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Oesophageal Varices
- due to Portal Hypertension
- connection between systemic and portal circulations at lower end of
oesophagus
Treatment of haemorrhage
- treat as emergency
- Airway
- Breathing
- Circulation
- check for signs of shock
- IV access and resuscitate as necessary
- bloods for cross-match, FBC, U&E, LFTs and clotting
- Urgent Endoscopy
- Vasoconstrictor therapy
- Balloon tamponade
- Sengstaken-Blakemore tube
- complications
- aspiration pneumonia
- oesophageal rupture
- mucosal ulceration
- 5% mortality
- Additional
Rebleed
- Endoscopy
- one repeat of sclerotherapy
- Octreotide infusion (3-5
days)
- TIPS
- Emergency surgery
Long Term Prevention of Rebleed
- Long-term sclerotherapy or banding
- complications (less with banding)
- oesophageal ulceration
- mediastinitis
- oesophageal strictures
- Propranolol
- Surgery
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