Regarding the use of non-selective beta-blockers in 1ry prevention of variceal hge, which of the following is FALSE?
Anonymous Quiz
10%
Reduces the possibility of bleeding by 50%
10%
May be associated with increased survival
20%
Cost-effective
60%
Indicated for severely asthmatic patients with cirrhosis
Initial step for management of bleeding esophageal varices
Anonymous Quiz
20%
Urgent endoscopy
7%
Sclerotherapy band ligation
63%
Resuscitation
7%
Terlipressin
3%
Sengstaken tube
Which of the following is FALSE about resuscitation of acute variceal hge?
Anonymous Quiz
27%
Over-correction of hypovolemia is preferred due to the diminished baroreceptor reflexes in cirrhosis
35%
Target blood Hb of 8 g/L is sufficient to prevent rebleeding
19%
Ascitic tap is carried out
15%
Prophylactic antibiotics
4%
IV thiamine is given in cases of alcohol withdrawal
Which of the following is TRUE about Terlipressin?
Anonymous Quiz
16%
Induces splanchnic arterial dilatation
24%
Used in 1ry prevention of variceal hge
20%
Suitable for patients with ischemic heart disease
40%
The only vasoconstrictor proved to ⬇️ mortality
The main role of vasoconstrictive therapy in management of variceal hge is:
Anonymous Quiz
26%
The 1st line ttt & the most effective single therapeutic modality in acute variceal hge
26%
Adjuvant to endoscopic ttt
7%
1ry prevention of variceal hge
41%
1 & 3
Which of the following is FALSE about Sangstaken-Blakemore tube?
Anonymous Quiz
23%
Indicated if endoscopic ttt has failed in management of severe acute variceal hge
15%
Shouldn't be left in place for more than 12 days
38%
Should be placed in close opposition to GEJ to ❌ cephalad varcieal flow to the bleeder
19%
Esophageal balloon is inflated only if gastric balloon failed to stop bleeding alone
4%
Hemostasis is achieved in 90% of cases
Complications of balloon temponade do NOT include:
Anonymous Quiz
19%
Aspiration pneumonia
12%
Esophageal rupture
15%
Mucosal ulceration
54%
Significant ⬆️ risk of developing hepatic encephalopathy
Which of the following is FALSE about management of acute variceal hge?
Anonymous Quiz
22%
The patient should remain NPO til bleeding stops
26%
PPIs is preferred over ranitidine in ⬇️ acid secretion
13%
Prevention of encephalopthy is crucial; specially in cases with large bleed
39%
Sucralfate is used after endoscopic therapy to reduce esophageal ulceration
The 1st ttt option in management of acute rebleed is:
Anonymous Quiz
48%
Endoscopy
21%
TIPS
7%
Balloon temponade
24%
Surgery (Esophageal transection & ligation of the feeding vessels to the bleeding varices)
Which of the following drugs is the best in 2ry prevention of variceal hge?
Anonymous Quiz
13%
Propranolol
19%
Carvedilol
59%
Terlipressin
9%
Somatostatin
The most significant complication of portosystemic shunts is:
Anonymous Quiz
3%
Barret's esophagus
68%
Hepatic encephalopathy
10%
Peptic ulcer
19%
Splanchnic venous thrombosis
Warren operation
Anonymous Quiz
21%
Portocaval anastmosis
55%
Splenorenal shunt
7%
TIPS
17%
Devascularization
📌 Case:
A 43-year-old cirrhotic patient came to the ER with acute attack of variceal hge.
Pulse = 130 bpm.
Blood pressure = 92/63.
Hb = 6 g/L.
The patient has a history of MI. He was alcoholic for 12 years & has joined a withdrawal program 3 weeks ago.
A 43-year-old cirrhotic patient came to the ER with acute attack of variceal hge.
Pulse = 130 bpm.
Blood pressure = 92/63.
Hb = 6 g/L.
The patient has a history of MI. He was alcoholic for 12 years & has joined a withdrawal program 3 weeks ago.
The 1st step in management of this case is:
Anonymous Quiz
15%
Upper GI Endoscopy
4%
Balloon temponade
8%
TIPS
73%
Resuscitation (ABCD)
The following are done for the patient during resuscitation EXCEPT
Anonymous Quiz
34%
IV vitamin B1 (thiamine)
14%
Prophylactic antibiotics
17%
Blood transfusion with target Hb of 7 g/L
34%
Ascitic tap
The 1st ttt option for the bleeding varices:
Anonymous Quiz
77%
Urgent endoscopy + Adjuvant vasoconstrictor e.g. somatostatin
6%
Teripressin
6%
TIPS
10%
Balloon temponade
If this ttt option failed to stop bleeding, the next step will be:
Anonymous Quiz
34%
TIPS
11%
Warren shunt
46%
Balloon temponade
9%
Devascularization surgery
The 1st ttt option for acute rebleeding will be:
Anonymous Quiz
14%
TIPS
51%
Endoscopy
19%
Acute portosystemic shunt surgery
16%
Balloon temponade
Clinical Pearl | Cholecystectomy Safety
📍 أخطر خطأ ممكن يقع فيه الجراح أثناء عملية استئصال المرارة: إصابة القناة الصفراوية بسبب سوء التعرف على Calot’s Triangle
📌 الحدود:
1⃣ Medial → Common hepatic duct
2⃣ Inferior → Cystic duct
3⃣ Superior → Inferior surface of liver
⚠️ المحتوى: Cystic artery
✅ القاعدة الذهبية :
Don’t clip or cut Until you achieve the Critical View of Safety (CVS)
#Surgery
https://t.me/Surgery_Practice
📍 أخطر خطأ ممكن يقع فيه الجراح أثناء عملية استئصال المرارة: إصابة القناة الصفراوية بسبب سوء التعرف على Calot’s Triangle
📌 الحدود:
1⃣ Medial → Common hepatic duct
2⃣ Inferior → Cystic duct
3⃣ Superior → Inferior surface of liver
⚠️ المحتوى: Cystic artery
✅ القاعدة الذهبية :
Don’t clip or cut Until you achieve the Critical View of Safety (CVS)
#Surgery
https://t.me/Surgery_Practice