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
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)
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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.