Episode two of the Upper GI Bleeding chapter covers acute variceal hemorrhage and the unusual non-variceal causes a routine scope misses. It anchors on the variceal bundle delivered before endoscopy, early TIPS for the high-risk cirrhotic, and the Sarin split for gastric varices. The second half is a recognition drill: each rare lesion is easy to treat once its history cue is named. Topics covered Variceal bundle: octreotide, ceftriaxone, band ligation Restrictive transfusion and selective coagulopathy correction Balloon tamponade and covered esophageal stent bridges Early pre-emptive TIPS in high-risk cirrhotics Sarin classification and gastric varices Dieulafoy, Mallory-Weiss, GAVE, Cameron lesions Angiodysplasia, Heyde syndrome, and HHT Hemobilia, hemosuccus, aortoenteric fistula Key decisions Start octreotide, ceftriaxone, and band ligation reflexively the moment variceal bleeding is suspected, before endoscopic confirmation; octreotide runs five days, ceftriaxone seven. Transfuse restrictively to hemoglobin of seven in cirrhotics; liberal transfusion raises portal pressure and worsens rebleeding. Choose early pre-emptive TIPS within seventy-two hours for Child-Pugh C, or Child-Pugh B with active bleeding on the index endoscopy. An isolated fundal gastric varix without esophageal involvement always triggers a splenic vein thrombosis workup. GAVE (distal antral stripes) does not respond to TIPS and is treated with argon plasma coagulation; portal hypertensive gastropathy (proximal snake-skin) responds to beta-blockade and TIPS. A herald bleed after prior aortic aneurysm graft surgery is aortoenteric fistula until proven otherwise; get CT angiography and go to emergent repair. For the full chapter with MCQs, tables, and primary-guideline references, visit www.boardpearls.com. Questions or feedback: [email protected]. (00:00) - Introduction (00:23) - The variceal bundle before endoscopy (02:30) - Resuscitation modifiers in cirrhosis (03:33) - Balloon tamponade as a bridge (04:09) - Early TIPS in the high-risk patient (05:07) - Gastric varices and the Sarin classification (06:46) - Unusual non-variceal causes (07:03) - Dieulafoy and the recognition cues

Ask this episode

“What did the council decide on item 42?” — answered with the speaker and the moment.

Transcript

Related