January 2016 Quiz 1

Q1: ANSWER: E

Critique

The incidence of bacterial infections in patients with cirrhosis with and without ascites who are admitted to the hospital with an upper GI bleed is 45% and studies have shown that the use of short-term (less than 7 days) prophylactic antibiotics is associated with lower rates of bacterial infections and lower risk for bleeding and death. Nadolol, a noncardioselective beta-blocker, is not helpful in active bleeding from gastric fundic varices. Imaging studies are the second step in the management of the patient to look for splenic vein thrombosis as a cause for fundic gastric varices. In cases where isolated gastric fundic varices are due to splenic vein thrombosis the treatment would be surgical referral for splenectomy.

References

1. Chavez-Tapia N.C., Barrientos-Gutierrez T., Tellez-Avila F.I., et al. Antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding. Cochrane Database Syst Rev. 2010;Sep 8:CD002907.
2. Hou M.C., Lin H.C., Liu T.T., et al. Antibiotic prophylaxis after endoscopic therapy prevents rebleeding in acute variceal hemorrhage: a randomized trial. Hepatology. 2004;39:746-53.
3. Rimola A., García-Tsao G., Navasa M., et al. Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document. International Ascites Club. J Hepatol. 2000 Jan;32:142-53.

Q1: ANSWER: E

Critique

The incidence of bacterial infections in patients with cirrhosis with and without ascites who are admitted to the hospital with an upper GI bleed is 45% and studies have shown that the use of short-term (less than 7 days) prophylactic antibiotics is associated with lower rates of bacterial infections and lower risk for bleeding and death. Nadolol, a noncardioselective beta-blocker, is not helpful in active bleeding from gastric fundic varices. Imaging studies are the second step in the management of the patient to look for splenic vein thrombosis as a cause for fundic gastric varices. In cases where isolated gastric fundic varices are due to splenic vein thrombosis the treatment would be surgical referral for splenectomy.

References

1. Chavez-Tapia N.C., Barrientos-Gutierrez T., Tellez-Avila F.I., et al. Antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding. Cochrane Database Syst Rev. 2010;Sep 8:CD002907.
2. Hou M.C., Lin H.C., Liu T.T., et al. Antibiotic prophylaxis after endoscopic therapy prevents rebleeding in acute variceal hemorrhage: a randomized trial. Hepatology. 2004;39:746-53.
3. Rimola A., García-Tsao G., Navasa M., et al. Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document. International Ascites Club. J Hepatol. 2000 Jan;32:142-53.

Q1: ANSWER: E

Critique

The incidence of bacterial infections in patients with cirrhosis with and without ascites who are admitted to the hospital with an upper GI bleed is 45% and studies have shown that the use of short-term (less than 7 days) prophylactic antibiotics is associated with lower rates of bacterial infections and lower risk for bleeding and death. Nadolol, a noncardioselective beta-blocker, is not helpful in active bleeding from gastric fundic varices. Imaging studies are the second step in the management of the patient to look for splenic vein thrombosis as a cause for fundic gastric varices. In cases where isolated gastric fundic varices are due to splenic vein thrombosis the treatment would be surgical referral for splenectomy.

References

1. Chavez-Tapia N.C., Barrientos-Gutierrez T., Tellez-Avila F.I., et al. Antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding. Cochrane Database Syst Rev. 2010;Sep 8:CD002907.
2. Hou M.C., Lin H.C., Liu T.T., et al. Antibiotic prophylaxis after endoscopic therapy prevents rebleeding in acute variceal hemorrhage: a randomized trial. Hepatology. 2004;39:746-53.
3. Rimola A., García-Tsao G., Navasa M., et al. Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document. International Ascites Club. J Hepatol. 2000 Jan;32:142-53.