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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
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
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
Endoscopy - Management of Bleeding Esophageal Varices 
What to Band?
 - Always find the varix that
Esophageal Varices ... - Varices in ... during banding, varices ... seen hundreds of varices ... #Esophageal #Varices
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
Lower GI Bleed - Differential Diagnosis Framework
Structural:
 - Diverticulosis
 - Post-Polypectomy Bleeding
 - Hemorrhoids
 - Polyps
Post-Polypectomy Bleeding ... Colonic or rectal varices
Upper Gastronintestinal Bleed - Differential Diagnosis Algorithm
Acute Hematemesis/Melena
 - Blood in vomitus?/black, tarry stools
 - If
- Exclude bleeding ... Gastro-esophageal varices
Esophageal Variceal Bleeding - Scoping Summary
GENERAL PRINCIPLES OF MANAGEMENT (VARICEAL-B):
V - Vasoconstrictor therapy: (Octreotide 50mcg bolus
Esophageal Variceal Bleeding ... - Refractory Bleeding ... Esophageal #Variceal #Varices ... #Bleeding #Summary
Minnesota Tubes for Upper GI Bleeds
Minnesota tubes (MT) are typically placed in intubated patients with life-threatening
particular esophageal varices ... and esophageal bleeding
Evidence for Treatment of Acute Esophageal Variceal Bleeding
 • Octreotide (PMID: 11870374) - Endoscopic banding +
Esophageal Variceal Bleeding ... May help prevent bleeding ... 7611595) • Stops bleeding ... 8698192) - Stops bleeding ... #varices #management