Kenneth Kee

Esophageal Varices, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions (eBook, ePUB)

• Format: ePub

Produktbeschreibung

This book describes Esophageal Varices, Diagnosis and Treatment and Related Diseases
Esophageal varices are excessively swollen sub-mucosal veins present in the lower third of the esophagus.
They are most often an effect of portal hypertension, often due to cirrhosis
Patients with esophageal varices have a strong tendency to bleed readily.
Variceal hemorrhage happens from dilated veins (varices) at the junction between the portal and systemic venous systems.
Varices are likely to occur in the distal esophagus and the proximal stomach but isolated varices may be present in the distal stomach, large and small intestine.
Bleeding is typically severe and may be threatening to life.
Bleeding from esophageal varices is responsible for 5-11% of all cases of upper gastrointestinal bleeding (UGIB).
In Western countries, alcoholic and viral cirrhosis are the primary causes of esophageal varices and portal hypertension.
30% of patients with compensated cirrhosis and 60-70% of patients with decompensated cirrhosis have gastro-esophageal varices at the time of presentation.
Esophageal varices are diagnosed mainly with endoscopy
Causes
The causes of esophageal varices are anything that can produce portal hypertension.
Pre-hepatic
a. Portal vein thrombosis.
b. Portal vein obstruction - congenital atresia or stenosis.
c. Increased portal blood flow - fistula.
d. Increased splenic flow
Other Pre-hepatic causes are:
1. Splenic vein thrombosis and
2. Portal vein thrombosis.
These disorders often are linked with:
1. Hyper-coagulable states and
2. Malignancy (e.g., pancreatic cancer).
Intra-hepatic
a. Cirrhosis due to different causes such as alcoholic, chronic hepatitis (e.g. viral or autoimmune).
b. Idiopathic portal hypertension (hepatoportal sclerosis).
c. Acute hepatitis (particularly alcoholic).
d. Schistosomiasis.
e. Congenital hepatic fibrosis.
f. Myelosclerosis
Post-hepatic
a. Compression (e.g. from tumor).
b. Budd-Chiari syndrome.
c. Constrictive pericarditis (and rarely right-sided heart failure).
Symptoms
a. Hematemesis (most often),
b. Melena.
c. Abdominal pain
d. Features of liver disease and specific underlying condition.
e. Dysphagia or odynophagia (pain on swallowing; uncommon)
f. Confusion secondary to encephalopathy (even coma).
Diagnosis
a. Endoscopy is needed at an early stage.
b. FBC - hemoglobin may be low; MCV may be high, normal or low; platelets may also be low; WBC may be raised.
c. Clotting factors including INR
d. Renal function
e. LFT
Chest X-Ray - patients may have aspiration or chest infection.
Treatment
In emergency situations, the treatment is directed at:
a. Stopping blood loss,
b. Maintaining plasma volume,
c. Correcting disorders in coagulation induced by cirrhosis,
d. Proper use of antibiotics (normally a quinolone or ceftriaxone, as infection by gram-negative strains is either concomitant or a precipitant).
The purpose of treatment should be hemodynamic stability and hemoglobin of over 8 g/dL.
Two main treatment methods are present:
a. Variceal ligation or banding
b. Sclerotherapy
Acute Variceal Bleeding Medical Treatment
1. Upper Endoscopy urgently (within 12 hours)
2. Vasoactive agents
a. Octreotide or Sandostatin (preferred)
b. Long-acting somatostatin analog
This is the preferred vasoactive agent in Upper GI Bleed
c. Intravenous Vasopressin
This is used with Nitroglycerin
d. Non-selective Beta Blocker
Propanolol, Nadalol, Timolol
Acute Variceal Bleeding Invasive Treatment
1. Endoscopic ligation or banding
2. Transjugular intrahepatic Portosystemic Shunt (TIPS)
Liver transplant is the treatment of choice for patients with advanced liver disease

TABLE OF CONTENT
Introduction
Chapter 1 Esophageal Va...

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Produktdetails

• Verlag: Kenneth Kee
• Erscheinungstermin: 29. Januar 2018
• Englisch
• ISBN-13: 9781370534562
• Artikelnr.: 75905625

Autorenporträt

Dr. Kenneth Kee is a well-known medical doctor from Singapore who has been practicing medicine since 1972.
He graduated from the University of Singapore and furthered his studies with a Master of Science in Health Management in 1991, followed by a Ph.D. in Healthcare Administration in 1993.
Dr. Kee established Kee Clinic in 1974, located in the Holland Drive area of Singapore. The clinic has been a prominent feature of the community, offering general medical services for 5 decades.
Dr Kee also served his country Singapore as a national service police Inspector at night from 1975 to 1985 while working at his clinic during the day.
He had served as a police guard to the Woodland Petroleum Tanks at night during the Indonesian Confrontation period, took part in police rounds at night in the Beach Road area and taught First aid and emergency resuscitation to Police recruits.
He received the Singapore Police Bicentennial 2020 Medallion on 1st March 2024 as recognition for his work in the Singapore Police.
Even as he grew older, Dr. Kee continued to work actively in his clinic, although he eventually reduced his consultation hours.
Beyond his medical career, Dr. Kee is also an author.
He started writing about medical conditions in 2007, using blogs and other online platforms to share his knowledge with a broader audience.
Over time, he published various books, many of which provide simple and accessible guides to different health conditions.
His works include "A Family Doctor's Tale," "My Personal Singapore History," and numerous medical guides, available through platforms like Amazon.
His books often combine his personal experiences as a family doctor with insights into Singapore's healthcare system and history.
Dr. Kee has written extensively on health topics, contributing to both medical literature and general knowledge resources.

Dr. Kenneth Kee has written numerous books, primarily focused on health education and personal experiences as a family doctor. Some of his notable titles include:
"A Family Doctor's Tale"
This book is a blend of Dr. Kee's personal experiences and his reflections on being a family doctor in Singapore. It's a great choice if you're looking for a narrative that combines both medical knowledge and human stories.
"Specialized Medical Conditions"
Books like **"Congestive Heart Failure: Diagnosis and Treatment"** focus on specific conditions, offering in-dept...