scholarly journals Bleeding Ectopic Varices as the First Manifestation of Portal Hypertension

2014 ◽  
Vol 2014 ◽  
pp. 1-3
Author(s):  
Brij Sharma ◽  
Sujeet Raina ◽  
Rajesh Sharma
Keyword(s):  
Portal Hypertension ◽  
Upper Gastrointestinal Bleeding ◽  
Venous Obstruction ◽  
Gastroesophageal Varices ◽  
Upper Gi ◽  
Ectopic Varices ◽  
Extrahepatic Portal Venous Obstruction ◽  
Portosystemic Collateral ◽  
Upper Gi Endoscopy ◽  
Upper Gastrointestinal

Ectopic varices are defined as dilated portosystemic collateral veins in locations other than the gastroesophageal region. We present a case of recurrent upper gastrointestinal bleeding as the first manifestation of portal hypertension. We diagnosed ectopic duodenal varices without gastroesophageal varices on upper GI endoscopy and extrahepatic portal venous obstruction (EHPVO) on CT angiography and managed this case.

scholarly journals AGREEMENT BETWEEN MULTIDETECTOR COMPUTED TOMOGRAPHY AND ENDOSCOPY FOR THE EVALUATION OF GASTRO-ESOPHAGEAL VARICES IN PATIENTS WITH PORTAL HYPERTENSION.

2021 ◽  
pp. 1-3
Author(s):  
Mehak Garg ◽  
Nirmal Kumar Prabhu ◽  
Shivane Garg ◽  
Saravanan S ◽  
Rubalakshmi S ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Esophageal Varices ◽  
Predictive Value ◽  
Gold Standard ◽  
Gastric Fundus ◽  
Observer Agreement ◽  
Gastroesophageal Varices ◽  
Gi Endoscopy ◽  
Upper Gi ◽  
Upper Gi Endoscopy

Aim: The aim is to study the agreement between MDCT and endoscopy in diagnosing gastroesophageal varices in patients of chronic liver disease with portal hypertension, keeping endoscopy as gold standard. Materials and Methods: The study included 29 cirrhotic patients with portal hypertension assessed between August 2018 to August 2020 who underwent upper gastrointestinal (GI) endoscopy and MDCT within 12 weeks. Two radiologists reviewed the scans, to determine the grade of esophageal varices. To evaluate the accuracy of MDCT findings by Radiologists 1 and 2 with respect to endoscopy findings (GOLD STANDARD), McNemar’s chi square test with validity parameters such as Sensitivity, Specificity, Positive predictive value, Negative predictive value and accuracy was computed. Cohens kappa was used to ascertain the inter-observer agreement for grading of varices between MDCT and endoscopy. Results: The sensitivity of MDCT for radiologist A was 76.7%, specificity 93%, Accuracy 89.7%, PPV 91.6%, NPV 93.9% and for radiologist B, 79%, 93.4%, 89.6%, 81.4% and 93.1% respectively. For the inter-rater agreement the kappa value between Radiologist A v/s upper GI endoscopy was 0.716, Radiologist B v/s upper GI endoscopy was 0.720 and Radiologist A v/s Radiologist B was 0.808. MDCT detected para esophageal varices in 16 cases, gastric fundus varices in 9 cases and splenorenal collaterals in 3 cases, palisade vein dilatation was positive in 9 cases, negative in 20 cases. 3 cases of HCC were incidentally found during examination. Conclusion: MDCT is a good replacement for endoscopy in the detection of gastroesophageal varices, especially those with high grade varices (grade 2 and 3). MDCT helps in detection of palisade vein and other extra-luminal findings like HCC, other portosystemic collaterals.

scholarly journals Clinical and endoscopic features of aorto-duodenal fistula resulting in its definitive diagnosis: an observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chikamasa Ichita ◽  
Akiko Sasaki ◽  
Chihiro Sumida ◽  
Karen Kimura ◽  
Takashi Nishino ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Ct Scan ◽  
Upper Gastrointestinal Bleeding ◽  
Definitive Diagnosis ◽  
Duodenal Fistula ◽  
Gi Endoscopy ◽  
Upper Gi ◽  
Aortic Pathology ◽  
Upper Gi Endoscopy ◽  
Upper Gastrointestinal

Abstract Background Upper gastrointestinal (GI) bleeding is the most important presentation of an aorto-duodenal fistula (ADF). Early diagnosis is difficult, and the disease is associated with high mortality. The present study aimed to examine the clinical and the endoscopic characteristics of ADF in eight patients who presented to our hospital. We also sought to clarify the diagnostic approach towards the disease. Methods The present study examined the clinical and the endoscopic/computed tomography (CT) characteristics of ADF in eight patients who were definitively diagnosed with this condition in a 12-year period at our hospital. Results The patients comprised of five men and three women, with a mean age of 69.8 years. Upper gastrointestinal bleeding was the chief complaint for all the patients. Out of these, two patients presented with shock. The patients’ mean haemoglobin at presentation was 7.09 g/dL, and the mean number of blood transfusions was 7.5. All patients had undergone intervention to manage an aortic pathology in the past. As the first investigation, an upper GI endoscopy in 5 and a CT scan in 3 patients were performed. In cases where CT scan was performed first, no definitive diagnosis was obtained, and the diagnosis was confirmed by performing an upper GI endoscopy. In cases where endoscopy was performed first, definitive diagnosis was made in only one case, and the other cases were confirmed by the CT scan. In some cases, tip attachments, converting to long endoscopes, and marking clips were found useful. Conclusions In patients who have undergone intervention to manage an aortic pathology and have episodes of upper gastrointestinal bleeding, ADF cannot be definitively diagnosed with only one investigation. In addition, when performing upper GI endoscopy in cases where an ADF is suspected, tip attachment, converting to a long endoscope, and using marking clips can be helpful.

scholarly journals Clinico-etiological pattern of upper gastrointestinal bleeding in children

2016 ◽  
Vol 4 (1) ◽  
pp. 132
Author(s):  
Shiv Ram Krishna Dubey ◽  
Neha Bhadauria ◽  
Mukesh Shukla ◽  
Purvi Mittal ◽  
Arun Kumar Arya ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Age Group ◽  
Gi Bleeding ◽  
Venous Obstruction ◽  
Upper Gi Bleeding ◽  
Upper Gi ◽  
Group 5 ◽  
Hepatic Portal ◽  
Upper Gastrointestinal

Background: Upper GI bleeding (UGIB) is defined as bleeding occurring proximal to ligament of treitz. Upper gastrointestinal bleeding (UGIB) can lead to potentially serious and life-threatening clinical situation in children. Globally, the cause of UGIB differs significantly depending on variations in patient population and the presence of comorbid conditions. The objective of this study was to understand the clinico-etiological pattern of upper gastrointestinal bleeding in children in the age group 5-18 years, at a tertiary care centre in central India.Methods: This prospective study was carried out at a tertiary health care centre between January 2011 and August 2012. We consecutively enrolled all patients in the age group 5-18 years who came to our centre with hematemesis or hematemesis and malena both. Blood sample for CBC, stool sample for occult blood was taken and Ultrasonography of abdomen for liver echotexture, portal vein diameter/pressure and splenomegaly, done. Then, all patients underwent upper gastro intestinal endoscopy (Olympus GIF-V70 upper GI video endoscope).Results: Total 112 patients were included in the study during the study period. UGIB is most common in the age group 5-10 years (71.4%), followed by 10-14 years (26.8%). Hematemesis is the most common presenting symptom (75%) followed by both hematemesis and melena (25%). The most common causes of UGIB on EGD were oesophageal or gastric varices (91.1%) followed by erosive gastritis (5.3%), gastric ulcer (1.8%) and esophagitis (1.8%). Most common finding on ultrasonography (USG) abdomen was extra-hepatic portal venous obstruction (EHPVO) 75%, followed by liver cirrhosis (16.1%). No abnormality was detected on USG in 8.9% of patients.Conclusions: We conclude that Upper GI bleeding is more common in 5-10 years age group with hematemesis as the main presenting symptom. The causes of upper GI bleeding in children in developing countries are different from those in developed countries (variceal bleeding due to extra hepatic portal venous obstruction is the most common cause and peptic ulcer is rare).

scholarly journals Current Trends in Etiological Profile of Acute Upper Gastrointestinal Bleeding in Northern India: A Retrospective Analysis of 5-Year Endoscopic Data

2021 ◽  
Vol 12 (01) ◽  
pp. 031-035
Author(s):  
Vishal Bodh ◽  
Brij Sharma ◽  
Rajesh Kumar ◽  
Rajesh Sharma
Keyword(s):  
Portal Hypertension ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
The Other ◽  
Western India ◽  
Anastomotic Site ◽  
Care Hospital ◽  
Acute Upper Gastrointestinal Bleeding ◽  
Etiological Spectrum ◽  
Upper Gastrointestinal

Abstract Introduction The etiological spectrum of acute upper gastrointestinal bleeding (AUGIB) varies from region to region. This study was performed to find out the latest etiological spectrum of the AUGIB in a tertiary care hospital in North India and to compare it with etiological spectra from a previous study from the same center and from the other regions of India. Methods Clinical notes and endoscopic data of all consecutive patients who had presented with AUGIB in Indira Gandhi Medical College Shimla, Himachal Pradesh, from May 2015 to December 2019, were analyzed retrospectively with the objective of finding out the various endoscopic etiologies that lead to AUGIB. The findings were compared with the previous study from the same center and with the data from the other regions of the country. Results A total of 1,513 patients were enrolled and majority were males (74.6%) with male:female ratio of 2.9:1. Majority were 41 to 60 years (46.46%) of age. Melena was the presenting complaint in 93.98% and hematemesis in 46.06%. Peptic ulcer disease (PUD; 46.19%) was the commonest cause of AUGIB followed by portal hypertension (26.23%). Other less common causes were erosive mucosal disease, erosive esophagitis, neoplasm, Mallory–Weiss tear, gastric angiodysplasia, anastomotic site ulcers, and Dieulafoy’s lesion. Conclusion PUD was still the commonest cause of AUGIB followed by portal hypertension. This is in agreement with the previous report from the same center and in contrast to the reports from other studies from Northern and Western India that create the impression that portal hypertension related bleeding is the most common cause of AUGIB in India.

scholarly journals A comparative study of multi-detector CT portography versus endoscopy in evaluation of gastro-esophageal varices in portal hypertension patients

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Hany El-Assaly ◽  
Lamiaa I. A. Metwally ◽  
Heba Azzam ◽  
Mohamed Ibrahim Seif-Elnasr
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Esophageal Varices ◽  
Imaging Modality ◽  
Splenic Vein ◽  
Gastric Varices ◽  
Gi Endoscopy ◽  
Upper Gi ◽  
Upper Gi Endoscopy ◽  
Vein Diameter

Abstract Background Portal hypertension is a major complication resulting from obstruction of portal blood flow, like cirrhosis or portal vein thrombosis, that leads to portal hypertension. MDCT angiography has become an important tool for investigation of the liver as well as potentially challenging varices by detailing the course of these tortuous vessels. This information is decisive for liver transplantation as well as for common procedures in which an unexpected varix can cause significant bleeding. Results This study included an assessment of 60 cases of portal hypertension (28 males and 32 females), their age ranged from 42 to 69 years (mean age = 57.2 ± 6.63). All patients were diagnosed with portal hypertension, underwent upper GI endoscopy followed by a triphasic CT scan with CT angiographic assessment for the screening of gastro-esophageal varices. CT is highly sensitive as compared to upper GI endoscopy (sensitivity 93%) in detecting esophageal varices. Gastric varices detected by CT in 22 patients (37%) compared to 14 patients (23%) detected by endoscopy. While paraesophageal varices were detected in 63% of patients and retro-gastric varices in 80% of patients that were not visualized by endoscopy. Our study reported that the commonest type of collaterals were the splenic collaterals, and we also found there is a significant correlation between the portal vein diameter and the number of collaterals as well as between the portal vein diameter and splenic vein diameter. Conclusions Multi-slice CT serves as an important non-invasive imaging modality in the diagnosis of collaterals in cases of portal hypertension. CT portography can replace endoscopy in the detection of high-risk varices. It also proved that there is a correlation between portal vein diameter, splenic vein diameter, and number of collaterals.

A Comparative study between Dexmedetomidine versus Propofol for sedation in upper GI endoscopy procedure considering effect on intraoperative vital data, patient amnesia and onset of recovery after the procedure

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Eslam Ahmed Mohamed Elsamahi ◽  
Bassem P Ghobrail ◽  
Ghada Mohamed Samir ◽  
Hany Victor Zaki
Keyword(s):  
Heart Rate ◽  
Oxygen Saturation ◽  
Respiratory Rate ◽  
Gastrointestinal Endoscopy ◽  
Upper Gastrointestinal Endoscopy ◽  
Day Case ◽  
Upper Gi ◽  
Significant Difference ◽  
Upper Gi Endoscopy ◽  
Upper Gastrointestinal

Abstract Background In the modern medicine, upper gastrointestinal endoscopy has become a definitive tool for diagnosis and management of many diseases. It is usually preformed in separate unit as day-case procedure and for outpatient clinic. The search of a safe and effective sedation for these patients is still an open topic. Objective The aim of the study is to compare the use of propofol and dexmedetomedine in upper GI endoscopy regarding the hemodynamics, sedative effect and the patient satisfaction. Methods Double – blinded, randomized controlled trial with allocation ratio 1:1 arranged in two parallel groups. This study was conducted in the endoscopy unit of Ainshams University Hospital, Cairo, Egypt within a period of 6 months started from April 2019. All recruited patients were adults undergoing upper gastrointestinal endoscopy. They were included in the study according to the following criteria: Age 21-60 years; elective procedures under general anesthesia with patients who completed eight hours of fasting; and physical Status: ASA I and II Patients after taking written and informed consent. Results Concerning the results of the study, there was no statistically significant difference considering the heart rate in relation to base line readings. The changes of heart rate between the two groups were significantly different with dexmedetomidine associated with lower readings. Respiratory rate and oxygen saturation were insignificantly different in both groups. Time of induction was significantly shorter in propofol than dexmedetomidine (P < 0.001) and time to reach full recovery identified by modified Alderete’s score 10/10 was significantly shorter in dexmedetomidine than propofol (P < 0.014). There was a significant difference between the two dugs concerning the patients and endoscopists satisfaction. The patients were more satisfied with propofol (P 0.047), while the endoscopists were more satisfied with dexmedetomidine (P 0.034). Conclusion Dexmedetomidine and propofol are equally effective and safe to provide enough sedation for upper gastrointestinal endoscopy in a day-case manner. Advantages of dexmedetomidine were providing analgesic effect, rapid recovery from sedation and stability of respiratory rate and oxygen saturation. However, there were some disadvantages such as the bradycardia and patient dissatisfaction although the bradycardia can be utilized in cardiac patients as a safety factor against myocardial ischemia. Other point noticed that using dexmedetomidine for sedation was more costly than propofol and requires the usage of a syringe pump for accurate dosing. On the contrary, propofol is cheap and available in all centers with rabid onset of induction but it causes hypotension and respiratory depression which might be risky in cardiac patients.

scholarly journals Diagnosis and management of extrahepatic oesophageal variceal bleed in children in a low resourced setting

2020 ◽  
Vol 54 (4) ◽  
pp. 274-278
Author(s):  
Taiba J. Afaa ◽  
Kokou H. Amegan-Aho ◽  
Elikem Richardson ◽  
Bamenla Goka
Keyword(s):  
Portal Hypertension ◽  
Gastrointestinal Bleeding ◽  
Portal Vein ◽  
Upper Gastrointestinal Bleeding ◽  
Liver Function Tests ◽  
Tertiary Hospital ◽  
Secondary Prophylaxis ◽  
Resource Constraint ◽  
Oesophageal Varices ◽  
Upper Gastrointestinal

Extrahepatic portal vein obstruction (EHPVO) is a major cause of portal hypertension (PH) in children. Portal vein thrombosis (PVT) is the most common cause accounting for up to 75% of cases in developing countries. Upper gastrointestinal bleeding is the most dreaded and commonest presentation of portal hypertension. Successful treatment of paediatric PH, though challenging is performed in resource constraint countries. Cases: Five children presented over three years to a tertiary hospital in Ghana, with massive upper gastrointestinal bleeding. They had anaemia, thrombocytopaenia and four had splenomegaly. Liver function tests, INR, haemoglobin electrophoresis as well as HIV serology, hepatitis B and C screening were all normal. Abdominal doppler ultrasound scan confirmed portal vein thromboses. They were resuscitated and managed with octreotide, propranolol, antibiotics and sclerotherapy or oesophageal variceal banding in the acute setting and long term secondary prophylaxis with propranolol. Subsequently, an algorithm was developed to assist with the management of bleeding from oesophageal varices and the diagnosis of EHPVO. Conclusion: Portal hypertension due to EHPVO is an important cause of upper gastrointestinal (GI) bleeding in children. This can be successfully managed even in a resource constraint setting once the appropriate measures are taken.

scholarly journals Endovascular and Percutaneous Treatment of Pediatric Portosystemic Varices: A Case Review

2019 ◽  
Vol 03 (03) ◽  
pp. 214-226
Author(s):  
Alexander Dabrowiecki ◽  
Eric J. Monroe ◽  
Rene Romero ◽  
Anne E. Gill ◽  
C. Matthew Hawkins
Keyword(s):  
Portal Hypertension ◽  
Small Bowel ◽  
Endovascular Treatment ◽  
Treatment Guidelines ◽  
Treatment Options ◽  
Percutaneous Treatment ◽  
Roux Limb ◽  
Case Review ◽  
Gastroesophageal Varices ◽  
Ectopic Varices

AbstractPortal hypertension is a significant cause of morbidity and mortality in pediatric patients. Complications of portal hypertension include development of portosystemic varices. The most common type of portosystemic varices are gastroesophageal varices; however, other ectopic varices can also be a cause of recurrent, life-threatening gastrointestinal bleeding. Problematic ectopic varices include isolated gastric, anorectal, small bowel, roux-limb, and stomal varices. There are no standardized treatment guidelines on how to manage ectopic varices in children; however, new innovations in endovascular treatment options provide potential therapeutic alternatives when varices are refractory to conventional therapy. This review provides a case-based literature review for endovascular treatment of isolated gastric, anorectal, small bowel, roux-limb, and stomal ectopic varices in children (age 0-9 years) and adolescents (age 10-19 years).

scholarly journals Air, Air Everywhere‑ A Rare Entity

2018 ◽  
Vol 09 (01) ◽  
pp. 022-025
Author(s):  
Gazal Singla ◽  
Shikha Sood ◽  
Sanjeev Sharma
Keyword(s):  
Gastric Perforation ◽  
Rare Complication ◽  
Interesting Case ◽  
Rare Entity ◽  
Gi Endoscopy ◽  
Upper Gi ◽  
Recurrent Vomiting ◽  
Upper Gi Endoscopy ◽  
Gastric Mass ◽  
Upper Gastrointestinal

ABSTRACTUpper gastrointestinal (GI) endoscopy is a widely used diagnostic and therapeutic procedure. Gastric perforation causing pneumothorax, pneumomediastinum, pneumoperitoneum, pneumorrhachis, and subcutaneous emphysema after upper GI endoscopy is an extremely rare complication. We present an interesting case of a 58‑year‑old male who presented to the Emergency Department with recurrent vomiting, abdominal pain and diffuse swelling over abdomen, chest, neck bilateral arms, and thighs after undergoing an endoscopy for a gastric mass.

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