3.  Melaena – the passage of black, tarry stools
indicates likely UGI bleed (proximal to the
ligament of Treitz)
 Haematemesis – vomitus containing frank blood
or brown-black “coffee grounds”
 Haematochezia – passage of bright or dark red
blood per rectum
In general, the redder the blood, the more
distal the site of bleeding

4.  Red: beets, laxatives, phenytoin, rifampin
 Black:
bismuth, activated
charcoal, iron, spinach, blueberry, licorice

12.  Drugs
 Retching or vomiting
 Jaundice
 Procedures
 Recurrent abdominal pain
 Bleeding disorders in family
 Odynophagia

13.  Stigmata of chronic liver disease
 General condition
 External vascular malformation
 Hyperpigmented lips
 Dilated abdominal wall veins, Splenomegaly

15.  Removes blood from stomach – facilitates
easier endoscopy
 Confirmation of bleed/ongoing blood loss
 Prevents development of encephalopathy in
cirrhotic patients

16.  Disproportionate tachycardia
 “Tilt” test
 Capillary refill time
 Signs of shock

20.  Portal vein agenesis, atresia, stenosis
 Portal vein thrombosis or cavernous
transformation
 Splenic vein thrombosis
 Arteriovenous fistula

22.  Acts by increasing splanchnic vascular tone
 0.3
units per kg per hour after a bolus of 0.3
U/kg over 20 min
 Theaddition of nitroglycerin (skin patch)
decreases the systemic .effects of
vasopressin
 Terlipressin-longer duration of action and
lesser cardiac side effects

23.  much better side-effect profile and similar
efficacy
3 to 5 μg per kg per hour
 Octreotide has a longer half-life- bolus (2
μg/kg) followed by continuous infusion (1 to
5 μg per kg per hour)

24.  antibioticprophylaxis directed at intestinal
flora (third-generation cephalosporin) should
be started from admission
 H2receptor blocker or proton pump inhibitor
intravenously

25.  Acts by producing intimitis
 Injected either intra- or paravariceal
 Intravariceal
cyanoacrylate or histacryl glue
and thrombin for gastric varices
 Complications of EST include
ulceration, pain, perforation, and
bacteremia.

26.  Draws a visible varix into the lumen of the
ligator and a band is placed around the varix
 EVLis just as effective as EST but was
associated with fewer complications and
faster obliteration of varices.

29.  Indications:
 Recurrent variceal hemorrhage
 Refractory ascites
 Hepatorenal syndrome
 Contraindications
 Polycystic liver disease
 Right heart failure
 Systemic infection
 Portal vein thrombosis
 Severe hepatic encephalopathy

30.  Primary prophylaxis - propranolol
 Secondary prophylaxis – EVL/EST
 Surgical treatment:
 Patients with EHPVO
 bleeding gastric or other nonesophageal
varices
 severe hypersplenism

31.  Decompressive shunts
 Devascularization
 Liver transplantation