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Esophageal varices

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Narangerel Tuwshinbyar
Narangerel Tuwshinbyar

丕仍舒舒仆 仂仂仍仂亶仆 于亠仆亳亶仆 亟舒仆 唏亞唏唏仍

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丕丱丐亅 亳 仄 .丐勵于亳仆弍舒
勳勵亟仆 于亠仆亳亶仆 亟舒舒仍 (P) 亳仍 弍勵亳亶 仍亞仆亳亶 舒舒亞 仄亞亞勵勵亟亳亶仆 勵亠亟 舒仄亞亳亶仆 仆亳亶仍亞 勵勵亟亞 弍舒 仆 勵亠亟 勵勵亟仆 于亠仆亳亶仆 仆 亞舒仍 (Q) , 勵勵亟仆 于亠仆亳亶仆 亟舒仆 亞勵勵仍 (R) 亳仍 舒仄 磦舒亞亟亟舒亞. 勳勵亟仆 于亠仆亳亶仆 亟舒舒仍 亳仍亳亶仆 勵仆亟仍勵勵亟: 亠仆亳亶仆 亟舒仆 唏亞唏唏仍唏唏 舒仍亟舒 勳勵亟仆 于亠仆亳亶仆 亟舒舒仍 亳仍亳亶仆 亞舒仂仗舒亳 亳 礌亟舒舒 勵勵仆 弍舒从亠亳亶仆 舒仍亞舒舒仆 仗亠亳仂仆亳 亅仍亞仆亳亶 舒仍亞舒舒仆 亞亳亟仂仂舒从 World Gastroenterology Organisation, 2014
Gastroenterology 2014;150:11711182 Incidence CommonCauses Peptic Ulcer 45% Duodenal Ulcer Gastric Ulcer Esophageal varcies 20% Gastritis 20% Mallore-Weiss Syndrome 10% Uncommon Causes 5% Gastric Carcinoma Esophagitis Pancreatitis
亅-仆 仄亟亞 2014 仂仆 弍舒亶亟仍舒舒 Child A (Child-Pugh Class) 唏于唏仆亳亶 40% 仆, Child 弌 唏于唏仆勵勵亟亳亶仆 85% 仆 varices 弍舒亶仆舒. Child 弌-舒亶 唏于唏仆亟 舒仍亟舒 亟仍 70%<弍舒亶舒亟, Child -舒亶 唏于唏仆亟 舒仍亟舒 亟仍 10%>- 舒舒 弍舒亞舒 弍舒亶仆舒. 亳亶 Child 弌-舒亶, EV-舒亶 唏于唏仆勵勵亟亳亶仆 30% 仆 仂仆仂仍仂亞亟仂仆 仆亳亶 亢亳仍亟 舒仍亟舒亢 弍舒亶仆舒. 亠仗舒亳 弌-舒亶 亳弍仂亰 勵勵仆 唏于唏仆亟 EV-16% . American Journal of Medicine and Medical Sciences 2016, 6(1): 29-33 DOI: 10.5923/j.ajmms.20160601.05
EV-亳亶仆 舒仍亟舒仍仆 仆舒 弍舒舒仍舒舒 丱丕, 亅仆亞, 舒仍舒亶亰 仂仂仆. 丱丕, 亅仆亞-HCV 舒仍舒亶亰-HBV, ALD 亞亳仗亠, 弌亟舒仆 - 亳仂仂仄舒亰 仆 亞舒舒仍舒亶 仍亞仆亳亶 舒舒仍 varices 舒仄亞亳亶仆 勵亞仄仍 舒仍亞舒舒仆 弍仂仍亟仂亞. 亳亶 Sch.仍亞仆亳亶 舒仍仆 30% 仆 varices-舒亶 弍仂仍仂于, EV 舒仍亟舒仍仆 于 2%> 弍舒亶亟舒亞, (Child ), 25year> 仆舒仍舒亟舒亞. WGO Practice Guidelines Esophageal varices,2014 http://www.worldgastroenterology.org/graded-evidence-access.html.
亳仆舒舒 勵勵亟仍亶 仍亞仆亳亶 舒舒仍舒亶 43 (63.2%) 唏于唏仆 varices 弍舒亶舒仆 , 4 (80%) HBV 弍ﾑ; 舒亳, 仂亞仍舒 仆亟舒舒 + HCV 仆 HBV 1 (50%), 14 (66.6%), 4 (80%) EV 弍舒亶舒仆. Clinical Gastroenterology and Hepatology 2015;12:919928
Clinical Gastroenterology and Hepatology 2015;12:919928
仆 仂仆仂仍仂亞亟仂亢 弍舒亶亞舒舒 丶-舒亶 唏于唏仆勵勵亟亳亶仆 亟仆亟 30% 仆 EV-舒亶 弍舒亶亟舒亞 弍仂仍 10 亢亳仍亳亶仆 亟舒亶 90% 仆 EV-舒亶 弍仂仍仂仆 弍舒亶亟舒亞. 丶-舒亶 唏于唏仆勵勵亟亳亶仆 30% 仆 EV-仆亳亶 舒仍亟舒仍舒舒 仆舒 弍舒亟舒亞 . 丶 舒仍亟舒仍仆 亟舒舒舒 仆亳亶 3 仂仆仂亞 仆舒 弍舒舒仍 20-29%. 舒于舒仆 舒仍亟舒仍亟舒仆 仆亳亶 仂亳仂仍亟仍亟仆 20-64%./1 亢亳仍亳亶仆 亟仂仂 仆舒 弍舒舒 亟仍亶 弍舒亶亟舒亞./ Clinical Gastroenterology and Hepatology 2015;12:919928
INR> 1.5, 13 仄仄<勵勵亟仆 于亠仆亳亶仆 亟亳舒仄亠 仂仄弍仂亳仆 仂仂 弍舒仆. 仍 仆亞 仆- 唏于唏仆勵勵亟亳亶仆 <10%, 丱于 2 仆- 20-50%, 丱于 3 仆 - 40-60%, 唏仆 舒舒亞 亳仆亢 > 90% -亳亶仆 舒仍亟舒 亟仍 弍舒亶仆舒 亞亢 仂仂仂亢 亟亳仍舒仆 亞亳亶仍仍亳亶亞 亳亶亳亶仆 舒 仂仆仂仍仂亞仂仂, 仄亳仍亞仆亳亶 亰仂亳仍亞仂仂 亟舒仆 亳亶 亰舒舒仍 弍仂仍仆仂. Clinical guideline, Acute upper gastrointestinal bleeding in over 16s: management Published: 13 June 2012 nice.org.uk/guidance/cg141
A-Upper Gastrointestinal endoscopy B-Ultrasound C-CT D-MRI E-Endoscopic ultrasound Clinical guideline, Acute upper gastrointestinal bleeding in over 16s: management Published: 13 June 2012 nice.org.uk/guidance/cg141
亅仄亳亶仆 仄亳仍亞-亟亳仍舒仆 亞亳亶仍 舒仆亞亳亶仆 仄亳仍亞- 礌舒仍 弍仂仍仂仆 勵仆亟仍 亞亳亶仍-50%(12 months) 亰舒舒仍 仄亳仍亞 1.Non-shunt procedures: - Esophageal Transection -Devascularization Procedure 2.Portosystemic shunt procedures:20% 亟舒亳仆 舒仍亟亟舒亞.(12 months) - TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT(TIPS) 3. liver transplantation Clinical guideline, Acute upper gastrointestinal bleeding in over 16s: management Published: 13 June 2012 nice.org.uk/guidance/cg141
Vasopressin (analogues) Somatostatin (analogues)-14-舒仄亳仆仂-从亳仍仂仆亶 仗亠仗亳亟-丐丐(lanreotide, and vapreotide) 勵勵亟仆 于亠仆亳亶仆 亟舒舒仍 弍仍舒.(25-50 仄从亞/舒亞 仆亞舒舒 5 唏亟亳亶仆 - 舒仍亟舒仍仆 勵亠亟) Non-cardioselective 硫-blockers-仂仗舒仆仂仍仂仍 于仍 仆舒亟仂仍仂仍 (nadolol) 亅仄亳亶仆 仄亳仍亞亞 亟舒仆亞亳亶仆 弍仂仍仂仆 仄 亰舒舒仍 仄亳仍亞亶 仂仍仍舒仆 亳亶仆. Clinical guideline, Acute upper gastrointestinal bleeding in over 16s: management Published: 13 June 2012 nice.org.uk/guidance/cg141
EV-仆 舒仍亟舒仍舒舒 亟亳仍舒仆 亞亳亶仍 亰仂亳仍亞仂仂 亠仍亠从亳于 弍 舒亟亠仆仂弍仍仂从舒仂亟亞 亞仍仆. 亅仆 弍勵仍亞亳亶仆 仄勵勵亟亳亶仆 亞仍亟 舒仍亟舒仍仆 亟仍 50%< 弍舒亶舒仆 唏于唏仆亟 15-25% 弍仂仍亢 亟仍 弍舒 弍仂仍仂仄亢仂亶. 丐仆亞 3-5 仂仆仂亞亳亶仆 亳亟 舒舒亢仄舒舒 仆仄亞亟勵勵仍 弍舒亶亟仍舒舒 仂亳仍仆舒.(丶丐 55-60, 90仄仄.仄弍<) 仂仗舒仆仂仍仂仍 仂仆仂亞亳亶仆 亟亟 仆 40仄亞, 仆舒亟仂仍仂仍 仂仆仂亞亳亶仆 仆 亟亟 20仄亞.(舒亳仄 亟舒仍亞舒舒仆亟 60仄亞, 40仄亞) 丶 舒仍亟舒 亟仍 仆 唏仆唏 仂仂亶仆 舒亞舒舒 亳 弍舒亶亟舒亞 仍 仄亳亶仆 仄唏仆 勵亠亟 仍亞舒于舒仍 勵 亟勵仆亶. Selective 硫-blocker-弌亠仍亠从亳于 硫-弍仍仂从舒仂 (metoprolol, atenolol) Clinical guideline, Acute upper gastrointestinal bleeding in over 16s: management Published: 13 June 2012 nice.org.uk/guidance/cg141
Clinical guideline, Acute upper gastrointestinal bleeding in over 16s: management Published: 13 June 2012 nice.org.uk/guidance/cg141
Esophageal varices

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Esophageal varices

  • 2. 勳勵亟仆 于亠仆亳亶仆 亟舒舒仍 (P) 亳仍 弍勵亳亶 仍亞仆亳亶 舒舒亞 仄亞亞勵勵亟亳亶仆 勵亠亟 舒仄亞亳亶仆 仆亳亶仍亞 勵勵亟亞 弍舒 仆 勵亠亟 勵勵亟仆 于亠仆亳亶仆 仆 亞舒仍 (Q) , 勵勵亟仆 于亠仆亳亶仆 亟舒仆 亞勵勵仍 (R) 亳仍 舒仄 磦舒亞亟亟舒亞. 勳勵亟仆 于亠仆亳亶仆 亟舒舒仍 亳仍亳亶仆 勵仆亟仍勵勵亟: 亠仆亳亶仆 亟舒仆 唏亞唏唏仍唏唏 舒仍亟舒 勳勵亟仆 于亠仆亳亶仆 亟舒舒仍 亳仍亳亶仆 亞舒仂仗舒亳 亳 礌亟舒舒 勵勵仆 弍舒从亠亳亶仆 舒仍亞舒舒仆 仗亠亳仂仆亳 亅仍亞仆亳亶 舒仍亞舒舒仆 亞亳亟仂仂舒从 World Gastroenterology Organisation, 2014
  • 3. Gastroenterology 2014;150:11711182 Incidence CommonCauses Peptic Ulcer 45% Duodenal Ulcer Gastric Ulcer Esophageal varcies 20% Gastritis 20% Mallore-Weiss Syndrome 10% Uncommon Causes 5% Gastric Carcinoma Esophagitis Pancreatitis
  • 4. 亅-仆 仄亟亞 2014 仂仆 弍舒亶亟仍舒舒 Child A (Child-Pugh Class) 唏于唏仆亳亶 40% 仆, Child 弌 唏于唏仆勵勵亟亳亶仆 85% 仆 varices 弍舒亶仆舒. Child 弌-舒亶 唏于唏仆亟 舒仍亟舒 亟仍 70%<弍舒亶舒亟, Child -舒亶 唏于唏仆亟 舒仍亟舒 亟仍 10%>- 舒舒 弍舒亞舒 弍舒亶仆舒. 亳亶 Child 弌-舒亶, EV-舒亶 唏于唏仆勵勵亟亳亶仆 30% 仆 仂仆仂仍仂亞亟仂仆 仆亳亶 亢亳仍亟 舒仍亟舒亢 弍舒亶仆舒. 亠仗舒亳 弌-舒亶 亳弍仂亰 勵勵仆 唏于唏仆亟 EV-16% . American Journal of Medicine and Medical Sciences 2016, 6(1): 29-33 DOI: 10.5923/j.ajmms.20160601.05
  • 5. EV-亳亶仆 舒仍亟舒仍仆 仆舒 弍舒舒仍舒舒 丱丕, 亅仆亞, 舒仍舒亶亰 仂仂仆. 丱丕, 亅仆亞-HCV 舒仍舒亶亰-HBV, ALD 亞亳仗亠, 弌亟舒仆 - 亳仂仂仄舒亰 仆 亞舒舒仍舒亶 仍亞仆亳亶 舒舒仍 varices 舒仄亞亳亶仆 勵亞仄仍 舒仍亞舒舒仆 弍仂仍亟仂亞. 亳亶 Sch.仍亞仆亳亶 舒仍仆 30% 仆 varices-舒亶 弍仂仍仂于, EV 舒仍亟舒仍仆 于 2%> 弍舒亶亟舒亞, (Child ), 25year> 仆舒仍舒亟舒亞. WGO Practice Guidelines Esophageal varices,2014 http://www.worldgastroenterology.org/graded-evidence-access.html.
  • 6. 亳仆舒舒 勵勵亟仍亶 仍亞仆亳亶 舒舒仍舒亶 43 (63.2%) 唏于唏仆 varices 弍舒亶舒仆 , 4 (80%) HBV 弍ﾑ; 舒亳, 仂亞仍舒 仆亟舒舒 + HCV 仆 HBV 1 (50%), 14 (66.6%), 4 (80%) EV 弍舒亶舒仆. Clinical Gastroenterology and Hepatology 2015;12:919928
  • 7. Clinical Gastroenterology and Hepatology 2015;12:919928
  • 8. 仆 仂仆仂仍仂亞亟仂亢 弍舒亶亞舒舒 丶-舒亶 唏于唏仆勵勵亟亳亶仆 亟仆亟 30% 仆 EV-舒亶 弍舒亶亟舒亞 弍仂仍 10 亢亳仍亳亶仆 亟舒亶 90% 仆 EV-舒亶 弍仂仍仂仆 弍舒亶亟舒亞. 丶-舒亶 唏于唏仆勵勵亟亳亶仆 30% 仆 EV-仆亳亶 舒仍亟舒仍舒舒 仆舒 弍舒亟舒亞 . 丶 舒仍亟舒仍仆 亟舒舒舒 仆亳亶 3 仂仆仂亞 仆舒 弍舒舒仍 20-29%. 舒于舒仆 舒仍亟舒仍亟舒仆 仆亳亶 仂亳仂仍亟仍亟仆 20-64%./1 亢亳仍亳亶仆 亟仂仂 仆舒 弍舒舒 亟仍亶 弍舒亶亟舒亞./ Clinical Gastroenterology and Hepatology 2015;12:919928
  • 9. INR> 1.5, 13 仄仄<勵勵亟仆 于亠仆亳亶仆 亟亳舒仄亠 仂仄弍仂亳仆 仂仂 弍舒仆. 仍 仆亞 仆- 唏于唏仆勵勵亟亳亶仆 <10%, 丱于 2 仆- 20-50%, 丱于 3 仆 - 40-60%, 唏仆 舒舒亞 亳仆亢 > 90% -亳亶仆 舒仍亟舒 亟仍 弍舒亶仆舒 亞亢 仂仂仂亢 亟亳仍舒仆 亞亳亶仍仍亳亶亞 亳亶亳亶仆 舒 仂仆仂仍仂亞仂仂, 仄亳仍亞仆亳亶 亰仂亳仍亞仂仂 亟舒仆 亳亶 亰舒舒仍 弍仂仍仆仂. Clinical guideline, Acute upper gastrointestinal bleeding in over 16s: management Published: 13 June 2012 nice.org.uk/guidance/cg141
  • 10. A-Upper Gastrointestinal endoscopy B-Ultrasound C-CT D-MRI E-Endoscopic ultrasound Clinical guideline, Acute upper gastrointestinal bleeding in over 16s: management Published: 13 June 2012 nice.org.uk/guidance/cg141
  • 11. 亅仄亳亶仆 仄亳仍亞-亟亳仍舒仆 亞亳亶仍 舒仆亞亳亶仆 仄亳仍亞- 礌舒仍 弍仂仍仂仆 勵仆亟仍 亞亳亶仍-50%(12 months) 亰舒舒仍 仄亳仍亞 1.Non-shunt procedures: - Esophageal Transection -Devascularization Procedure 2.Portosystemic shunt procedures:20% 亟舒亳仆 舒仍亟亟舒亞.(12 months) - TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT(TIPS) 3. liver transplantation Clinical guideline, Acute upper gastrointestinal bleeding in over 16s: management Published: 13 June 2012 nice.org.uk/guidance/cg141
  • 12. Vasopressin (analogues) Somatostatin (analogues)-14-舒仄亳仆仂-从亳仍仂仆亶 仗亠仗亳亟-丐丐(lanreotide, and vapreotide) 勵勵亟仆 于亠仆亳亶仆 亟舒舒仍 弍仍舒.(25-50 仄从亞/舒亞 仆亞舒舒 5 唏亟亳亶仆 - 舒仍亟舒仍仆 勵亠亟) Non-cardioselective 硫-blockers-仂仗舒仆仂仍仂仍 于仍 仆舒亟仂仍仂仍 (nadolol) 亅仄亳亶仆 仄亳仍亞亞 亟舒仆亞亳亶仆 弍仂仍仂仆 仄 亰舒舒仍 仄亳仍亞亶 仂仍仍舒仆 亳亶仆. Clinical guideline, Acute upper gastrointestinal bleeding in over 16s: management Published: 13 June 2012 nice.org.uk/guidance/cg141
  • 13. EV-仆 舒仍亟舒仍舒舒 亟亳仍舒仆 亞亳亶仍 亰仂亳仍亞仂仂 亠仍亠从亳于 弍 舒亟亠仆仂弍仍仂从舒仂亟亞 亞仍仆. 亅仆 弍勵仍亞亳亶仆 仄勵勵亟亳亶仆 亞仍亟 舒仍亟舒仍仆 亟仍 50%< 弍舒亶舒仆 唏于唏仆亟 15-25% 弍仂仍亢 亟仍 弍舒 弍仂仍仂仄亢仂亶. 丐仆亞 3-5 仂仆仂亞亳亶仆 亳亟 舒舒亢仄舒舒 仆仄亞亟勵勵仍 弍舒亶亟仍舒舒 仂亳仍仆舒.(丶丐 55-60, 90仄仄.仄弍<) 仂仗舒仆仂仍仂仍 仂仆仂亞亳亶仆 亟亟 仆 40仄亞, 仆舒亟仂仍仂仍 仂仆仂亞亳亶仆 仆 亟亟 20仄亞.(舒亳仄 亟舒仍亞舒舒仆亟 60仄亞, 40仄亞) 丶 舒仍亟舒 亟仍 仆 唏仆唏 仂仂亶仆 舒亞舒舒 亳 弍舒亶亟舒亞 仍 仄亳亶仆 仄唏仆 勵亠亟 仍亞舒于舒仍 勵 亟勵仆亶. Selective 硫-blocker-弌亠仍亠从亳于 硫-弍仍仂从舒仂 (metoprolol, atenolol) Clinical guideline, Acute upper gastrointestinal bleeding in over 16s: management Published: 13 June 2012 nice.org.uk/guidance/cg141
  • 14. Clinical guideline, Acute upper gastrointestinal bleeding in over 16s: management Published: 13 June 2012 nice.org.uk/guidance/cg141