

David Leaper

Keyword(s):

Surgical Site Infection ◽

Risk Reduction ◽

Low Cost ◽

Surgical Care ◽

Infection Risk ◽

Chlorhexidine Gluconate ◽

Low Risk ◽

Care Bundle ◽

Site Infection ◽

Methodological Issues

Showering preoperatively with chlorhexidine gluconate is an issue that continues to promote debate; however, many studies demonstrate evidence of surgical site infection risk reduction. Methodological issues have been present in many of the studies used to compile guidelines and there has been a lack of standardisation of processes for application of the active agents in papers pre-2009. This review and commentary paper highlights the potential for enhancing compliance with this low-risk and low-cost intervention and provides some guidance for enhancing implementation of preoperative showering with both chlorhexidine in solution and impregnated wipes.

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Plasminogen Activator and Factor VIII in Cirrhosis Following Infusion of Lysine Vasopressin and Triglycyl Lysine Vasopressin

10.1055/s-0039-1684630 ◽

1979 ◽

Author(s):

C.V. Prowse ◽

J.G. Douglas ◽

J.D. Cash

Keyword(s):

Clinical Trials ◽

Gastrointestinal Bleeding ◽

Factor Viii ◽

Plasminogen Activator ◽

Half Life ◽

Normal Subjects ◽

Oesophageal Varices ◽

Lysine Vasopressin ◽

Cirrhotic Patients ◽

Fibrinolytic Potential

While lysine vasopressin (LVP) has been used for many years for the treatment of cirrhotic patients with bleeding oesophageal varices, on the basis of its ability to cause splanchnic vasoconstriction, its use remains contraversial. Previous studies have shown that infusion of this drug to normal subjects results in a rapid increase in plasminogen activator and factor VIII. When infused into cirrhotic patients with varices we found that LVP caused a large increase in the, already raised, level of plasminogen activator (and factor VIII). This increase in fibrinolytic potential might contribute to poor deposition of fibrin in bleeding patients. .In contrast infusion of the analogue triglycyl lysine vasopressin (GVP) in the same patients produced no change in plasminogen activator or factor VIII. GVP retains the vasoconstrictive properties of LVP and has a considerably longer half-life. In view of these advantages clinical trials of the use of GVP in gastrointestinal bleeding are warranted.

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