{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 9, Ep 2 of 2: Variceal and Unusual","html":"<iframe width=\"100%\" height=\"180\" frameborder=\"no\" scrolling=\"no\" seamless src=\"https://share.transistor.fm/e/794eaef5\"></iframe>","width":"100%","height":180,"duration":868,"description":"Episode two of the Upper GI Bleeding chapter covers acute variceal hemorrhage and the unusual non-variceal causes a routine scope misses. It anchors on the variceal bundle delivered before endoscopy, early TIPS for the high-risk cirrhotic, and the Sarin split for gastric varices. The second half is a recognition drill: each rare lesion is easy to treat once its history cue is named.\n \nTopics covered\n\nVariceal bundle: octreotide, ceftriaxone, band ligation\nRestrictive transfusion and selective coagulopathy correction\nBalloon tamponade and covered esophageal stent bridges\nEarly pre-emptive TIPS in high-risk cirrhotics\nSarin classification and gastric varices\nDieulafoy, Mallory-Weiss, GAVE, Cameron lesions\nAngiodysplasia, Heyde syndrome, and HHT\nHemobilia, hemosuccus, aortoenteric fistula\n \n \nKey decisions\n\nStart octreotide, ceftriaxone, and band ligation reflexively the moment variceal bleeding is suspected, before endoscopic confirmation; octreotide runs five days, ceftriaxone seven.\nTransfuse restrictively to hemoglobin of seven in cirrhotics; liberal transfusion raises portal pressure and worsens rebleeding.\nChoose early pre-emptive TIPS within seventy-two hours for Child-Pugh C, or Child-Pugh B with active bleeding on the index endoscopy.\nAn isolated fundal gastric varix without esophageal involvement always triggers a splenic vein thrombosis workup.\nGAVE (distal antral stripes) does not respond to TIPS and is treated with argon plasma coagulation; portal hypertensive gastropathy (proximal snake-skin) responds to beta-blockade and TIPS.\nA herald bleed after prior aortic aneurysm graft surgery is aortoenteric fistula until proven otherwise; get CT angiography and go to emergent repair.\n \n \nThis is an AI-generated podcast, and some pronunciations may be imperfect. Thank you for your understanding, and we hope you enjoyed this content.\n \n \nStudy the full chapter on Board Pearls, with practice questions, tables and primary-guideline references: Upper GI Bleeding...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}