Upper GI bleeding & portal hypertension in Children
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
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
much better side-effect profile and similar efficacy3 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)
antibioticprophylaxis directed at intestinal flora (third-generation cephalosporin) should be started from admission H2receptor blocker or proton pump inhibitor intravenously
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.
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.