Nonselective p-blockers should be used for primary prophylaxis in patients with advanced liver disease and large varices. Optimal resuscitation in a timely fashion is crucial for a better outcome in patients with acute variceal bleeding. Pharmacologic intervention while the patient is resuscitated is safe and beneficial, and pharmacologic treatment should be continued for 5 to 7 days to prevent early rebleeding. Endoscopic diagnosis and therapy should be performed when patient is adequately resuscitated and stabilized. TIPS or shunt surgery should be reserved for nonresponders to a combination of pharmacologic and endoscopic therapy, and should not be delayed when endoscopic therapy has failed on two separate occasions. Bleeding fundal varices are managed by either early surgery or TIPS, and balloon tamponade should be used to control active bleeding. If tissue adhesives are available, endoscopic treatment with these agents may be an alternate option for bleeding gastric or ectopic varices before considering surgery or TIPS. A combination of p-blockers (+ nitrates) and endoscopic treatment (preferably banding) may be a logical approach for secondary prophylaxis. TIPS or shunt surgery should be reserved for patients who rebleed despite a combination of endoscopic and pharmacologic therapy. Liver transplantation is the treatment of choice for patients with advanced liver disease and recurrent variceal bleeding.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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