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Esophageal Varices - #PHARMFAX

Theres only two outlets for GI bleeds to go out of; your mouth and rectum.

 

Theres only two outlets for GI bleeds to go out of, your mouth and rectum. Esophageal varices develops from structural changes to the liver from cirrhosis. Intrahepatic vascsular resistance to portal flow and splanchnic vasodilation cause portal hypertension. Overtime, varices develop and rupture from an overpressure.

Volume resuscitation should be initiated, but limit crystalloid fluids and replace blood with blood. Infections from bacterial translocation increases incidence of rebleeding and hospital mortality. Meta-analysis indicate prophylactic antibiotics reduces this risk. Ceftriaxone 1gm every 24 hours for 7 days runs along guideline recommendations.

Acid suppression with pantoprazole should be initiated, 80 mg IV followed by a continuous infusion or 40 mg q12 hours. PPI reduce incidence of rebleeding and transfusion requirements by promoting hemostasis via increased gastric pH.

Vasoactive medications target portal hypertension by inducing splanchnic vasocontrisction indirectly from glucagon secretion inhibition. Octreotide is utilized as a 50 mcg bolus, then 50 mcg/hr. the #PHARMFAX, check out another video on my page, share the PHARMFAX with a friend, and I hope you learned something new.

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