A 40 year old patient, a known case of cirrhosis develops acute episode of GI bleed. Initial therapy given for 6 hours. Which of the following procedure is useful :
Answer is B (Urgent endoscopy): Acute episode of GI bleeding in a known patient of cirrhosis suggests a clear cut diagnosis of variceal bleed. Urgent endoscopy is the modality of choice following haemodynamic stabilization as it is both a diagnostic and therapeutic modality. Management protocol : Cardinal principles of resuscitation (Airway / Breathing / Circulation) Urgent endoscopy (diagnostic + therapeutic modality) Ligation is the endoscopic therapy of choice for variceal bleedin_ (Harrison 16th/236) Other options : Endoscopic sclerotherapy /IV oetreotide -) (Medical management) Principles: Once the patient is hemodynamically stable urgent endoscopy should be performed Ligation is the endoscopic therapy of choice for esophageal varices because it has requires fewer treatment sessions. - Less rebleeding - Fewer moality rate - Fewer local complication Acute treatment with octreotide (preferred over vasopressin) is the medical management of choice In patients who have persistent or recurrent bleeding despite endoscopic and medical therapy, TIP is recommsended (TIPS is Transjugular intrahepatic poosystemic shunt)
Nasogastric aspiration
Urgent endoscopy
Sedation
Ultrasound