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Upper GI Bleeding (Variceal Bleeding)

Aug 1, 2022
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ADVICE

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.
INSIGHT

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.
INSIGHT

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.
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