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Management of Bleeding Gastric Varices

Gastric Varices
Saad-Caldwell Classification
Endoscopic Evaluation and Management
Endovascular Management

By Chuma G. Obineme, MD @TypicallySilent
Management of Bleeding ... Gastric Varices ... Gastric Varices ... EmoryGastroHep #Gastric #Varices ... #Variceal #Bleeding
Evidence for Treatment of Acute Esophageal Variceal Bleeding
 • Octreotide (PMID: 11870374) - Endoscopic banding +
Acute Esophageal Variceal ... Bleeding • Octreotide ... acute esophageal variceal ... Endoscopic Variceal ... #Bleeding #varices
Esophageal Variceal Bleeding - Scoping Summary
GENERAL PRINCIPLES OF MANAGEMENT (VARICEAL-B):
V - Vasoconstrictor therapy: (Octreotide 50mcg bolus
Esophageal Variceal ... Bleeding - Scoping ... OF MANAGEMENT (VARICEAL-B ... - Refractory Bleeding ... #Varices #Bleeding
Endoscopy - Management of Bleeding Esophageal Varices 
What to Band?
 - Always find the varix that
Management of Bleeding ... Esophageal Varices ... anticipate active bleeding ... - If without bleeding ... is not actively bleeding
Beta-Blockers in Cirrhosis
 • Pathophysiology
 • Indications:  Prevention of decompensation, Prevention of first variceal bleeding,
Prevention of first variceal ... bleeding, Prevention ... of variceal rebleeding
Cirrhosis Timeline and Mortality Rate
Compensated Cirrhosis
Stage 1 - No varices (Annual Mortality Rate 1%)
Stage 2 -
Stage 1 - No varices ... 1%) Stage 2 - Varices ... Stage 4 - Gl bleeding
Esophageal Variceal Bleeding - Diagnosis and Management Summary
PRE-ENDOSCOPY
Vasoactive agents - Octreotide: 
 • 50mcg bolus →
Esophageal Variceal ... Bleeding - Diagnosis ... #Esophageal #Variceal ... #Bleeding #Diagnosis ... treatment #endoscopy #varices
The Minnesota Tube
-Flexible plastic tube with 4 important components
-Gastric Aspiration Port
-Gastric Balloon (400cc)
-Esophageal Balloon (inflated typically
-Used to stop bleeding ... to esophageal varices ... the esophageal varices ... does not stop bleeding
Variceal bleeding
Variceal bleeding
Causes of Small Bowel Bleeding - Differential Diagnosis
Common Causes:
 • Under age 40 years: Inflammatory Bowel
of Small Bowel Bleeding ... purpura, Small bowel varices ... #SmallBowel #Bleeding