gastrointestinal emergencies evidence based answers to key clinical questions end stage liver disease and variceal bleeding graham
Geschreven voor
Chamberlain College Of Nursing
- NURSING NR326
Alle documenten voor dit vak (794)
Verkoper
Volgen
akademica
Ontvangen beoordelingen
Voorbeeld van de inhoud
End-Stage Liver Disease and Variceal
Bleeding 18
Autumn Graham and Andrew C. Meltzer
hen Should I Suspect Esophagogastric
W
Pearls and Pitfalls Varices in a Patient with a History of Liver
• By the time patients have ascites associated with Disease?
their liver dysfunction, 60% have varices on EGD.
• Nasogastric tube placement is likely safe in patients Portal hypertension is defined as a hepatic venous pressure
with varices, but risks and benefits should be care- gradient greater than 5 mmHg and occurs due to increased
fully weighed and discussed with patient. structural resistance and decreased endogenous nitric oxide
• Risk factors associated with early re-bleeding and production [5]. Esophagogastric varices develop when the
poor outcomes include severe initial bleeding as hepatic venous pressure gradient (HPVG) rises above
defined by a hemoglobin less than 8 g/dL, gastric 10 mmHg.
variceal bleeding, thrombocytopenia, encephalopa- By the time cirrhosis is diagnosed or suspected based on
thy, alcohol-related cirrhosis, large varices, and stigmata of chronic liver disease (e.g., spider angiomas,
active bleeding during endoscopy. jaundice, pruritis, palmar erythema) and laboratory abnor-
• Antibiotics have a proven benefit in variceal bleed- malities, approximately 30–40% of patients will have varices
ing with decreased morbidity and mortality. [3]. The American College of Gastroenterology (ACG) rec-
ommends screening esophagogastroduodenoscopy (EGD) at
time of cirrhosis diagnosis; thus, many patients with a diag-
Cirrhosis occurs when damage to the liver results in scar nosis of cirrhosis will know if they have varices [5]. Of those
tissue (hepatic fibrosis), affecting liver function. Cirrhosis without varices at the time of diagnosis, another 10–15%
is the third leading cause of death in patients between the will develop varices each year [3]. By the time patients have
ages of 45 years and 64 years, with a median survival of ascites associated with their liver dysfunction, 60% have
9–12 years after diagnosis. In the United States, end-stage varices on EGD [3]. In advanced disease (e.g., Child-Pugh
liver disease is most often due to hepatitis C infections [1]. C), 85% of patients have varices [5, 6].
Gastrointestinal bleeding in patients with cirrhosis is com- Once varices are present, portal hypertension causes them
mon and carries a high mortality rate of approximately to grow in size by approximately 7% each year [4]. The size
15–30% [2–4]. of varices directly correlates with the risk of bleeding: 1–2%
without varices, 5% with small varices, and 15% with
medium or large (>5 mm) varices [3, 5]. When patients pres-
ent with gastrointestinal bleeding and have a history of vari-
ces, 70% of cases are due to ruptured esophageal varices,
usually at the GE junction [3, 5].
A. Graham
Department of Emergency Medicine, MedStar Washington
Hospital Center, MedStar Georgetown University Hospital, an I Place a Nasogastric Tube (NGT)
C
Washington, DC, USA
in Patients with Esophagogastric Varices?
A. C. Meltzer (*)
Department of Emergency Medicine, George Washington
Traditional dogma would suggest that blind placement of
University School of Medicine & Health Sciences,
Washington, DC, USA nasogastric tubes for nasogastric aspiration (NGA) or naso-
e-mail: ameltzer@mfa.gwu.edu gastric lavage (NGL) is unsafe in the advanced liver disease
Voordelen van het kopen van samenvattingen bij Stuvia op een rij:
√ Verzekerd van kwaliteit door reviews
Stuvia-klanten hebben meer dan 700.000 samenvattingen beoordeeld. Zo weet je zeker dat je de beste documenten koopt!
Snel en makkelijk kopen
Je betaalt supersnel en eenmalig met iDeal, Bancontact of creditcard voor de samenvatting. Zonder lidmaatschap.
Focus op de essentie
Samenvattingen worden geschreven voor en door anderen. Daarom zijn de samenvattingen altijd betrouwbaar en actueel. Zo kom je snel tot de kern!
Veelgestelde vragen
Wat krijg ik als ik dit document koop?
Je krijgt een PDF, die direct beschikbaar is na je aankoop. Het gekochte document is altijd, overal en oneindig toegankelijk via je profiel.
Tevredenheidsgarantie: hoe werkt dat?
Onze tevredenheidsgarantie zorgt ervoor dat je altijd een studiedocument vindt dat goed bij je past. Je vult een formulier in en onze klantenservice regelt de rest.
Van wie koop ik deze samenvatting?
Stuvia is een marktplaats, je koop dit document dus niet van ons, maar van verkoper akademica. Stuvia faciliteert de betaling aan de verkoper.
Zit ik meteen vast aan een abonnement?
Nee, je koopt alleen deze samenvatting voor $18.49. Je zit daarna nergens aan vast.
