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Gastroenterology
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Variceal Hemorrhage
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Octreotide + abx + urgent endoscopic ligation.
Decision
Outcome
Decision
Suspected variceal hemorrhage. Initial management?
✓
2 large-bore IVs + volume resuscitation + IV octreotide + IV antibiotics (ceftriaxone) + endoscopy within 12 h
✗
Wait and observe
✗
Heparin
Decision
After urgent endoscopic band ligation — course?
✓
No further bleeding → secondary prophylaxis: non-selective β-blocker + EVL 1–2 weeks later
✓
Continued bleeding → balloon tamponade (Sengstaken–Blakemore), then TIPS or shunt surgery
✓
Early rebleeding → repeat endoscopic therapy
Outcome
Nadolol/propranolol + serial EVL until obliteration
Outcome
TIPS for refractory bleeding
Outcome
Repeat endoscopic therapy; if recurrent, TIPS