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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 ... Saad-Caldwell ... #Variceal #Bleeding
Esophageal Variceal Bleeding - Scoping Summary
GENERAL PRINCIPLES OF MANAGEMENT (VARICEAL-B):
V - Vasoconstrictor therapy: (Octreotide 50mcg bolus
Esophageal Variceal ... (VARICEAL-B): ... #Esophageal #Variceal ... #Varices #Bleeding ... #algorithm #VARICEALB
VIBES Mnemonic - Cirrhosis Management Checklist

V - Volume (Ascites, HRS)
	- Evaluate for Ascites, Edema, Hydrothorax, Hepatorenal
spironolactone (2:5 ratio), paracentesis ... (Variceal) - ... esophageal gastric varices ... octreotide, EGD -> variceal ... varices): Non-selective
Upper GI Bleed - Management Algorithm

Upper GI bleed Suspected: Melena, hematemesis, coffee-ground emesis, BRBPR
Initial Stabilization
Concern for
Upper GI Bleed - Management ... Algorithm Upper ... Ulcer Disease • Variceal ... Bleeding • Mallory ... #Algorithm #gastrointestinal
Spontaneous Bacterial Peritonitis
DIAGNOSTICS
Paracentesis: 
 • Calculate absolute PMN count (total WBC x PMN %)
 • Correct
DIAGNOSTICS Paracentesis ... Day 3 repeat paracentesis ... Any etiology (variceal ... not) - ↓ rebleeding ... SBP #diagnosis #management
Procedure Risks and Platelet Targets for Transfusion
LOW RISK - Transfuse ≥ 20,000/uL
 • Paracentesis, EGD or
≥ 20,000/uL • Paracentesis ... , Prophylactic variceal ... bleeding, Small ... thresholds #targets #management
Endoscopy in Non-Variceal Upper GI Bleeding - Scoping Summary
Pre-Endoscopic Care:
 • Adequate resuscitation: Restrictive> Liberal strategy
Endoscopy in Non-Variceal ... Upper GI Bleeding ... NonVariceal #UpperGI #Bleeding ... Endoscopy #diagnosis #management ... #algorithm