Michele Bettinelli RN CCRN Lahey Health and Medical Center
|
|
- Edmund Palmer
- 5 years ago
- Views:
Transcription
1 Michele Bettinelli RN CCRN Lahey Health and Medical Center
2 Differentiate the types of varices Identify glue preparations utilized when treating gastric varices Review the process of glue administration Explain possible complications and discuss appropriate treatment Present alternative treatments and the dilemma with determining standard of care
3
4
5 Associated with cirrhosis Alcoholic Chronic Hepatitis C Portal Vein Thrombosis Biliary Atresia Sarcoidosis Miliary Tuberculosis Constrictive Pericarditis
6
7
8 Increased portal pressure Structural resistance to blood flow Formation of porto-systemic collaterals
9 Changes in mucosa related to portal hypertension Friable Increased risk of hemorrhage
10 Varices and variceal hemorrhage are complications of cirrhosis that are directly related to portal hypertension AND Variceal hemorrhage can be lethal
11 Child Pugh Score Bilirubin Albumin INR Ascites Encephalopathy Model for Endstage Liver Disease Score (MELD) Bilirubin Creatnine INR
12 Group A B C Bilirubin Below >3.0 Albumin > <2.8 Ascites None Slight Moderate Encephalopathy None Minimal Grade 1-2 Grade 3-4 INR < >2.3
13 Calculation which predicts liver transplant survivability Score is between 6 and 40
14 Varices are present in approximately 50% of individuals with cirrhosis Presence of varices correlates with severity of liver disease Usually asymptomatic but there is an increased risk of rupture EGD to diagnose and evaluate risk of bleeding Variceal hemorrhage occurs yearly between 5-15%
15 Gastric varices are less prevalent than esophageal varices Present in 5-33% of all individuals with portal hypertension Size of varices is directly correlated with risk of hemorrhage Incidence of bleeding associated with gastric varices is approximately 25% within two years of diagnosis
16 Approximately 30% mortality rate during initial hospitalization 20% mortality rate within the first 6 weeks of hemorrhage 60% mortality rate within first year following hemorrhage
17 70% incidence of re-bleeding following initial hemorrhage Development of varices occurs at a rate of 8% for 2 years then increases to 30%
18 Common misconception that all varices despite location can be treated identically
19 Nonselective beta blocker medication Variceal band ligation Sclerotherapy Balloon Tamponade TIPS
20 Bleeding from gastric varices is rare compared to bleeding from esophageal varices however it is more difficult to treat and usually more severe
21 EGD Assess severity of bleeding Identify the source and determine the location of the bleeding Bleeding varices Presence of stigmata Presence of varices Determine best management of bleeding
22
23
24 Helps to determine management Sarin Classification is most common Based on anatomical location Hashizume Classification Based on endoscopic features
25 GOV 1 70% GOV 2 / IGV 1 Nearly 30% Bleed the most frequently IGV 2 Very rare
26
27
28 Few randomized controlled clinical trials exist with limited guidelines GOV 1 Located along the lesser curvature and treated as esophageal varices GOV 2/IGV1 Management Approaches Endoscopic Radiologic Surgical
29 Determined by location of varices GOV 1 Consider band ligation GOV2/IGV1 Sclerotherapy not effective Glue obliteration Thrombin Balloon Tamponade Esophageal Stents TIPS Coil embolization BRTO Surgical shunting Caldwell S. Gastroenterology 2012
30 AASLD guidelines EGD within 12 hours of hemodynamic stabilization Diagnosis Challenging Consider EUS Bhat YM et al. Gastrointestinal Endoscopy 2015 Endoscopic Treatment Closure with Cyanoacrylate (glue)
31 Cyanoacrylate Liquid that polymerizes into a solid substance with blood contact Soehendra N et al. Endoscopy 1986 Current evidence demonstrates that the use of Cyanoacrylate controls gastric variceal bleeding in 87%-93% of cases Garcia-Tsao G et al. Hepatology 2007 Tan PC et al.hepatology 2006 Lo GH et al. Hepatology 2001
32 Histocryl N-butyl-2-cyanoacrylate Rapid polymerization Diluted with Lipiodol Administered with sterile water prime and flush Dermabond 2-octyl-cyanoacrylate Slower polymerization Injected without dilution over seconds Administered with Normal saline prime and flush Rengstorff D et al Gastrointestinal Endoscopy 2004
33 Patient +/- Airway intubation Routine endoscopy preparation Eye protection Glue Personal protective equipment Time consuming Endoscope Tip coated in oil Instrument channel flushed with oil
34 Therapeutic Gastroscope 23 gauge sclerotherapy needles Cyanoacrylate Lipiodol Oil Sterile water / Normal saline Filtered needles 1 cc syringes 3 cc syringes
35 Type and location of varices evaluated by complete EGD End of endoscope is coated with oil Working channel of endoscope is flushed with oil/lipiodol
36 Histocryl Syringes prepared with 0.5ml of lipiodol and 1ml of Histocryl Additional syringes with 3cc of lipiodol used to prime and flush needle Syringes with sterile water used to flush needle Dermabond Syringes prepared with 1cc of Dermabond Additional syringes with saline used to prime and flush needle
37 Histocryl Needle is primed with 1cc lipiodol Varix is identified and needle is inserted lipiodol Histocryl mixture is administered Needle is flushed with lipiodol or sterile water Needle is withdrawn into stomach and flushed with additional sterile water Varix is probed with blunt end of needle catheter to assess effectiveness of glue Dermabond Needle is primed with 1cc of saline Varix is identified and needle is primed with 1cc of Dermabond in stomach Needle is inserted into varix and Dermabond is administered with 1cc saline over seconds Needle with withdrawn into stomach and flushed with additional saline Varix is probed with blunt end of needle catheter to assess effectiveness of glue
38
39 Embolization of glue Pulmonary Splenic Portal Vein Cerebral Inability to obliterate varix Sepsis Recurrent bleeding due to ulcer formation Fever Chest pain Abdominal pain Adherence of needle in varixdamage to endoscope due to glue adherence
40 Balloon Tamponade Temporary measure TIPS Procedure Transjugular intrahepatic portosystemic shunt Fibrin Sealant/Thrombin EUS guided Coiling and Cyanoacrylate injection BRTO Balloon-occluded retrograde transvenous obliteration Surgical Shunt
41
42 Steps in a TIPS procedure: A portal hypertension has caused the coronary vein (arrow) and the umbilical vein(arrowhead) to dilate and flow in reverse. This leads to varices in the esophagus and stomach, which can bleed B a needle has been introduced (via the jugular vein) and is passing from the hepatic vein into the portal vein C the tract is dilated with a balloon D after placement of a stent, portal pressure is normalized and the coronary and umbilical veins no longer fill
43 Cyanoacrylate has been successfully used to treat gastric varices since 1987 Cyanoacrylate is not approved to treat gastric variceal bleeding by the FDA Controlled randomized studies are necessary to validate the effectiveness of Cyanoacrylate
44 AASLD Practice Guidelines for Gastroesophageal Varices Baveno VI Consensus Conference June 2015 Bhat YM et al. Gastrointestinal Endoscopy 2015 Blinder HJ et al. Gastroenterology 2001 Caldwell S. Gastroenterology 2012 Dale C. Gastroenterology Nursing 2016 Kapoor A et al. Gastrointestinal Endoscopy Clinics of North America 2015 Rengstorff, DS & Binmoeller KF. Gastrointestinal Endoscopy 2004 Weilert F & Binmoeller KF. Gastroenterology Clinics of North America
45
VARICEAL BLEEDING. Ram Subramanian MD Hepatology & Critical Care Medical Director of Liver Transplant Emory University, Atlanta.
VARICEAL BLEEDING Ram Subramanian MD Hepatology & Critical Care Medical Director of Liver Transplant Emory University, Atlanta Disclosures: None OUTLINE Pathophysiology of portal hypertension Splanchnic
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Acute variceal bleeding management of, 251 262 balloon tamponade of esophagus in, 257 258 endoscopic therapies in, 255 257. See also Endoscopy,
More informationEvidence-Base Management of Esophageal and Gastric Varices
Evidence-Base Management of Esophageal and Gastric Varices Rino Alvani Gani Hepatobiliary Division Department of Internal Medicine Faculty of Medicine Universitas Indonesia Cipto Mangunkusumo National
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A ACLF. See Acute-on-chronic liver failure (ACLF) Acute kidney injury (AKI) in ACLF patients, 967 Acute liver failure (ALF), 957 964 causes
More informationGI bleeding in chronic liver disease
GI bleeding in chronic liver disease Stuart McPherson Consultant Hepatologist Liver Unit, Freeman Hospital, Newcastle upon Tyne and Institute of Cellular Medicine, Newcastle University. Case 54 year old
More informationManejo Actual del Sangrado por Varices Gástricas
Manejo Actual del Sangrado por Varices Gástricas Juan Carlos Garcia-Pagán Barcelona Hepatic Hemodynamic Laboratory. Liver Unit. IMDIM. Hospital Clinic. IDIBAPS. Ciberehd. XXIV Congreso de la Asociación
More informationACG & AASLD Joint Clinical Guideline: Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis
ACG & AASLD Joint Clinical Guideline: Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis Guadalupe Garcia-Tsao, M.D., 1 Arun J. Sanyal, M.D., 2 Norman D. Grace,
More informationVariceal bleeding. Mainz,
Variceal bleeding Mainz, 21.09.2008 Risk of complications 5 years 10 years Ascites 10 % 25 % HCC 10 % 25 % Bleeding < 5 % 5-10 % Enceph. < 5 % < 5 % Typical situation : Mortality 10 % to 40 % Sequence
More informationTranjugular Intrahepatic Portosystemic Shunt
Tranjugular Intrahepatic Portosystemic Shunt Christopher Selhorst July 25, 2005 BIDMC Radiology Overview Portal Hypertension Indications, Contraindications The Procedure Case Review Complications Outcomes
More informationبسم الله الرحمن الرحيم أوتيتم من العلم إال قليال وما
بسم الله الرحمن الرحيم أوتيتم من العلم إال قليال وما 1 2 Goals of the Lecture: What is the portal vein? How common is PVT? What conditions are associated with PVT? How does patient with PVT present? How
More informationBRTO: Updates to Techniques
Session XIV: BRTO, PARTO and Portal Hypertension GEST2016 BRTO: Updates to Techniques Hiro Kiyosue Oita University Hospital, Japan Hiro Kiyosue, MD Royalty: Cook, Medkit Consulting Fee: Stryker Japan,
More informationEUS-guided thrombin injection for management of gastric fundal varices
EUS-guided thrombin injection for management of gastric fundal varices Authors John W. Frost, Srisha Hebbar Institution Royal Stoke University Hospital Gastroenterology, Stokeon-Trent, United Kingdom of
More informationPrimary Prophylaxis against Variceal Hemorrhage Pharmacotherapy vs Endoscopic Band Ligation
Primary Prophylaxis against Variceal Hemorrhage Pharmacotherapy vs Endoscopic Band Ligation Siwaporn Chainuvati, MD Faculty of Medicine Siriraj Hospital Outline Natural history of esophageal varices Which
More informationPractical Approach to Endoscopic Management for Bleeding Gastric Varices
Review Article http://dx.doi.org/10.3348/kjr.2012.13.s1.s40 pissn 1229-6929 eissn 2005-8330 Korean J Radiol 2012;13(S1):S40-S44 Practical Approach to Endoscopic Management for Bleeding Gastric Varices
More informationPortogram shows opacification of gastroesophageal varices.
Portogram shows opacification of gastroesophageal varices. http://clinicalgate.com/radiologic-hepatobiliary-interventions/ courtesyhttp://emedicine.medscape.com/article/372708-overview DR.Thulfiqar Baiae
More informationBRTO /PARTO Indications and outcomes
BRTO /PARTO Indications and outcomes Saher Sabri, MD Associate Professor of Radiology and Surgery Division of Interventional Radiology University of Virginia Health System Saher Sabri, M.D. Speakers Bureau:
More informationLeft-sided portal hypertension with a patent splenic vein: An impossible or a not-so-uncommon scenario?
Khan et al. 108 CASE REPORT PEER REVIEWED OPEN ACCESS Left-sided portal hypertension with a patent splenic vein: An impossible or a not-so-uncommon scenario? Iftikhar Khan, Ghassan Ramahi, Saif Zaabi,
More informationEsophageal Varices Beta-Blockers or Band Ligation. Cesar Yaghi MD Hotel-Dieu de France University Hospital Universite Saint Joseph
Esophageal Varices Beta-Blockers or Band Ligation Cesar Yaghi MD Hotel-Dieu de France University Hospital Universite Saint Joseph Esophageal Varices Beta-Blockers or Band Ligation? Risk of esophageal variceal
More informationReview Article Self-Expandable Metal Stents in the Treatment of Acute Esophageal Variceal Bleeding
Hindawi Publishing Corporation Gastroenterology Research and Practice Volume 2011, Article ID 910986, 6 pages doi:10.1155/2011/910986 Review Article Self-Expandable Metal Stents in the Treatment of Acute
More informationPORTAL HYPERTENSION. Tianjin Medical University LIU JIAN
PORTAL HYPERTENSION Tianjin Medical University LIU JIAN DEFINITION Portal hypertension is present if portal venous pressure exceeds 10mmHg (1.3kPa). Normal portal venous pressure is 5 10mmHg (0.7 1.3kPa),
More informationVirtual Mentor American Medical Association Journal of Ethics December 2008, Volume 10, Number 12:
Virtual Mentor American Medical Association Journal of Ethics December 2008, Volume 10, Number 12: 805-809. CLINICAL PEARL Indications for Use of TIPS in Treating Portal Hypertension Elizabeth C. Verna,
More informationNYU School of Medicine Department of Radiology Rotation-Specific House Staff Evaluation
Vascular & Interventional Radiology Rotation 1 Core competency in vascular and interventional radiology during the first resident rotation consists of clinical objectives, technical objectives and image
More informationContraindications. Indications. Complications. Currently TIPS is considered second or third line therapy for:
Contraindications Absolute Relative Primary prevention variceal bleeding HCC if centrally located Active congestive heart failure Obstruction all hepatic veins Thomas D. Boyer, M.D. University of Arizona
More informationTransjugular Intrahepatic Portosystemic Shunt Reduction for Management of Recurrent Hepatic Encephalopathy
CLINICAL IMAGES Ochsner Journal 17:311 316, 2017 Ó Academic Division of Ochsner Clinic Foundation Transjugular Intrahepatic Portosystemic Shunt Reduction for Management of Recurrent Hepatic Encephalopathy
More informationRuptured duodenal varices arising from the main portal vein successfully treated with endoscopic injection sclerotherapy: a case report
The Korean Journal of Hepatology 2011;17:152-156 DOI: 10.3350/kjhep.2011.17.2.152 Case Report Ruptured duodenal varices arising from the main portal vein successfully treated with endoscopic injection
More informationLIVER CIRRHOSIS. The liver extracts nutrients from the blood and processes them for later use.
LIVER CIRRHOSIS William Sanchez, M.D. & Jayant A. Talwalkar, M.D., M.P.H. Advanced Liver Disease Study Group Miles and Shirley Fiterman Center for Digestive Diseases Mayo College of Medicine Rochester,
More informationNursing Care & Management of the Pre-Liver Transplant Population. Christine Kiamzon, RN, MSN, PCCN 8 North Educator
Nursing Care & Management of the Pre-Liver Transplant Population Christine Kiamzon, RN, MSN, PCCN 8 North Educator Objectives 1. Identify key nursing interventions in caring for pre-transplant ESLD patients.
More informationNursing Care & Management of the Pre-Liver Transplant Population
Nursing Care & Management of the Pre-Liver Transplant Population Christine Kiamzon, RN, MSN, PCCN 8 North Educator Objectives 1. Identify key nursing interventions in caring for pre-transplant ESLD patients.
More informationThe secondary prophylactic efficacy of beta-blocker after endoscopic gastric variceal obturation for first acute episode of gastric variceal bleeding
pissn 2287-2728 eissn 2287-285X Original Article Clinical and Molecular Hepatology 2013;19:280-287 The secondary prophylactic efficacy of beta-blocker after endoscopic gastric variceal obturation for first
More informationEndovascular Techniques for Symptomatic Portal Hypertension. Michael Meuse, M.D. Vascular and Interventional Radiology
Endovascular Techniques for Symptomatic Portal Hypertension Michael Meuse, M.D. Vascular and Interventional Radiology Objectives Review indications and contraindications for TIPS Define a treatment algorithm
More informationPatrick S. Kamath, MD, and David M. Nagorney, MD
gastrointestinal tract and abdomen PORTAL HYPERTENSION Patrick S. Kamath, MD, and David M. Nagorney, MD Portal hypertension is diagnosed when the hepatic veinpressure gradient (HVPG), which reflects hepatic
More informationTIPS. D Patch Royal Free Hospital London UK
TIPS D Patch Royal Free Hospital London UK TIPS Technique Ascites Budd Chiari Variceal Bleeding Historical Experimental Development 1967 Piccone Shunt between recanalized umbilical vein and saphenous
More informationCyanoacrylate Glue versus Band Ligation for Acute Gastric Variceal Hemorrhage - A randomized controlled trial at Services Hospital, Lahore
ORIGINAL ARTICLE Cyanoacrylate Glue versus Band Ligation for Acute Gastric Variceal Hemorrhage - A randomized controlled trial at Services Hospital, Lahore ISMAIL HASSAN 1, ASMA SIDDIQUE 2, MUHAMMAD IBRAR
More informationUpper gastrointestinal bleeding in children. Nguyễn Diệu Vinh, MD Department of Gastroenterology
Upper gastrointestinal bleeding in children Nguyễn Diệu Vinh, MD Department of Gastroenterology INTRODUCTION Upper gastrointestinal (UGI) bleeding : arising proximal to the ligament of Treitz in the distal
More informationTools of the Gastroenterologist: Introduction to GI Endoscopy
Tools of the Gastroenterologist: Introduction to GI Endoscopy Objectives Endoscopy Upper endoscopy Colonoscopy Endoscopic retrograde cholangiopancreatography (ERCP) Endoscopic ultrasound (EUS) Endoscopic
More informationGastro-Intestinal Bleeding- Interventional Radiology turning off the tap. Simon McPherson, Vascular Interventional Radiologist, Leeds
Gastro-Intestinal Bleeding- Interventional Radiology turning off the tap Simon McPherson, Vascular Interventional Radiologist, Leeds Scale UK 100,000 /year Commonest Vascular IR on-call 75% UGIB 65% NVUGIB
More informationThe Leeds Teaching Hospitals NHS Trust Transjugular Intrahepatic Portosystemic Shunt (TIPS)
n The Leeds Teaching Hospitals NHS Trust Transjugular Intrahepatic Portosystemic Shunt (TIPS) Information for patients Your liver doctor has recommended that you have a Transjugular Intrahepatic Portosystemic
More informationManagement of Chronic Liver Failure/Cirrhosis Complications in Hospitals. By: Dr. Kevin Dolehide
Management of Chronic Liver Failure/Cirrhosis Complications in Hospitals By: Dr. Kevin Dolehide Overview DX Cirrhosis and Prognosis Compensated Decompensated Complications Of Cirrhosis Management Of Complications
More informationFollow this and additional works at:
Washington University School of Medicine Digital Commons@Becker Open Access Publications 2017 Comparison of transjugular intrahepatic portosystemic shunt with covered stent and balloon-occluded retrograde
More informationOriginal Article INTRODUCTION. pissn eissn X
pissn 2287-2728 eissn 2287-285X Original Article Clinical and Molecular Hepatology 2016;22:466-476 Emergency endoscopic variceal ligation in cirrhotic patients with blood clots in the stomach but no active
More informationGubler, Christoph; Bauerfeind, Peter
Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich www.zora.uzh.ch Year: 2014 Safe and successful endoscopic initial treatment and long-term eradication
More informationTransjugular Intrahepatic
Transjugular Intrahepatic Portosystemic Shunt (TIPS): A Clinical and Procedural Review Mark R. Werley, M.D. and John Briguglio, M.D. Lancaster Radiology Associates, Ltd. INTRODUCTION This article reviews
More informationReview Article Role of Self-Expandable Metal Stents in Acute Variceal Bleeding
Hindawi Publishing Corporation International Journal of Hepatology Volume 2012, Article ID 418369, 6 pages doi:10.1155/2012/418369 Review Article Role of Self-Expandable Metal Stents in Acute Variceal
More informationDRAFT. Angiography: Transjugular Intrahepatic Portosystemic Shunt (TIPS) What to expect. What is a transjugular intrahepatic portosystemic shunt?
UW MEDICINE PATIENT EDUCATION Angiography: Transjugular Intrahepatic Portosystemic Shunt (TIPS) What to expect This handout explains a transjugular intrahepatic portosystemic shunt and what to expect when
More informationfollowing the last documented transfusion; thereafter, evaluate the residual impairment(s).
Adult Listings 5.01 Category of Impairments, Digestive System 5.02 Gastrointestinal hemorrhaging from any cause, requiring blood transfusion (with or without hospitalization) of at least 2 units of blood
More informationConflict of interest disclosures. Complications of end stage liver disease. None. The many complications of Cirrhosis. Portal Hypertension.
Complications of end stage liver disease Conflict of interest disclosures None Amir Qamar, MD Instructor of Medicine Brigham and Women s s Hospital Harvard Medical School Boston, MA 02115 The many complications
More informationEndoscopic treatment of gastroesophageal varices in young infants with cyanoacrylate glue: a pilot study
ORIGINAL ARTICLE Endoscopic treatment of gastroesophageal varices in young infants with cyanoacrylate glue: a pilot study Christine Rivet, MD, Carlos Robles-Medranda, MD, Jérôme Dumortier, MD, PhD, Catherine
More informationGastric varices are present in 5% 30% of patients with ENDOSCOPY CORNER
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2010;8:760 766 ENDOSCOPY CORNER Low Incidence of Complications From Endoscopic Gastric Variceal Obturation With Butyl Cyanoacrylate LIU FANG CHENG,* ZHI QIANG WANG,*
More informationBefore Endoscopy? Indications Thermal Coagulation Injection Therapy Combination Therapy Fibrin Sealant Endoclips Argon Plasma Coagulation Lysine -
Dr Simon Smale Before Endoscopy? Indications Thermal Coagulation Injection Therapy Combination Therapy Fibrin Sealant Endoclips Argon Plasma Coagulation Lysine - Haemmostop Variceal Banding Histoacryl
More informationRisk factors for 5-day bleeding after endoscopic treatments for gastroesophageal varices in liver cirrhosis
Original Article Page 1 of 9 Risk factors for 5-day bleeding after endoscopic treatments for gastroesophageal varices in liver cirrhosis Rui Sun*, Xingshun Qi* #, Deli Zou, Xiaodong Shao, Hongyu Li, Xiaozhong
More informationGlue. Lessons Learned. GEST 2016 Session IX Masterclass & Materials: Liquid Material. Yasuaki Arai, M.D. FSIR National Cancer Center, Japan
GEST 2016 Session IX Masterclass & Materials: Liquid Material Lessons Learned Glue Yasuaki Arai, M.D. FSIR, Japan Yasuaki Arai, M.D. Speakers Bureau: Toshiba Medical Systems Intellectual Property/Patents:
More informationV ariceal haemorrhage is a major cause of mortality and
270 LIVER DISEASE The role of the transjugular intrahepatic portosystemic stent shunt (TIPSS) in the management of bleeding gastric : clinical and haemodynamic correlations D Tripathi, G Therapondos, E
More informationGastric fundal varices with hemorrhage are
alloon-occluded Retrograde Transvenous Obliteration of Gastric Varices review of the anatomy, technique, and outcomes. Y SHER S. SRI, MD; ULKU C. TUR, MD; WEL E.. SD, MD; UH WHN PRK, MD; ND JOHN F. NGLE,
More informationTransjugular intrahepatic portosystemic shunt (TIPS) Information for patients Sheffield Vascular Institute
Transjugular intrahepatic portosystemic shunt (TIPS) Information for patients Sheffield Vascular Institute You have been given this leaflet because you need a procedure called a transjugular intrahepatic
More informationLiver failure &portal hypertension
Liver failure &portal hypertension Objectives: by the end of this lecture each student should be able to : Diagnose liver failure (acute or chronic) List the causes of acute liver failure Diagnose and
More informationUse of transjugular intrahepatic portosystemic shunt in liver disease
Vol. XVIII No. 3 JOURNAL OF VASCULAR NURSING PAGE 83 Use of transjugular intrahepatic portosystemic shunt in liver disease Patricia Ann Radovich, RN, MSN, CCRN, FCCM Persons with cirrhosis have many complications.
More informationEDUCATION PRACTICE. Management of Refractory Ascites. Clinical Scenario. The Problem
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2005;3:1187 1191 EDUCATION PRACTICE Management of Refractory Ascites ANDRÉS CÁRDENAS and PERE GINÈS Liver Unit, Institute of Digestive Diseases, Hospital Clínic,
More informationCCTC Minnesota Procedure: Minnesota Tube, Assisting with Insertion and Care of Patient
CCTC Minnesota Procedure: Minnesota Tube, Assisting with Insertion and Care of Patient Purpose: To control bleeding from esophageal or gastric varices that have not responded to medical therapy (ie. Sclerotherapy,
More informationPreliminary study of the permeability and safety of covered stents-grafts in pediatric TIPS
Preliminary study of the permeability and safety of covered stents-grafts in pediatric TIPS Poster No.: C-0354 Congress: ECR 2013 Type: Scientific Exhibit Authors: A. Bueno Palomino, L. Zurera Tendero,
More informationMANAGEMENT OF LIVER CIRRHOSIS: PRACTICE ESSENTIALS AND PATIENT SELF-MANAGEMENT
MANAGEMENT OF LIVER CIRRHOSIS: PRACTICE ESSENTIALS AND PATIENT SELF-MANAGEMENT Sherona Bau, ACNP The Pfleger Liver Institute 200 UCLA Medical Plaza, Suite 214 Los Angeles, CA 90095 September 30, 2017 I
More informationA Prospective, Randomized Trial of Butyl Cyanoacrylate Injection Versus Band Ligation in the Management of Bleeding Gastric Varices
A Prospective, Randomized Trial of Butyl Cyanoacrylate Injection Versus Band Ligation in the Management of Bleeding Gastric Varices GIN-HO LO, KWOK-HUNG LAI, JIN-SHIUNG CHENG, MEI-HSIU CHEN, AND HUNG-TING
More informationDetection of Esophageal Varices Using CT and MRI
Dig Dis Sci (2011) 56:2696 2700 DOI 10.1007/s10620-011-1660-8 ORIGINAL ARTICLE Detection of Esophageal Varices Using CT and MRI Michael J. Lipp Arkady Broder David Hudesman Pauline Suwandhi Steven A. Okon
More informationManagement of Ascites and Hepatorenal Syndrome. Florence Wong University of Toronto. June 4, /16/ Gore & Associates: Consultancy
Management of Ascites and Hepatorenal Syndrome Florence Wong University of Toronto June 4, 2016 6/16/2016 1 Disclosures Gore & Associates: Consultancy Sequana Medical: Research Funding Mallinckrodt Pharmaceutical:
More informationCirrhosis and Portal Hypertension Gastroenterology Teaching Project American Gastroenterological Association
CIRRHOSIS AND PORTAL HYPERTENSION Cirrhosis and Portal Hypertension Gastroenterology Teaching Project American Gastroenterological Association WHAT IS CIRRHOSIS? What is Cirrhosis? DEFINITION OF CIRRHOSIS
More informationCase Report: Refractory variceal bleeding Christophe Hézode, Henri Mondor Hospital, Paris-Est University, Créteil, France
Case Report: Refractory variceal bleeding Christophe Hézode, Henri Mondor Hospital, Paris-Est University, Créteil, France Thank you to Marika Rudler, Dominique Thabut, Adrian Gadano, and Jaime Bosch for
More informationUseful Endoscopic Ultrasonography Parameters and a Predictive Model for the Recurrence of Esophageal Varices and Bleeding after Variceal Ligation
Gut and Liver, Vol. 11, No. 6, November 2017, pp. 843-851 ORiginal Article Useful Endoscopic Ultrasonography Parameters and a Predictive Model for the Recurrence of Esophageal Varices and Bleeding after
More informationTransjugular Intrahepatic Portosystemic Shunt (TIPS) About your procedure
Patient Education Transjugular Intrahepatic Portosystemic Shunt (TIPS) About your procedure This handout explains what a transjugular intrahepatic portosystemic shunt is and what to expect when you have
More informationA. Purpose and Scope of the Guidance PRACTICE GUIDANCE HEPATOLOGY, VOL. 65, NO. 1, 2017
AMERICAN ASSOCIATION FOR THE STUDY OFLIVERD I S E ASES PRACTICE GUIDANCE HEPATOLOGY, VOL. 65, NO. 1, 2017 Portal Hypertensive Bleeding in Cirrhosis: Risk Stratification, Diagnosis, and Management: 2016
More informationPORTAL HYPERTENSION An Introduction to the Culprit of Many Liver Failure Complications
PORTAL HYPERTENSION An Introduction to the Culprit of Many Liver Failure Complications Edy G. Trujillo, RN, MSN, ACNP-BC Liver Transplant RRUCLA Medical Center July 31, 2018 What Do We All Look Forward
More informationAASLD PRACTICE GUIDELINE. The Role of Transjugular Intrahepatic Portosystemic Shunt in the Management of Portal Hypertension. Preamble.
AASLD PRACTICE GUIDELINE The Role of Transjugular Intrahepatic Portosystemic Shunt in the Management of Portal Hypertension Thomas D. Boyer 1 and Ziv J. Haskal 2 Preamble The recommendations in this article
More informationManagement of Cirrhosis Related Complications
Management of Cirrhosis Related Complications Ke-Qin Hu, MD, FAASLD Professor of Clinical Medicine Director of Hepatology University of California, Irvine Disclosure I have no disclosure related to this
More informationEditorial Process: Submission:07/25/2018 Acceptance:10/19/2018
RESEARCH ARTICLE Editorial Process: Submission:07/25/2018 Acceptance:10/19/2018 Clinical Outcome and Predictive Factors of Variceal Bleeding in Patients with Hepatocellular Carcinoma in Thailand Jitrapa
More informationGastroenterology. Certification Examination Blueprint. Purpose of the exam
Gastroenterology Certification Examination Blueprint Purpose of the exam The exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment skills expected of the certified gastroenterologist
More informationPortal hypertension is the main complication of cirrhosis
GASTROENTEROLOGY 2001;120:726 748 Current Management of the Complications of Cirrhosis and Portal Hypertension: Variceal Hemorrhage, Ascites, and Spontaneous Bacterial Peritonitis GUADALUPE GARCIA TSAO
More informationInformation Technology Solutions
2016 2014 CPT Esophagoscopy Changes - Gastroenterology CPT Changes Information Technology Solutions ASGE LOGO AND INFO Esophagogastroduodenoscopy CPT Codes 43235-43270 The American Society for Gastrointestinal
More informationNICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic.
bring together all NICE guidance, quality standards and other NICE information on a specific topic. are interactive and designed to be used online. They are updated regularly as new NICE guidance is published.
More informationSclerosing Agents: Tips & Tricks Session: Liquid Embolics
Sclerosing Agents: Tips & Tricks Session: Liquid Embolics Jeffrey S. Pollak, M.D. Robert I. White, Jr., M.D. Professor of Interventional Radiology Yale University School of Medicine Department of Radiology
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Accelerated intravascular coagulation and fibrinolysis (AICF) in liver disease, 390 391 Acid suppression in liver disease, 403 404 ACLF.
More informationResearch Article Validation of an Endoscopic Fibre-Optic Pressure Sensor for Noninvasive Measurement of Variceal Pressure
Hindawi Publishing Corporation BioMed Research International Volume 2016, Article ID 1893474, 7 pages http://dx.doi.org/10.1155/2016/1893474 Research Article Validation of an Endoscopic Fibre-Optic Pressure
More informationJMSCR Vol 04 Issue 08 Page August 2016
www.jmscr.igmpublication.org Impact Factor 5.244 Index Copernicus Value: 83.27 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: http://dx.doi.org/10.18535/jmscr/v4i8.23 Portal Hypertension in Adults- A Comprehensive
More informationORIGINAL ARTICLES LIVER, PANCREAS, AND BILIARY TRACT
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2010;8:703 708 ORIGINAL ARTICLES LIVER, PANCREAS, AND BILIARY TRACT Compliance With Practice Guidelines and Risk of a First Esophageal Variceal Hemorrhage in Patients
More informationTitle: Cholestasis after TIPS placement in a patient with primary sclerosing cholangitis: an uncommon complication
Title: Cholestasis after TIPS placement in a patient with primary sclerosing cholangitis: an uncommon complication Authors: Alejandro Salagre García, Carolina Muñoz Codoceo, Elena Gómez Domínguez, Inmaculada
More informationTreating patients with end-stage liver disease: Are we ready? Dr. Mino R. Mitri, M.D., C.M., M.Ed., FRCPC
Treating patients with end-stage liver disease: Are we ready? Dr. Mino R. Mitri, M.D., C.M., M.Ed., FRCPC mino.mitri@ubc.ca No Conflict of Interest 157 patients 157 patients 6 transplanted Criteria Liver
More informationPortal hypertension and ascites
Portal hypertension and ascites Muhammad S Mirza Guruprasad P Aithal Abstract Portal pressure is the product of portal blood flow and resistance; an increase in either leads to increased portal pressure.
More informationEvaluation of Clinical, Biochemical and Ultrasound Parameters in Diagnosis of Oesophageal Varices
Med. J. Cairo Univ., Vol. 78, No. 2, June: 105-109, 2010 www.medicaljournalofcairouniversity.com Evaluation of Clinical, Biochemical and Ultrasound Parameters in Diagnosis of Oesophageal Varices FAWZY
More informationIs pharmacological therapy the best choice for primary prevention of variceal hemmorhaging in patients with hepatic cirrhosis?
Controversies en Gastroenterology Is pharmacological therapy the best choice for primary prevention of variceal hemmorhaging in patients with hepatic cirrhosis? Rolando José Ortega Quiroz, MD, 1 Adalgiza
More informationMedical Necessity Guidelines: Upper GI Endoscopy: Certain Elective Procedures
Medical Necessity Guidelines: Upper GI Endoscopy: Certain Elective Procedures Effective: October 11, 2017 Clinical documentation and prior authorization required Coverage guideline, no prior authorization
More informationLong-term follow-up of endoscopic Histoacryl glue injection for the management of gastric variceal bleeding
Q J Med 2011; 104:41 47 doi:10.1093/qjmed/hcq161 Advance Access Publication 25 September 2010 Long-term follow-up of endoscopic Histoacryl glue injection for the management of gastric variceal bleeding
More information(a) (b) Plate 16.1 Esophageal tear after passage of the echoendoscope.
Plate 16.1 Esophageal tear after passage of the echoendoscope. Plate 11.1 Prophylactic pancreatic duct stents. 3-Fr, 4-cm long single-pigtail stent. 5-Fr, 3-cm long flanged stent. Plate 16.2 Esophageal
More informationThe role of endoscopy in the management of variceal hemorrhage
GUIDELINE The role of endoscopy in the management of variceal hemorrhage This is one of a series of statements discussing the use of GI endoscopy in common clinical situations. The Standards of Practice
More informationBarbara Rus Gadžijev Peter Popovič Klinični inštitut za radiologijo UKC Ljubljana
STROKOVNI SESTANEK ZDRUŽENJA HEMATOLOGOV SLOVENIJE IN ZDRUŽENJA ZA TRANSFUZIJSKO MEDICINO, Terme Zreče, 17.-18.4.2015 Barbara Rus Gadžijev Peter Popovič Klinični inštitut za radiologijo UKC Ljubljana goals,
More informationPrevention and treatment of variceal haemorrhage in 2017
Received: 12 October 2016 Accepted: 19 October 2016 DOI: 10.1111/liv.13277 REVIEW ARTICLE Prevention and treatment of variceal haemorrhage in 2017 Felix Brunner 1 Annalisa Berzigotti 1 Jaime Bosch 1,2
More informationDecompensated chronic liver disease
Decompensated chronic liver disease Definition of decompensated chronic liver disease Patients with chronic liver disease can present with acute decompensation due to various causes. The decompensation
More informationObliterative hepatocavopathy ultrasound and cavography findings
doi:10.2478/v10019-008-0020-6 case report Obliterative hepatocavopathy ultrasound and cavography findings Ramazan Kutlu Department of Radiology, Inonu University School of Medicine, Malatya, Turkey ackgound.
More informationLuis S. Marsano, MD March 2013
Portal HTN: Variceal Bleed, Portal Gastropathy, Hepatopulmonary Syndrome, Porto Pulmonary Hypertension, Cardiomyopathy, and Acute on Chronic Liver Failure Luis S. Marsano, MD March 2013 Variceal Hemorrhage
More informationManagement of Cirrhotic Complications Uncontrolled Ascites. Siwaporn Chainuvati, MD Siriraj Hospital Mahidol University
Management of Cirrhotic Complications Uncontrolled Ascites Siwaporn Chainuvati, MD Siriraj Hospital Mahidol University Topic Definition, pathogenesis Current therapeutic options Experimental treatments
More informationACUTE VARICEAL BLEEDING MULTIMODAL APPROACH
FALK symposium. Liver Cirrhosis: from pathophysiology to disease management Dresden, October 13-14 14 2007 ACUTE VARICEAL BLEEDING MULTIMODAL APPROACH Professor Andrew K Burroughs Hepato-biliary biliary-pancreatic
More informationCOPYRIGHTED MATERIAL. 1 Approach to the patient with gross gastrointestinal bleeding. Grace H. Elta, Mimi Takami
1 Approach to the patient with gross gastrointestinal bleeding Grace H. Elta, Mimi Takami Gastrointestinal (GI) bleeding is a common clinical problem that requires more than 300 000 hospitalizations annually
More information