Predictive Factors of Bleeding from Esophageal Varices in Patients with Liver Cirrhosis and Portal Hypertension (original) (raw)
Related papers
Canadian Medical Association journal, 1971
Combined hepatic and umbilicoportal catheterization was performed in 38 compensated cirrhotics. Portohepatography with opacification of the coronary vein was obtained in all cases. The free portal venous pressure (FPVP) and the wedged (WHVP) and free (FHVP) hepatic venous pressures were recorded. The portohepatic gradient (FPVP-FHVP) was used as an index of portal hypertension. The coronary vein was separately re-evaluated for varices and graded as 1+ to 4+.Eighteen patients had varices graded as 3+ or 4+ (Group A) and all had a portohepatic gradient of 10 mm. Hg or more. The other 20 cirrhotics (Group B) had varices graded as 1+ or 2+ and 15 had a portohepatic gradient of less than 10 mm. Hg. The difference between gradients of Group A and Group B was highly significant.Of the 38 cirrhotics studied, eight had bled from varices and all are included in Group A. There is no significant difference between the gradients of both bleeders and non-bleeders of Group A.There is a significant...
Variceal Bleeding and its Dependence on Portal Vein Size in Liver Cirrhotic Patients
2009
Upper gastrointestinal (GI) bleeding is common amongst liver cirrhosis having a meritorious cause of oesophageal varices due to portal hypertension. One-third of patients die because of bleeding oesophageal varices. In normal circumstances, ultrasound findings in portal system could predict both the presence of varices and risk of variceal bleeding which provides with contradictory results. In our study, 100 patients were assessed on the basic of portal vein size ranging from 1 cm to 2 cm Out of which, 17 patients having portal vein size more then 1.4 cm bled. From the above study it is concluded that the patients who had portal vein size more than 1.4 cm were at a great risk of bleeding from oesophagal varices.
Study of the causes associated with variceal rebleeding in hepatic cirrhosis
2013
Background: Esophageal variceal (EV) bleeding is a frequent and severe complication in patients with cirrhosis. Cirrhotic patients with acute EV bleeding are characterized by a high mortality and considerable rebleeding rate. Although therapeutic approaches such as pharmacological treatment and band ligation or transjugular intrahepatic portosystemic shunt (TIPS) have been developed to prevent rebleeding, mortality in these patients remains as high as 30% - 50% . Aims: Is to explore factors associated with variceal rebleeding in cirrhotic patient. Methods: This study was conducted on 200 cirrhotic patients who were admitted to Tanta University Hospital between April 2012 and Oc tober 2012 because of variceal bleeding. These patients were divided into 2 groups: Group I: Cirrhotic patients presented with rebleeding after previous endoscopic treatment of known varices within 6 weeks of acute bleeding. Group II: Cirrhotic patients wh o admitted with variceal bleeding and didn't deve...
Egyptian Liver Journal, 2021
Background Despite the great advancement in therapeutic modalities for esophageal varices, early variceal rebleeding still occurs at high rates leading to an exaggeration of the morbidity and mortality for cirrhotic patients, so meticulous follow-up with optimum prediction and proper preventive measures for early variceal rebleeding are mandatory for increasing survival of those patients. In this respect, we evaluated the clinical, laboratory, abdominal ultrasound, and endoscopic criteria of variceal cirrhotic patients as possible risk predictors of early variceal rebleeding after endoscopic control of first variceal bleeding. All included patients were followed up blindly for 12 weeks after endoscopic control of bleeding for ascertainment of first variceal rebleeding. The demographic, clinical, laboratory, abdominal ultrasound, and upper gastrointestinal endoscopic criteria were evaluated for all patients at first admission. Results By univariate regression analysis, the statistica...
Hepatology International, 2011
Background Acute variceal bleeding (AVB) is a medical emergency and associated with a mortality of 20% at 6 weeks. Significant advances have occurred in the recent past and hence there is a need to update the existing consensus guidelines. There is also a need to include the literature from the Eastern and Asian countries where majority of patients with portal hypertension (PHT) live. Methods The expert working party, predominantly from the Asia–Pacific region, reviewed the existing literature and deliberated to develop consensus guidelines. The working party adopted the Oxford system for developing an evidence-based approach. Only those statements that were unanimously approved by the experts were accepted. Results AVB is defined as a bleed in a known or suspected case of PHT, with the presence of hematemesis within 24 h of presentation, and/or ongoing melena, with last melanic stool within last 24 h. The time frame for the AVB episode is 48 h. AVB is further classified as active or inactive at the time of endoscopy. Combination therapy with vasoactive drugs (<30 min of hospitalization) and endoscopic variceal ligation (door to scope time <6 h) is accepted as first-line therapy. Rebleeding (48 h of T 0) is further sub-classified as very early rebleeding (48 to 120 h from T 0), early rebleeding (6 to 42 days from T 0) and late rebleeding (after 42 days from T 0) to maintain uniformity in clinical trials. Emphasis should be to evaluate the role of adjusted blood requirement index (ABRI), assessment of associated comorbid conditions and poor predictors of non-response to combination therapy, and proposed APASL (Asian Pacific Association for Study of the Liver) Severity Score in assessing these patients. Role of hepatic venous pressure gradient in AVB is considered useful. Antibiotic (cephalosporins) prophylaxis is recommended and search for acute ischemic hepatic injury should be done. New guidelines have been developed for management of variceal bleed in patients with non-cirrhotic PHT and variceal bleed in pediatric patients. Conclusion Management of acute variceal bleeding in Asia–Pacific region needs special attention for uniformity of treatment and future clinical trials.
Portal pressure, presence of gastroesophageal varices and variceal bleeding
Hepatology, 1985
This study was performed to examine the relationships between portal pressure measurements and the presence of esophagogastric varices, the size of varices and the occurrence of hemorrhage from varices in 93 patients with alcoholic cirrhosis, using standardized measurements of portal pressure by hepatic vein catheterization.
Primary prophylaxis of esophageal variceal bleeding in cirrhosis
Gastroentérologie Clinique et Biologique, 2008
Variceal bleeding is a common and severe complication of liver cirrhosis. The risk of bleeding increases with the size of varices, red wheal marks and disease severity. Noninvasive tests are not accurate enough for the diagnosis of varices, so all patients with cirrhosis should be screened by endoscopy. Nonselective beta-blockers (propranolol, nadolol) are indicated for primary prophylaxis in patients with medium/large varices, and for those with small varices and red signs or advanced liver failure (Child C). In such patients, beta-blockers have been shown to reduce the risk of bleeding from 25 to 15%. There is no evidence to support using beta-blockers with nitrates or spironolactone. In patients with contraindication or intolerance to beta-blockers, endoscopic band ligations are indicated.
Variceal bleeding: consensus meeting report from the Brazilian Society of Hepatology
Arquivos de Gastroenterologia, 2010
In the last decades, several improvements in the management of variceal bleeding have resulted in a significant decrease in morbidity and mortality of patients with cirrhosis and bleeding varices. Progress in the multidisciplinary approach to these patients has led to a better management of this disease by critical care physicians, hepatologists, gastroenterologists, endoscopists, radiologists and surgeons. In this respect, the Brazilian Society of Hepatology has, recently, sponsored a consensus meeting in order to draw evidence-based recommendations on the management of these difficult-to-treat subjects. An organizing committee comprised of four people was elected by the Governing Board and was responsible to invite 27 researchers from distinct regions of the country to make a systematic review of the subject and to present topics related to variceal bleeding, including prevention, diagnosis, management and treatment, according to evidence-based medicine. After the meeting, all par...