Unit:
Κατεύθυνση Κλινική Νοσηλευτική: Χειρουργική ΝοσηλευτικήLibrary of the School of Health Sciences
Supervisors info:
Μπίρμπας Κωνσταντίνος, Αναπληρωτής Καθηγητής, Νοσηλευτική, ΕΚΠΑ
Μαυρογιάννης Χρήστος, Καθηγητής, Νοσηλευτική, ΕΚΠΑ
Ελευσινιώτης Ιωάννης, Αναπληρωτής Καθηγητής, Νοσηλευτική, ΕΚΠΑ
Original Title:
Τελευταία δεδομένα στη θεραπευτική αντιμετώπιση της αιμορραγίας σε ασθενείς με πυλαία υπέρταση.
Translated title:
Latest data in treatment of hemorrhage in patients with portal hypertension.
Summary:
Introduction: Portal pressure is caused by the increased pressure at the portal vein which leads to the development of varices and portal gastropathy. The most common are the oesophageal and the gastric varices while ectopic varices are more infrequent. The bleeding that occurs is fatal for the patients.
Objective: Finding the developments and the newest haemostatic methods.
Material and methods: Electronic data bases have been searched with publication dates from January 2016 to August 2018.
Results: Endoscopic variceal ligation is a safe and more effective procedure than sclerotherapy for haemostasis. Argon Plasma coagulation improves the results of these treatments. Balloon tamponade device and Haemospray lead only to temporary haemostasis. Cyanoacrylate glue injection results in safe variceal obturation as does the balloon-occluded retrograde transvenous obliteration (BRTO). Transjugular intrahepatic portosystemic shunts (TIPS) decrease portal pressure leading to effective haemostasis. During the surgical treatment shunt creation or splenectomy take place for a safe and effective bleeding treatment.
Conclusions: A treatment with carvedilol, vasoactive drugs and antibiotics increases patients’ survival rate. Endoscopic variceal ligation in combination with Argon Plasma coagulation is suggested to treat oesopgageal bleeding. Haemostasis on gastric bleeding is suggested to be achieved by cyanoacrylate glue injection with N-butyl-2-cyanoacrylate or by BRTO with 3% sodium tetradecyl sulfate. Ectopic varices can be treated by cyanoacrylate glue injection or TIPS and variceal embolization. The use of covered stent dilated to 8mm for TIPS is recommented. Surgery, although effective, is no longer a popular bleeding treatment. Further searching is necessary to be able to extract safer results.
Main subject category:
Health Sciences
Keywords:
Bleeding, Portal hypertension, Treatment, Varices, Haemostasis
Number of references:
134
