Surgery Multiple Choice       Questions
Bleeding Varices

1. If esophageal varices are not treated in hospital , the chances of recurrent bleeding is more than 75%.

2. In resuscitation of bleeding varices maintain CVP between 2-5 cm of water.

3. Do not give sedatives in resuscitation of bleeding varices.

4.Sclerotherapy is better than medical managament as it has
a) Low incidence of rebleed
b) Increased long term survival
c) Less morbidity

Balloon Tube control
Done in cases of failure of endoscopic management in patients with exsanguinating bleed.
4 lumen minnesota tube
Gastric ballon maximum volume is 250 ml
Esophageal ballon can be inflated till 40 mm Hg
Remove tube after 6-12 hrs and  maximum permissible time is 24 hours.

If bleeding reoccurs after removal of tube, ask an experienced personnel to check if it was properly placed or
re introduce it .
Repeat endoscopy
 

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Esophaus
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Pancreas
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Miscellaneous
Imaging liver lesions
Injection Sclerotherapy

Intravariceal injection .
Paravariceal injection
Combined

To be done at weekly interval till all varices are obliterated.
Then Follow up after 3 months and 6 months.


Tissue Adhesives --Histoacryl
                               Bucrylate

Used in Gastric Varices and  Complex recurrent bleeding recurrent bleeding esophageal varices.

Thrombin   - Can be human or bovine
                       Effective in controlling bleed in esophgeal and gastric varices.

Esophageal Variceal Ligation

A band is tied around the varix endoscopically and there is ischeamic necrosis of mucosa and submucosa.
Scar heals by 14 -21 days.

Comparision between EIS (Endoscopic Sclerotherapy) and EVL (Endoscpic Variceal Ligation)

1. Eradication rates are similar in both

2. Similar number of treatment sessions are required.

3.Less complications with EVL

4. Chronic Esophageal ulceration after EIS is 36% and stricture rate is 10%
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These are the notes on endoscopic management of Bleeding varices. These are concise and only meant for doctors
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