Lectures

Variceal Hemorrhage

by Carlo Raj, MD
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    00:02 Variceal hemorrhage The most important and the most emergent of our portal hypertension sequelae will be Variceal hemorrhage Or what we talked about earlier when we have issues in engorgement.

    00:18 Let's go ahead and talk about the actual blood vessels.

    00:23 So your esophageal or gastric type of varices It can occur due to portal hypertension due to any cause.

    00:31 Mortality much lower in cases of non-cirrhotic portal hypertension.

    00:34 If it’s cirrhotic portal hypertension resulting in Esophageal varices then you're pretty much increasing risk of mortality.

    00:42 Surgical shunt maybe perhaps necessary.

    00:44 So, remember, your Esophageal varices will be An area or region of portocaval anastomosis So a shunt to therefore decrease the pressure in this area provides a durable control of bleeding and is indicated in child class A cirrhosis or non-cirrhotic portal hypertension And in that case, I mean to say That you can shunt and decrease the pressure immediately Gastric varices are treated with either glue We call this something like cyanoacrylate injections or what is TIPPS? Your transjugular intrahepatic portosystemic shunt In which, you completely bypass the liver Because this will be an example of cirrhotic porto hypertension causing esophageal varices your focus should be on esophageal varices and your focus should be on proper management of your patient.

    01:37 Because that is where the questions will come from Either cirrhotic or non-cirrhotic.

    01:46 The topic of pulmonary manifestations of portal hypertension is the following: There's something called hepato-pulmonary and in this case Porto-pulmonary hypertension.

    01:55 A relative contra-indication to transplantation is what you want to keep in mind.

    02:01 So, what do you want to do: is when you think about cirrhosis, As to take a look at all of our pressures.

    02:08 Can have portal hypertension You can have hypo-tension globally And you can have Porto-pulmonary hypertension And you can have Hepato-Pulmonary syndrome. What is this? This is when your patient is suffering hypoxemia and platypnea an orthodoxia due to interpulmonary shunting. Literally here.

    02:27 You want to think of this as being atelectases that is taking place.

    02:31 of your ovuli.

    02:34 and so therefore there is inter-pulmonary shunting taking place Here.

    02:40 Big time.

    02:41 Of the two, either porto pulmonary hypertension Or hepato-pulmonary syndrome You pay attention to hepato-pulmonary syndrome in which liver transplantation is curative.

    02:51 Liver damage causing, hypoxemia and death too.

    02:55 your ovuli.

    02:56 resulting to interpulmonary hypertension shunt.

    02:59 Remember, patient with portal hypertension, also suffering from ascites.

    03:04 In addition to accumulating fluid into the Peritoneal cavity there is also a possibility that a patient is also developing fluid in the pleural cavity.

    03:12 We've talked about this earlier, this is hepatic hydrothorax.

    03:15 Really important for you to pay attention to the origin of the pleural effusion Does it respond well to diuretics? Look for that as being a common description.

    03:26 And because the problem took place and originated in the liver, with Portal hypertension and ascites Than If, you're able to bypass the liver, using once again, TIPSS Then you'll find, Not only would ascites start dropping, but as would be the hepatic hydrothorax.


    About the Lecture

    The lecture Variceal Hemorrhage by Carlo Raj, MD is from the course Cirrhosis – Liver Diseases.


    Included Quiz Questions

    1. Child class A
    2. Child Class B
    3. Child Class C
    4. Hepatocellular carcinoma
    5. Cirrhotic portal hypertension
    1. Junction of 1st and 2nd part of duodenum
    2. Esophagus
    3. Retroperitoneal
    4. Rectal
    5. Paraumbilical
    1. Ascites
    2. Orthodexia
    3. Platypnea
    4. Hypoxemia
    5. Dyspnea

    Author of lecture Variceal Hemorrhage

     Carlo Raj, MD

    Carlo Raj, MD


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