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Varices (Treatment (Prophylatic antibiotics to treat and prevent infection…
Varices
Treatment
Prophylatic antibiotics to treat and prevent infection as well as reduce early rebreeding and mortality
Variceal banding - where a band is put around the varicella using an endoscope, after a few days the banded varix degenerates and falls off leaving a scar
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Prevention
- Non-selective beta blocker
- Variceal banding repeatedly to obliterate varices
- Liver transplant - best option when there is poor liver function
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Clinical Presentation
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Signs of chronic liver damage e.g. jaundice, increased bruising (since liver produces coagulation factors) and ascites
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Key Points
A dilated vein which is at risk of rupture resulting in haemorrhage and in the GI system can result in GI bleeding
As portal pressure rises above 10-12mmHg, the compliant venous system DILATES and varies form within the systemic venous system
Gastro-oesophageal varices are superficial and tend to rupture resulting in GI bleeding - usually when pressure exceeds 12 mmHg
Epidemiology
Bleeding is likely to occur with large varices, or those with red signs at endoscopy and in severe liver disease
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Around 90% of patients with CIRRHOSIS will develop gastro-oesophageal varices over 10 years - but only a third of these will bleed
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Pathophysiology
Following liver injury and fibrogenesis, the contraction of activated myofibroblasts contributes to increased resistance to blood flow
This leads to portal hypertension, splanchnic vasodilation, drop in BP, increased cardiac output to compensate for BP
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