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Diagnostic Timeout for Variceal Bleeding
- Consider a variceal source when a patient presents with upper GI bleeding, especially with hematemesis and a history of varices.
- Take a diagnostic timeout to evaluate for underlying liver disease and portal hypertension.
Clues for Underlying Liver Disease
- Thrombocytopenia in cirrhosis is due to decreased thrombopoietin production and splenic sequestration.
- Look for physical exam findings, lab abnormalities (AST/ALT ratio, INR, albumin), and imaging clues.
Varices Formation
- Varices form when blood bypasses the high-pressure portal system through collateral vessels.
- Esophageal varices are most concerning due to their thin vessel walls and high bleeding risk.