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Esophageal variceal bleeding treatment

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https://www.readbyqxmd.com/read/29118569/embolia-cutis-medicamentosa-an-unusual-adverse-reaction-to-terlipressin
#1
Polychronis Gatos-Gatopoulos, Stephanos Kostantoudakis, Ioannis G Panayiotides, George D Dimitriadis, Konstantinos Triantafyllou
Terlipressin is a synthetic long-acting analog of vasopressin widely used to control variceal bleeding by lowering portal venous pressure. We report an unusual adverse reaction to terlipressin in a 78-year-old patient with esophageal variceal bleeding who developed skin necrosis soon after treatment initiation. Skin biopsy revealed embolia cutis medicamentosa.
2017: Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology
https://www.readbyqxmd.com/read/29117668/outcomes-of-patients-treated-with-sengstaken-blakemore-tube-for-uncontrolled-variceal-hemorrhage
#2
Ja Yun Choi, Yun Won Jo, Sang Soo Lee, Wan Soo Kim, Hye Won Oh, Cha Young Kim, Eun Young Yun, Jin Joo Kim, Jae Min Lee, Hong Jun Kim, Hyun Jin Kim, Tae Hyo Kim, Woon Tae Jung, Ok Jae Lee, Rock Bum Kim
Background/Aims: The aim of this study was to investigate the mortality, bleeding control rate, and their associated predictors in patients treated with Sengstaken-Blakemore (SB) tube for uncontrolled variceal hemorrhage associated with hemodynamic instability or failure of endoscopic treatment. Methods: The clinical data of 66 consecutive patients with uncontrolled variceal hemorrhage treated with SB tube at Gyeongsang National University Hospital from October 2010 to October 2015 were retrospectively analyzed...
November 10, 2017: Korean Journal of Internal Medicine
https://www.readbyqxmd.com/read/29110128/endoscopic-treatments-for-portal-hypertension
#3
REVIEW
Gin-Ho Lo
Acute esophageal variceal hemorrhage is a dreaded complication of portal hypertension. Its management has evolved rapidly in recent years. Endoscopic therapy is often employed to arrest bleeding varices as well as to prevent early rebleeding. The combination of vasoconstrictor and endoscopic therapy is superior to vasoconstrictor or endoscopic therapy alone for control of acute esophageal variceal hemorrhage. After control of acute variceal bleeding, combination of banding ligation and beta-blockers is generally recommended to prevent variceal rebleeding...
November 7, 2017: Hepatology International
https://www.readbyqxmd.com/read/29055931/congenital-shunts-of-the-portal-venous-system-case-series-of-uncommon-shunts
#4
Liliana Santos, Susana Nobre, Nadia Laezza, Catarina Cunha, Isabel Gonçalves, Maria F Lopes
BACKGROUND AND AIMS: Congenital shunts of the portal venous system are rare entities that can present in children with clinical heterogeneity. To evaluate the clinical course of children with uncommon shunts presenting to our institution and examine the available literature on this topic. Medical records of children with rare forms of congenital shunts were retrospectively reviewed for demographics, symptoms, management, and outcome between 2003 and 2016. RESULTS: Three female patients with congenital shunts, including a congenital mesenterico-portal Rex shunt (n = 1) and congenital portosystemic shunts (CPSS) (n = 2), were referred for surgical evaluation between ages 4 and 9...
October 16, 2017: Annals of Hepatology
https://www.readbyqxmd.com/read/29033774/hemothorax-following-uncomplicated-endoscopic-variceal-sclerotherapy-and-ligation-for-esophageal-varices
#5
Tomoko Ochiai, Yukiomi Nakade, Rena Kitano, Shunsuke Kato, Kazumasa Sakamoto, Tadahisa Inoue, Yuji Kobayashi, Norimitsu Ishii, Tomohiko Ohashi, Yoshio Sumida, Kiyoaki Ito, Haruhisa Nakao, Chihiro Furuta, Motoki Yano, Masashi Yoneda
Endoscopic variceal sclerotherapy and ligation are standard treatment modalities used for the management of esophageal varices. Reportedly, sclerotherapy and ligation are associated with complications such as hematuria, pulmonary thrombus formation, pleural effusion, renal dysfunction, and esophageal stenosis. However, hemothorax following sclerotherapy and ligation has not yet been reported. We treated a patient who presented with liver cirrhosis and polycythemia vera and later developed hemothorax following the above-mentioned procedures...
September 2017: Case Reports in Gastroenterology
https://www.readbyqxmd.com/read/28962152/study-of-the-association-between-hemorrhage-and-the-position-of-hemorrhagic-stigmata-in-patients-with-esophageal-varices
#6
Shao-Hua Shen, Ying-Di Liu, Xiao Sun, Meng Li, Guo-Hui Sun, Juan Wang, Jiang-Tao Liu, Jun Tie, Jing Yang
The aim of the present study was to investigate the predilection position of hemorrhagic stigmata (HS) in patients with esophageal variceal hemorrhage and provide guidance on endoscopic therapy for esophageal varices. The clinical characteristics, particularly the endoscopic manifestations of HS, in the patients who presented with gastroesophageal variceal hemorrhage and cirrhosis between January 2003 and December 2013 at our hospital were summarized and patients were grouped according to the distance of the lesion site to incisors at 35-40 and ~30 cm...
September 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28923638/treatment-of-refractory-gastrointestinal-bleeding-in-patients-with-portal-hypertension-a-case-series-and-treatment-algorithm
#7
J Balogh, S Gordon-Burroughs, P Schwarz, J Galati, R A McFadden, M Cusick, M J Snyder, H R Bailey, M Weiner, A Wong, R A Ochoa, A Saharia, A O Gaber, R M Ghobrial
In patients with portal hypertension, ectopic varices can develop at any site along the gastrointestinal tract outside the classically described gastroesophageal location. Like esophageal variceal hemorrhage, bleeding from ectopic varices can be life-threatening. Diagnosis and treatment of ectopic varices can be challenging; to date, no effective treatment algorithm has been described. A systematic teamwork approach to diagnosing and treatment of ectopic varices is required to successfully manage hemorrhage from ectopic varices...
October 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28838434/management-of-portal-hypertension-after-liver-transplantation
#8
D Korda, P Á Deák, G Kiss, Z Gerlei, L Kóbori, D Görög, I Fehérvári, L Piros, Z Máthé, A Doros
INTRODUCTION: Post-transplantation portal hypertension has severe complications, such as esophageal varix bleeding, therapy refractory ascites, extreme splenomegaly, and graft dysfunction. The aim of our study was to analyze the effectiveness of the therapeutic strategies and how to visualize the procedure. METHODS: A retrospective study involving liver transplantation patients from the Semmelweis University Department of Transplantation and Surgery was performed between 2005 and 2015...
September 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28763856/-endoscopic-ultrasonography-a-new-method-for-evaluation-diagnosis-and-treatment-of-portal-hypertension
#9
W Lu, S Li
Through a comprehensive scan of collateral circulation establishment in portal hypertension, endoscopic ultrasonography (EUS) can predict the risks of esophageal and gastric varices, variceal bleeding, recurrence after treatment, and rebleeding and guide and participate in the treatment of varices. With the help of these advantages, EUS provides an important reference for individualized treatment in patients with liver cirrhosis complicated by portal hypertension and can improve response rate and safety. As a new method for systematic evaluation, diagnosis, and treatment of portal hypertension, EUS has become a new research hotspot in recent years...
June 20, 2017: Zhonghua Gan Zang Bing za Zhi, Zhonghua Ganzangbing Zazhi, Chinese Journal of Hepatology
https://www.readbyqxmd.com/read/28746314/outcome-of-endoscopic-variceal-band-ligation
#10
B Shrestha, S Kc, S Chaudhary, B K Basnet, A K Mandal, N S Poudyal
INTRODUCTION: Bleeding from esophageal varices in cirrhosis is an emergent condition with high mortality. One of the preferred modality of treating esophageal varices is EVL. We aimed to find out the outcome of EVL in controlling acute esophageal variceal bleeding, prophylactic banding to prevent future bleeding and the number of sessions required for complete eradication of varices. METHODS: This descriptive observational study was carried out in Gastroenterology and Hepatology unit of Bir Hospital, NAMS from June 2016 to May 2017...
April 2017: JNMA; Journal of the Nepal Medical Association
https://www.readbyqxmd.com/read/28699947/fecal-occult-blood-testing-in-hospitalized-patients-with-upper-gastrointestinal-bleeding
#11
Benji Mathews, Temple Ratcliffe, Raj Sehgal, James Abraham, Bradley Monash
A 47-year-old man with a history of alcohol abuse, cirrhosis, and grade II esophageal varices is admitted for treatment of alcohol withdrawal. He reports having some dark-colored stools a week prior to admission, but his stools since then have been normal in color. A repeat hemoglobin is stable, but a fecal occult blood test is positive. What should be done next?
July 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28612224/extrahepatic-portal-venous-obstruction-what-should-be-the-mainstay-of-treatment
#12
Richa Lal, Moinak Sen Sarma, Manish K Gupta
The two cornerstones of management for Extrahepatic portal vein obstruction (EHPVO) are endotherapy and surgery [Porto-systemic shunts (PSS)/Mesorex bypass (MRB)]. Endotherapy is the mainstay of treatment for acute variceal bleed control and has also been used extensively for secondary prophylaxis till variceal eradication is achieved. However, long-term follow-up beyond endoscopic eradication of esophageal varices (EEEV) indicates that there are numerous delayed bleed and non bleed sequelae of EHPVO, which merit surgery as a definitive procedure to decompress the hypertensive portal venous system...
September 2017: Indian Journal of Pediatrics
https://www.readbyqxmd.com/read/28580075/role-of-vasopressin-in-current-anesthetic-practice
#13
REVIEW
Keun Suk Park, Kyung Yeon Yoo
Arginine vasopressin (AVP), also known as antidiuretic hormone, is a peptide endogenously secreted by the posterior pituitary in response to hyperosmolar plasma or systemic hypoperfusion states. When administered intravenously, it causes an intense peripheral vasoconstriction through stimulation of V1 receptors on the vascular smooth muscle. Patients in refractory shock associated with severe sepsis, cardiogenic or vasodilatory shock, or cardiopulmonary bypass have inappropriately low plasma levels of AVP ('relative vasopressin deficiency') and supersensitivity to exogenously-administered AVP...
June 2017: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/28576121/proximal-spleno-renal-shunt-with-retro-aortic-left-renal-vein-in-a-patient-with-extra-hepatic-portal-vein-obstruction-first-case-report
#14
Sundeep Jain, Mukesh Kalla, Adil Suleman, Alok Verma
BACKGROUND: Presence of retro-aortic left renal vein poses special challenge in creating spleno-renal shunt potentially increasing the chance of shunt failure. The technical feasibility and successful outcome of splenectomy with proximal spleno-renal shunt (PSRS) with retro-aortic left renal vein is presented for the first time. The patient was treated for portal hypertension and hypersplenism due to idiopathic extra-hepatic portal vein obstruction. CASE PRESENTATION: A twenty year old male suffering from idiopathic extra-hepatic portal vein obstruction presented with bleeding esophageal varices, portal hypertensive gastropathy, asymptomatic portal biliopathy and symptomatic hypersplenism...
June 2, 2017: BMC Surgery
https://www.readbyqxmd.com/read/28567454/distal-pancreatectomy-with-splenorenal-shunt-to-preserve-spleen-in-a-cirrhotic-patient
#15
Giuseppe Maria Ettorre, Giovanni Battista Levi Sandri, Marco Colasanti, Edoardo de Werra, Pasquale Lepiane
At pancreatic ductal adenocarcinoma is an aggressive malignancy with a high recurrence rate. Due to its high potentials of local invasion and distant metastasis, surgical resection is the only means for possible long-term survival. Surgical treatment comprises a distal pancreatectomy with or without splenectomy. Surgery has been conventionally contraindicated for patients with cirrhosis and portal vein hepato-biliary hypertension. Splenorenal shunt was first described by Warren and colleagues, to prevent death from bleeding esophageal varices in a patient with a patent portal vein hypertension...
May 2017: Annals of Hepato-Biliary-Pancreatic Surgery
https://www.readbyqxmd.com/read/28530783/a-rare-case-of-obscure-gastrointestinal-bleeding-small-bowel-varices-flowing-into-the-inferior-epigastric-vein
#16
Akira Hoshiai, Junya Tsurukiri, Yasuhiro Sumi
Ectopic varices include all varices except esophageal or gastric varices and comprise large portosystemic venous collaterals that occur anywhere in the abdomen. Ectopic varices are relatively rare; however, approximately 5% are related to gastrointestinal bleeding. Ectopic varices usually occur in the rectum, duodenum, or colon, and portal hypertension is the most common cause. Hemodynamic profiles of ectopic varices remain unknown, and extensive bleeding from these structures occurs because diagnosis and treatment are difficult...
May 2017: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
https://www.readbyqxmd.com/read/28515596/balloon-occluded-retrograde-transvenous-obliteration-for-bleeding-gastric-varices-eyes-see-what-the-mind-knows
#17
Pushpinder S Khera, Lee Myungsu, Choi Joonsung
Approximately one in six patients with portal hypertension who develop varices at sites of portosystemic venous collaterals has gastric varices due to hepatofugal flow into the gastric veins. Bleeding from gastric varices, though less common, has a higher mortality and morbidity compared to bleeding esophageal varices, which are easier to manage endoscopically. The efferent channel for gastric varices is mostly the gastrorenal shunt (GRS) which opens into the left renal vein. Balloon-occluded transvenous obliteration (BRTO) involves accessing the GRS with an aim to temporarily occlude its outflow using a balloon catheter and at the same time injecting sclerosant mixture within the varix so as to cause its thrombosis and thereby obliteration...
January 2017: Indian Journal of Radiology & Imaging
https://www.readbyqxmd.com/read/28501536/multicenter-external-validation-of-risk-stratification-criteria-for-patients-with-variceal-bleeding
#18
Irene Conejo, Maria Anna Guardascione, Puneeta Tandon, Alba Cachero, Josep Castellote, Juan G Abraldes, Lucio Amitrano, Joan Genescà, Salvador Augustin
BACKGROUND & AIMS: Early placement of a transjugular intrahepatic porto-systemic shunts (TIPS) is considered the treatment of choice for patients with acute variceal bleeding (AVB) and cirrhosis who have a high risk of death (Child-Pugh class B with active bleeding at endoscopy or Child-Pugh class C). It has been proposed that patients of Child-Pugh class B, even with active bleeding, should not be considered high risk. Alternative criteria have been proposed for identification of high-risk patients, such as Child-Pugh class C with plasma level of creatinine of 1 mg/dl or more (ChildC-C1) and a model for end-stage liver disease (MELD) score of 19 or more...
May 10, 2017: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/28494001/partial-spleen-embolization-reduces-the-risk-of-portal-hypertension-induced-upper-gastrointestinal-bleeding-in-patients-not-eligible-for-tips-implantation
#19
Matthias Buechter, Alisan Kahraman, Paul Manka, Guido Gerken, Alexander Dechêne, Ali Canbay, Axel Wetter, Lale Umutlu, Jens M Theysohn
INTRODUCTION: Upper gastrointestinal bleeding (UGIB) is a severe and life-threatening complication among patients with portal hypertension (PH). Covered transjugular intrahepatic portosystemic shunt (TIPS) is the treatment of choice for patients with refractory or recurrent UGIB despite pharmacological and endoscopic therapy. In some patients, TIPS implantation is not possible due to co-morbidity or vascular disorders. Spleen embolization (SE) may be a promising alternative in this setting...
2017: PloS One
https://www.readbyqxmd.com/read/28487619/one-step-minilaparotomy-assisted-transmesenteric-portal-vein-recanalization-combined-with-transjugular-intrahepatic-portosystemic-shunt-placement-a-novel-surgical-proposal-in-pediatrics
#20
Gloria Pelizzo, Pietro Quaretti, Lorenzo Paolo Moramarco, Riccardo Corti, Marcello Maestri, Giulio Iacob, Valeria Calcaterra
Transjugular intrahepatic portosystemic shunt (TIPS) placement is a standard procedure for the treatment of portal hypertension complications. When this conventional approach is not feasible, alternative procedures for systemic diversion of portal blood have been proposed. A one-step interventional approach, combining minilaparotomy-assisted transmesenteric (MAT) antegrade portal recanalization and TIPS, is described in an adolescent with recurrent esophageal varice bleeding and portal cavernoma (PC). A 16-year-old girl was admitted to our Unit because of repeated bleeding episodes over a short period of time due to esophageal varices in the context of a PC...
April 21, 2017: World Journal of Gastroenterology: WJG
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