Esophageal varices
Резюме
定义
病史和体格检查
关键诊断因素
- cirrhosis
- severe liver disease
- alcohol misuse
- hepatitis B or C infection
- ascites
- spider angioma
- caput medusa
- jaundice
- encephalopathy
- hematemesis
- melena
- hematochezia
- HIV coinfection
其他诊断因素
- splenomegaly
危险因素
- portal hypertension
- size of varices
- red wale marks
- decompensated cirrhosis
- ascites
诊断性检查
首要检查
- hepatic venous pressure gradient (HPVG)
- complete blood count
- coagulation profile (INR/prothrombin time)
- serum LFTs
- BUN and creatinine
- blood typing/cross-matching
- hepatitis B surface antigen (HBsAg)
- anti-hepatitis C virus IgG (anti-HCV IgG)
- esophago-gastro-duodenoscopy (EGD)
- liver stiffness measurement (LSM)
新兴检查
- capsule endoscopy
治疗流程
decompensated cirrhosis with acute variceal hemorrhage (hepatic venous pressure gradient ≥10 mmHg)
decompensated cirrhosis with acute variceal hemorrhage and failed endoscopic/pharmacologic therapy
compensated cirrhosis with mild portal hypertension (hepatic venous pressure gradient >5 and <10 mmHg)
compensated cirrhosis with clinically significant portal hypertension (hepatic venous pressure gradient ≥10 mmHg): without gastroesophageal varices
compensated cirrhosis with clinically significant portal hypertension (hepatic venous pressure gradient ≥10 mmHg): with gastroesophageal varices (no bleeding)
previous variceal bleed
撰稿人
专家顾问
Savio John, MD, AGAF, FACG
Chief (Division of Gastroenterology), Director (Hepatology), Associate Professor
Department of Medicine
State University of New York Upstate Medical University
Syracuse
NY
利益声明
SJ serves as editor of the hepatology section for Stat Pearls.
Kelita Singh, MD
Associate Professor of Medicine
Department of Gastroenterology
State University of New York Upstate Medical University
Syracuse
NY
利益声明
KS declares that she has no competing interests.
鸣谢
Dr Savio John and Dr Keilita Singh would like to gratefully acknowledge Dr Grace E. Dolman, Dr Gennaro D'Amico, Dr Giuseppe Malizia, Dr Vikram Boolchand, and Dr Thomas Boyer, previous contributors to this topic.
利益声明
GED, GDA, GM, VB, and TB declare that they have no competing interests.
同行评议者
Shreyas Saligram, MD, MRCP, FACG, FASGE
Assistant Professor
Department of Gastroenterology
University of California
San Francisco
CA
利益声明
SS declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Kaplan DE, Ripoll C, Thiele M, et al. AASLD practice guidance on risk stratification and management of portal hypertension and varices in cirrhosis. Hepatology. 2024 May 1;79(5):1180-211.全文 摘要
de Franchis R, Bosch J, Garcia-Tsao G, et al. Baveno VII - renewing consensus in portal hypertension. J Hepatol. 2022 Apr;76(4):959-74.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Hiatal hernia
- Gastric varices
- Mallory-Weiss tear
更多 鉴别诊断Guidelines
- AASLD practice guidance on risk stratification and management of portal hypertension and varices in cirrhosis
- American College of Gastroenterology–Canadian Association of Gastroenterology clinical practice guideline: management of anticoagulants and antiplatelets during acute gastrointestinal bleeding and the periendoscopic period
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