A 45 year old male presented with history of vomiting of 500 mL of blood 24 hrs back, BP 90/60, pulse - 110 bpm and splenomegaly 5 cm below costal margin.
This is a classical description of variceal bleed as a result of portal hypertension. About portal hypertension:
About portal hypertension
a. Defined as rise in pressure in portal vein> 0 mmhg (normal pressure: - 0 mmHg).
b. MC cause of portal hypertension – cirrhosis
c. A frequent marker of the presence of cirrhosis in a patient being followed up for chronic liver disease is a progressive decrease in platelet count.
d. Varices are best documented by - fibre optic esophagoscopy.
e. Other investigations for detecting collateral circulations: MRl, Contrast CT.
f. Variceal bleeding generally presents with painless but massive hematemesis with/without malena
g. Management of variceal bleed consists of fluid, replacement of clotting factors (using ffp), drugs like vasopressin and octreotide but where available endoscopic intervention should be the st line treatment.