Variceal bleeding

 



Indication for TIPS
1) Pre-emptive Rx for variceal bleeding
2) Treatment of transfusion dependent PHG despite endotherapy / betablockers
3) Ascites requiring >3 LVP a year


Comments

Post a Comment

Popular posts from this blog

Baveno portal hypertension

  Baveno 7   1)     Portal hypertension = HVPG >5 mm hg 2)     In viral & alcoholic hepatitis – CSPH = HVPG >=10 3)     In PBC, CSPH likely develops at lower HVPH, due to (unmeasured) component of pre-sinusoidal PH 4)     Similarly, in NASH, CSPH may develop at HVPG < 10     Reduction in HVPG secondary to Betablockers predicts clinical response!   In patients undergoing TIPS, HVPG <12 affords near-complete protection from PH complications     Compensated advanced chronic liver disease (cACLD) ( a.k.a cirrhosis) <10 kPa = unlikely cACLD      (<1% 3-year risk of decompensation or liver-related death) >15 Kpa = highly likely cACLD     Clinically significant reduction in LSM defined as either: 1)     20% reduction, such that LSM <20 Kpa 2)     Or LSM <10 Kpa ...
Read more

Pancreatic Cyst

Image
 MCN - (Mother cyst) >95% in pre-menopausal women Mostly in body and tail of pancreas Thick-walled cyst, lined by Ovarian type stroma. Cyst contains mucinous / hemorrhagic material. Does not communicate with PD (unlike IPMN) 10-20% have in-dwelling cancer One review found - no dysplasia in cysts <3 cm in size LN mets is rare. Distal pancreatectomy usually suffices.  Doesnt result in metachronous lesions. Surveillance isnt really necessary SCA - (Grandmother cyst) 75% of SCAs seen in post-menopausal women Can be anywhere in pancreas Honeycombing, with tiny cysts containing clear fluid distributed around central scarring. Central scarring may bear calcification in 30% cases Microcystic SCAs can undergo degeneration and become macrocystic variants zero risk of malignancy, but they can continue to grow and cause obstructive symptoms SPN - (daughter lesion) - Solid Pseudopapillary Neoplasm 90% of lesion occur in young women, in teens / twenties Anywhere  in pancreas Sol...
Read more

Hep B / HCC screening - ReachB

Image
 https://www.youtube.com/watch?v=3cP2kvPq7iQ m.c form of acquiring Hep B in Asia - Vertically m.c form of acquiring Hep B in western coutnries: Parenterally (sexual / needles etc) Neonates have immature immune system, so they cant 'fight-off' vertically acquired virus. Over 90% of babies infected with Hep B, go on to have chronic Hep B infection 95% of adults if they acquire Hep B - fight it off! HBV is a DNA virus - replicates efficiently. But is error-prone. Plagued with mutants.  e-antigen negative mutant - tend to be in older patients, tend to be more aggressive. 30-50% of HCC in HBV occurs in absence of cirrhosis Reveal study - 15 year follow-up study of untreated patients with HEp B. The only factor that was relevant in predicting risk of HCC was viral load at base-line! Viral load more than 10*4 (2000 IU/ml) was predictive of risk of HCC or Cirrhosis (similar graph for Cirrhosis as for HCC) Immune Tolerant Phase: typically after vertical infection. DNA remains very high...
Read more