Resuscitative Measures

Management of acute variceal bleeding includes general resuscitative measures and specific treatment aimed at arresting the variceal bleeding. It is important to protect airways in an encephalopathic patient, particularly during endoscopic procedures and balloon tamponade, since aspiration pneumonia is a major cause of morbidity and mortality in these patients. Measurement of central venous pressure is a sensitive guide to the blood volume status but caution should be exercised in the presence of tense ascites because diaphragmatic compression of the right atrium by the ascites may lead to an overestimation of the readings. Pulmonary capillary wedge pressure is the most accurate guide to control blood volume and may be invaluable in the presence of major ongoing bleeding. Blood volume restitution should be prompt and as accurate as possible to protect vital organs, particularly renal function. The ideal replacement fluid is blood and colloid is reserved for immediate infusion until blood becomes available. Isovolemic replacement should be the aim with care taken to avoid major overexpansion of the circulation that may precipitate further bleeding due to the associated increase in portal pressure. There is increasing evidence to support routine prophylactic antibiotics in those with ascites and in those with active bleeding. Control of bleeding is slower in patients with bacterial infection. It is therefore important to detect and treat complications, such as aspiration pneumonia and spontaneous bacterial peritonitis, at the earliest opportunity.

Because bleeding from a nonvariceal source is common in chronic liver disease, endoscopy should be performed when patient is stabilized. This may also be the ideal time to perform a therapeutic procedure to stop bleeding or prevent early rebleeding. If variceal bleeding is suspected, pharmacological treatment should be initiated while the patient is resuscitated before endoscopic confirmation of gastroesophageal variceal bleeding. Early pharmacologic treatment may improve the efficacy of endoscopic treatment as well as the survival.

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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