Treatment failure in variceal bleed

 Q: 'Treatment Failure' in variceal bleed is defined by all of the following EXCEPT? (select one)

A) More than 100 mL of fresh blood in the nasogastric (NG) aspirate - 2 hours after endoscopic treatment

B) New hypovolemic shock 

C) Drop in hemoglobin of ≥3 g/dL (30 g/L) within 24 hours period

D) Bleeding ≥120 hours after the first hemorrhage, given hemostasis was initially achieved

Answer: D

The objective of this question is to highlight the specific terminologies used in variceal bleed. Variceal bleed and rebleed are two different entities. 

Time zero: – Time of admission. 

 Clinically significant bleeding:  - Transfusion requirement of at least two units of blood within 24 hours of time zero combined with a systolic blood pressure (SBP) less than 100 mmHg, a postural systolic change >20 mmHg, and/or a pulse rate >100 beats per minute at time zero. 

 Acute variceal bleeding: – The time interval from time zero to 120 hours. 

 Treatment failure: Any of the Choices A, B, and C above within 120 hours of time zero 

 Variceal rebleeding - (choice D)

#gastroenterology

Reference:

1. de Franchis R, Baveno V Faculty. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol 2010; 53:762. 

2. de Franchis R, Baveno VI Faculty. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol 2015; 63:743. 

3. Tripathi D, Stanley AJ, Hayes PC, et al. U.K. guidelines on the management of variceal haemorrhage in cirrhotic patients. Gut 2015; 64:1680.