clarification please!

[northandponce]

---

Members don't see this ad.

Regarding Varices and Upper GI bleeds-
- i'm confused as to who gets what...
- PPI, Octreotide, and B-Blocker

Another concept I frequently get wrong...
- WHEN TO draw cultures before antibiotics???
- IE, Pyelonephritis, Sepsis, Meningitis...

Thanks!

 

[turkdlit]

Regarding Varices and Upper GI bleeds-
- i'm confused as to who gets what...
- PPI, Octreotide, and B-Blocker

Another concept I frequently get wrong...
- WHEN TO draw cultures before antibiotics???
- IE, Pyelonephritis, Sepsis, Meningitis...

Thanks!

Hey, I'm just going on memory here but regarding varices I believe ocreatide is used as an adjunct to banding or sclerotherapy during an acute bleed. B-blockers are used as long-term prophylaxis for varices. PPIs are used in the chronic treatment of upper GI bleeds due to ulcers, or reflux, or as part of triple therapy for H.Pylori, etc...

As far as drawing cultures if it is a non-emergent situation - i.e. endorcarditis sepsis or pyelo I think you're best off getting cultures first then emperic antibiotics. Meningitis though I'm not sure...probably want to do an LP before anything else. Anyone else wanna chime in?

 

[northandponce]

the thing is, i've read (and been told by my consultant) that anyone with portal-hypertention needs to be taking a PPI.
- B-Blockers for prophylaxis, how exactly would they work to prevent bleeding?
- and Octrotide--- is this for any cause of upper Gi bleed or just varices?

 

[Babycatcher2B]

the thing is, i've read (and been told by my consultant) that anyone with portal-hypertention needs to be taking a PPI.
- B-Blockers for prophylaxis, how exactly would they work to prevent bleeding?
- and Octrotide--- is this for any cause of upper Gi bleed or just varices?

When someone has an upper GI bleed (not knowing the source), you empirically give PPIs in case the source of bleeding is from an ulcer. You give octreotide in case the source is from bleeding varices (causes vasoconstriction therefore decreasing portal pressure).

Beta blockers decrease high portal pressure. Therefore used as prophylaxis for esophageal varices. That was a USMLE world question.

 

[northandponce]

Beta blockers decrease high portal pressure. Therefore used as prophylaxis for esophageal varices. That was a USMLE world question.

I know that much, I just don't understand how!

Thanks for the clarification!

 

[AlternateSome1]

Both somatostatin (octreotide is a long acting synthetic variant) and b-blockers help in variceal bleeding by reducing portal collateral blood flow. Activation of b2 receptors vasodilates blood vessels, blockade of which has a net vasoconstrictive effect.

 

[AlternateSome1]

Remember Laplace's law. The greater the diameter of the vessel (vasodilated) the greater the pressure on the vascular wall.