小结
定义
病史和体格检查
关键诊断因素
- presença de fatores de risco para hemorragia por varizes
- cirrose
- doença hepática grave
- abuso de álcool
- infecção por hepatite B ou C
- ascite
- aranha vascular
- cabeça de medusa
- icterícia
- encefalopatia
- hematêmese
- melena
- hematoquezia
- Coinfecção por HIV
其他诊断因素
- esplenomegalia
危险因素
- hipertensão portal
- tamanho das varizes
- marcas de vergões vermelhos
- cirrose descompensada
- ascite
诊断性检查
首要检查
- gradiente de pressão venosa hepática (GPVH)
- hemograma completo
- perfil de coagulação (razão normalizada internacional [INR]/tempo de protrombina)
- testes séricos da função hepática
- ureia e creatinina
- tipagem sanguínea/prova cruzada
- teste para o antígeno de superfície da hepatite B (HBsAg)
- IgG contra vírus da hepatite C (anti-HCV IgG)
- endoscopia digestiva alta (EDA)
- medição da rigidez hepática (MRH)
新兴检查
- endoscopia por cápsula
治疗流程
cirrose descompensada com hemorragia por varizes aguda (gradiente de pressão venosa hepática >10 mmHg)
cirrose descompensada com hemorragia aguda por varizes e sem resposta à terapia endoscópica/farmacológica
cirrose compensada com hipertensão portal leve (gradiente de pressão venosa hepática >5 e <10 mmHg)
cirrose compensada com hipertensão portal clinicamente significativa (gradiente de pressão venosa hepática ≥10 mmHg): sem varizes gastroesofágicas
cirrose compensada com hipertensão portal clinicamente significativa (gradiente de pressão venosa hepática ≥10 mmHg): com varizes gastroesofágicas (sem sangramento)
hemorragia prévia por varizes
撰稿人
作者
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
Disclosures
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
Disclosures
KS declares that she has no competing interests.
Acknowledgements
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.
Disclosures
GED, GDA, GM, VB, and TB declare that they have no competing interests.
Peer reviewers
Shreyas Saligram, MD, MRCP, FACG, FASGE
Assistant Professor
Department of Gastroenterology
University of California
San Francisco
CA
Disclosures
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.
References
Key articles
Kaplan DE, Ripoll C, Thiele M, Fortune BE, 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.Full text Abstract
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Hérnia hiatal
- Varizes gástricas
- Laceração de Mallory-Weiss
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