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
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%
These are the notes on endoscopic management of Bleeding varices. These are concise and only meant for doctors
