Pdf hemorragia digestiva alta historia clinica free. Non variceal upper gastrointestinal bleeding ugib is defined as bleeding proximal to the ligament of treitz in the absence of oesophageal, gastric or duodenal varices. Several treatments are available for the management of acute variceal hemorrhage. The role of endoscopy in the management of acute non variceal upper gi bleeding this is one of a series of statements discussing the use of gi endoscopy in common clinical situations. Management of variceal bleeding rachael harry, ma, mrcp, and julia wendon, frcp variceal hemorrhage complicates cirrhosis in as many as 50% of patients and results in considerable morbidity and mortality. Management of variceal bleeding icm case summaries. Upper gastrointestinal bleeding is a frequent cause of hospital admissions and morbimortality. Eboc level 1a or b evidence for management variceal haemorrhage athens password needed. Outcome of nonvariceal acute upper gastrointestinal bleeding in relation to the time of endoscopy and the experience of the endoscopist. These can be broadly grouped into treatments that address the local bleeding site and those that reduce portal pressure directly. Adrian cobos medico residente 2014 hospital jose carrasco arteaga iees 2. Hemorragia digestiva alta no variceal by javier villalba on prezi. Ugi bleed it is defined as bleeding from gastrointestinal tract proximal to ligament of trietz.
Surveillance egd 5 months later showed complete regression of banded dv with scarring at the site and nonbleeding. Adjunctive embolotherapy of gastroesophageal collateral vessels in the prevention of variceal rebleeding. Acute variceal bleeding erosionated varix of gastric. Liver cirrhosis study group, department of gastroenterology, general hospital of shenyang military area, shenyang, china. Endoscopic therapy using an endoscopic variceal ligation. Clinical practice guidelines on the management of variceal. Who should receive endoscopic variceal ligation after recovering from acute variceal bleeding. We assessed the patients rebleedingfree and overall survival using the. What the quality statement means for service providers, healthcare practitioners, and commissioners. We present the case of a 77yearold japanese man with alcoholic cirrhosis who underwent a routine endoscopy examination as a screening procedure for esophageal varices and was incidentally. Update on the management of gastrointestinal varices ncbi.
In the past, sclerotherapy was the main treatment to stop a first episode of variceal bleeding, but it has fallen out of favor. A portal pressure, presence of gastroesophageal varices and variceal bleeding guadalupe garciatsao, roberto j. Portal pressure, presence of gastroesophageal varices and variceal bleeding guadalupe garciatsao, roberto j. Gastrointestinal varices are abnormally dilated submucosal veins in the digestive tract due to.
Ppt hemorragia digestiva powerpoint presentation free. Nov 24, 2017 who should receive endoscopic variceal ligation after recovering from acute variceal bleeding. Causes of variceal bleeds prehepatic portal vein thrombosis obstruction increased portal blood flow. Gastroenterology education and cpd for trainees and. Treatment of duodenal variceal hemorrhage with endoscopic. Thus steroids and anticoagulants should be used with caution in patients at risk of gi bleed, especially in those taking aspirin or nsaids. A large metaanalysis looking at propranololnadolol versus placebo, in patients with cirrhosis and medium to large varices, found a significantly lower incidence of first variceal bleeding in the treatment group. The adobe flash plugin is needed to view this content. The endoscopic appearances of oesophageal and gastric varices can be seen in figures 1 and 2 respectively. Management of nonvariceal upper gastrointestinal bleeding. Carvedilol, endoscopic variceal ligation or combination of. The transjugular intrahepatic portosystemic shunt tips procedure is a minimally invasive imageguided intervention used for secondary prevention of.
Download hemorragia digestiva alta historia clinica. Since the publication of the brazilian association of hepatology recommendations for the prevention and treatment of variceal bleeding in 2010, new evidencebased data were reported in the literature. Sistema progetto nazionale emorragia digestiva pned vs. These clinical practice guidelines cpgs have been developed by pakistan society of hepatology psh and pakistan society of study of liver diseases pssld.
Service providers ensure that systems are in place for people with non variceal acute upper gastrointestinal bleeding and stigmata of recent haemorrhage to be offered endoscopic treatments combination or a mechanical method. The use of the tube was originally described in 1950, although similar approaches to bleeding varices were described by. Prevention and treatment of variceal haemorrhage in 2017. Endoscopic treatment for nonvariceal upper gastrointestinal bleeding lesions. Esophageal varices are extremely dilated submucosal veins in the lower third of the esophagus. Results for rebleeding and mortality were analyzed on an intentiontotreat basis and using the kaplanmeier method. The blood flow begins to back up, increasing pressure within the large vein portal vein that carries blood to your liver. Feb 14, 2019 esophageal varices sometimes form when blood flow to your liver is blocked, most often by scar tissue in the liver caused by liver disease. Endoscopic therapy using an endoscopic variceal ligation for. A randomized trial comparing transjugular intrahepatic. Gastroesophageal variceal bleeding is a major complication of portal hypertension resulting from cirrhosis. Click here to download free teaching notes on decompensated chronic liver. Oesophageal variceal bleed definition of a variceal bleed oesophageal varices are dilated oesophageal veins secondary toportal hypertension.
Esophageal varices symptoms and causes mayo clinic. Vorobioff, juan bordato, del libro medicina intensiva, dr. Hemorragia digestiva alta no variceal linkedin slideshare. Endoscopic therapy, particularly variceal banding also called ligation, may be used to treat and prevent variceal bleeding in the esophagus. Examples of the former are esophageal sclerotherapy, band ligation, and balloon tamponade. The frequency and the severity of variceal rebleeding was significantly lower in the tipss group 9. Esophageal varices are typically diagnosed through an esophagogastroduodenoscopy. Transjugular intrahepatic portosystemic shunt for acute. Banding ligation or betablockers for primary prevention of variceal. Kaare tesdal, thomas filser, christel weiss, eggert holm, christoph dueber, werner jaschke. Upload and share your own cases, ask questions and discuss.
Variceal hemorrhage provides an update of the evidence concerning several. Post ebl patient was hemodynamically stable and his melena resolved. The clinical presentation varies according to the intensity of bleeding from occult bleeding to melena or haematemesis and haemorrhagic shock. Ppt hemorragia digestiva alta powerpoint presentation. A free powerpoint ppt presentation displayed as a flash slide show on id. Portal pressure, presence of gastroesophageal varices and. Although there was a significant reduction in the incidence of bleeding peptic ulcers with the introduction of proton pump inhibitor ppi and eradication of helicobacter pylori,1,2 ugib still remains a clinically important issue due to the increase in the. Acute variceal bleeding large varices with red sign video. Endoscopic management of oesophageal and gastric varices. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Also, these nonselective betablockers may be equivalent to endoscopic variceal band ligation. The role of endoscopy in the management of acute nonvariceal. Outcome of nonvariceal acute upper gastrointestinal.
Steroids double the risk of gi bleed in patients taking nsaids. In patients with lowrisk small varices child a without red wale marks, the use of nonselective betablocker is optional. They showed that there was a reduced risk of rebleeding with a 97% chance of remaining rebleed free vs 50% for the medical group. Non variceal upper gastrointestinal bleeding ugib is a critical clinical condition that requires an urgent management. Variceal bleeding is one of the most serious complications of liver cirrhosis.
Endoscopic treatment for nonvariceal upper gastrointestinal. Prevention and management of gastroesophageal varices in. Management of variceal bleeding ucd emergency medicine. Eboc level 1a or b evidence for management variceal haemorrhage athens password needed nice guideline 141 mx upper gi bleed june 2012 content by dr iomhar o sullivan 82001. Standard endoscopic mucosal resection or endoscopic submucosal dissection is a procedure for patients with minute cancers, complicated with esophageal varices that puts them at high risk of bleeding. Endoscopic treatment for variceal bleeding caused by cirrhosis. This is likely to be due to improved treatments available e. The mortality rate from acute variceal bleed has been reducing over the last 20 years from 42 to 14% 1. Acute variceal bleeding erosionated varix of gastric cardia.
Who should receive endoscopic variceal ligation after. Gastroesophageal variceal hemorrhage, a major complication of portal hypertension resulting from cirrhosis, accounts for 10 to 30 percent of all cases of bleeding from. May 29, 2015 circumferential radiofrequency ablation of a longsegment barretts esophagus halo 360 system duration. Uk guidelines on the management of variceal haemorrhage in. The standards of practice committee of the american society for gastrointestinal endoscopy asge prepared this text. Description download hemorragia digestiva alta e baixa comments. The rate of survival was also improved with 6 week survivability of 97%. It occurs in 25 35 percent of patients with cirrhosis and. Endoscopic treatment for non variceal upper gastrointestinal bleeding lesions. Emergency endoscopic variceal ligation following variceal. In most cases, the varices were treated using endoscopic variceal band ligation evl. In this report, we describe endoscopic therapy using an endoscopic variceal ligation evl device. Service providers ensure that systems are in place for people with nonvariceal acute upper gastrointestinal bleeding and stigmata of recent haemorrhage to be offered endoscopic treatments combination or a mechanical method healthcare practitioners offer endoscopic treatments. They are most often a consequence of portal hypertension, commonly due to cirrhosis.
Diagnosis and therapy of nonvariceal upper gastrointestinal. Egd 2 weeks later showed of obliteration of the banded dv. Atterbury and morton glickman veterans administration medical center, west haven, connecticut 0651 6 and yale university school of medicine, new haven, connecticut 0651 0. Nonvariceal upper gastrointestinal bleeding ugib is a critical clinical condition that requires an urgent management. Pdf hemorragia digestiva alta e baixa free download pdf. Tratamento da hemorragia digestiva alta por varizes esofagicas. Acute variceal bleeding large varices with red sign. Giornale italiano di endoscopia digestiva, 172, 6570. Responsible for 5% of episodes of gi bleeding in the uk. A sengstakenblakemore tube is a medical device inserted through the nose or mouth and used occasionally in the management of upper gastrointestinal hemorrhage due to esophageal varices distended and fragile veins in the esophageal wall, usually a result of cirrhosis. To prospectively compare rebleeding rates in patients treated with transjugular intrahepatic portosystemic shunt tips creation alone and those treated with tips creation combined with adjunctive embolotherapy of gastroesophageal collateral vessels. Update on the management of gastrointestinal varices. Ppt hemorragia digestiva alta powerpoint presentation free to download id. Unlimited access to the largest elibrary of professional videos, images, documents, courses.
Variceal bleeding trailer by esge on vimeo, the home for high quality videos and the people who love. Endoscopic band ligation ebl of dv with one band was performed and hemostasis achieved. Minute cancer is a gastric cancer lesion of less than 5 mm in its maximum diameter, with tumor cells confined to the mucosa. Kaare tesdal, thomas filser, christel weiss, eggert holm, christoph dueber, werner jaschke, 2. Circumferential radiofrequency ablation of a longsegment barretts esophagus halo 360 system duration. Informed consent and ethics committee approval were obtained. Gastrointestinal varices are dilated submucosal veins, which often develop at.
Normal hvpg hepatic vein wedge pressure free hepatic vein. These characteristics of minute cancer provide the basis for using endoscopic therapy as a curative treatment. Atterbury and morton glickman veterans administration medical center, west haven, connecticut 0651 6 and yale university. Video journal and encyclopedia of gi endoscopy 11,579 views. Acute variceal bleeding is a lifethreatening condition that requires a multidisciplinary approach for effective therapy. There is limited evidence showing that nonselective betablockers may slow the growth of varices but they do not reduce mortality and their use cannot be universally recommended over regular endoscopic surveillance every 2 years and. The transjugular intrahepatic portosystemic shunt journal of hepatology, vol. Oesophageal variceal bleed oxford medical education.
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