A patient of chronic liver failure presented with acute variceal bleeding. The BP was 80/60 mm Hg. Which of the following is not done?
Ans. (D) Platelet transfusion(Ref: Bailey & Loves Short Practice of Surgery 27th Ed; Page No-1164)Bleeding Esophageal VaricesLower esophagus being the most common site for variceal bleeding.Diagnosis may be confirmed; if the patient is known to have liver cirrhosis.Esophageal varices will not bleed until the pressure exceeds 12 mm Hg.Variceal haemorrhage is a medical emergency. Patients with massive haemorrhage should be admitted to the intensive treatment unit (ITU).ManagementBlood transfusion: Blood volume should be replaced with colloids, plasma expanders and blood transfusions.Correct coagulopathy: Vitamin K is administered (10 mg intravenously), but correction of a coagulopathy will require the administration of fresh-frozen plasma (FFP).Esophageal balloon tamponade (Sengstaken-Blakemore tube)#Modified Sengstaken-Blakemore contains four lumens (old Sengstaken-Blakemore tube contains 3 tubes). One for aspiration rom stomach one from esophagus, one for esophageal balloon dilation and last one for gastric balloon dilation.#The gastric balloon inflated to 250 mL of air and esophageal balloon to a pressure of 40 mm Hg using Air.#The potentially lethal complication is accidentally inflating gastric balloon inside the esophagus resulting in perforation of esophagus.#Balloons should be temporarily deflated after 12 hours to prevent esophageal necrosis.#Pharmacotherapy:#Octreotide (Long acting analogue of somatostatin) and somatostatin are effective like endoscopy.#Vasopressin previously used id also effective but nitroglycerine must be given along with it to prevent coronary vessels constriction.#Recently Terlipressin is commonly used to arrest bleeding.Endoscopic sclerotherapy or banding#Endoscopic banding is advantageous over sclerotherapy because it doesn't lead to necrosis or ulceration of esophagus but both are equally effective in controlling bleeding.#Sclerosants used- Ethanolamine oleate, Cyanoacrylate, and sodium morrhuate or sodium tetradecyl sulphate.Assess portal vein patency (Doppler ultrasound or CT)Transjugular intrahepatic portosystemic stent shunts (TIPSS)#Short-term bridge to liver transplant.#Inserted via IJV by interventional radiologist.#Access the portal vein inside the liver via a branch of hepatic vein and dilate the tract to 10 m through which expandable metallic stent is inserted.#It is not used as initial therapy but can used if endoscopy and pharmacotherapy fails.#It is a type of non-selective shunt between PV and HV.#It is an intrahepatic shunt.Surgery#Portosystemic shunts#Esophageal transection#Splenectomy and gastric devascularization
Octreotide infusion
Endoscopy banding
TIPS
Platelet transfusion
Liver