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Haematemesis - Coggle Diagram

- - - - Patients with liver cirrhosis --> develop portal hypertension
        
        Oesophageal varices --> risk of rupturing
    - - ABC
        
        Patients should be resuscitated prior to endoscopy
        
        May require blood transfusion
      - Correct clotting
        
        FFP, vitamin K, platelet transfusions may be required
      - Terlipressin
        
        What is it?
        
        Prodrug of vasopressin
        
        Acts on V1 receptors, causes splanchnic vasoconstriction, decrease portal blood flow and pressure, decrease variceal pressure
        
        Side effects
        
        Hypertension
        
        Hyponatremia
        
        Myocardial, peripheral and mesenteric ischaemia
      - Prophylactic IV antibiotics = quinolone
        
        Shown to reduce mortality
      - Endoscopy + endoscopic variceal band ligation
      - If uncontrolled haemorrhage
        
        Sengstaken-Blakemore tube
        
        If fails...
        
        Transjugular Intrahepatic Portosystemic Shunt (TIPSS)
    - - Non-selective beta blockers
        
        In compensated liver cirrhosis
        
        Carvedilol
        
        In decompensated liver cirrhosis
        
        Propanolol, carvedilol lowers systemic bp more profoundly
      - Endoscopic variceal band ligation at two weekly intervals until all varices eradicated
        
        PPI to prevent ulceration
      - TIPPS maybe used if above unsuccessful in preventing further episodes