1. MIP ALEJANDRO MEJIA
VILLEGAS
27 DE SEPTIEMBRE 2013
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
© 2013 Baishideng. All rights reserved.

2. 
SANGRADO
VARICES
ESOFAGICAS
VARICES
DUODENALES
SANGRADO DE
ESTOMAGO
SANGRADO EN
COLON
GASTROPATIA
HIPERTENSIVA
PORTAL
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
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3. World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
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4. Prevención de la primera
hemorragia variceal
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
© 2013 Baishideng. All rights reserved.

5. 
Al momento
del diagnostico
50% de los
pacientes
cirróticos
presentan VE
90% la
presentara
n
Mortalida
d del 7-
15%
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
© 2013 Baishideng. All rights reserved.

6. 
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
© 2013 Baishideng. All rights reserved.

7. 

8. 
Diametro
Signos de wale
Función
hepática
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
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9. 
> 5 mm
< 5 mm
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
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© 2013 Baishideng. All rights reserved.

10. 
5% incidencia anual.
•1.5 año  21%
•3 años  45%
•4.5 anos  66%
Un estudio con 258 pacientes
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
© 2013 Baishideng. All rights reserved.

11. 
Varices pequeñas
seguimiento 1-2 años.
Sin varices
examen de
seguimiento 2-3 años
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
© 2013 Baishideng. All rights reserved.

12. 
β- Bloqueadores
Escleroterapia
Ligadura
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
© 2013 Baishideng. All rights reserved.

13. 
No previene formación de
varices
Previene ampliación de
varices pequeñas
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
© 2013 Baishideng. All rights reserved.

14. 
Varice
s >
5mm
30-35%
hemorragia
Tx reduce
50% el riesgo
de sangrado
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
© 2013 Baishideng. All rights reserved.

15. Escleroterapi
a
Derivación
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
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16. 
RIESGO DE SANGRADO NO ES DIFERENTE AL DE
LA POBLACION NO TRATADA
INTERRUPCION
EFECTOS
SECUNDARIOS
20%
World J Gastroenterol 2013 August 21; 19(31): 50
ISSN 1007-9327 (print) ISSN 2219-2840 (online
© 2013 Baishideng. All rights reserved.

17. 
REDUCE EL RIESGO DE HEMORRAGIA
REDUCE LA MORTALIDAD
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
© 2013 Baishideng. All rights reserved.

18. B-BLOQUEADORES
LIGADURA
MISMO
RESULTADO
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
© 2013 Baishideng. All rights reserved.

19. 
Tratamiento
primera linea
Pacientes con
contraindicaciones
de B-Bloqueadores
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
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20. World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
© 2013 Baishideng. All rights reserved.

21. 1.- sangrado activo al momento
de endoscopia
2.- varices sin evidencia de
sangrado
con sangre presente en esófago y
estomago sin otra fuente de
sangrado
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
© 2013 Baishideng. All rights reserved.

22. 
40% MUEREN
INFECCIONES
INSUFICIEN
CIA
HEPATICA
SANGRA
DO
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
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23. ESTABILIZ
AR
HEMODINAMICAME
NTE
TRATAMIE
NTOVASOPRESORES
TRATAMIE
NTO
ANTIBIOTICOTERAP
IA
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
© 2013 Baishideng. All rights reserved.

24. 
• Disminuye mortalidad
• Disminuye probabilidad de resangrado
ANTIBIOTICOS
• Mantener 7-8 g/dl
TRANSFUSIÓN
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
© 2013 Baishideng. All rights reserved.

25. 
TERLIPRESI
NA
SOMATOSTAI
NA
VASOPRESI
NA
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
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26. 
COMPLICACIONES
Isquemia mesenterica
infarto
Vasopresina
Nitratos
Disminuye
complicaciones
Control de
hemorragia
no modifica
mortalidad World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
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27. 
• Menos eventos
adversos
• Impacto en mortalidad
efecto
• 80% y 67%
• 48 horas y %5 Dias.Hemorragia
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
© 2013 Baishideng. All rights reserved.

28. 2 MG CADA 4 HORAS EN LAS
PRIMERAS 48 HORAS
SE CONTINUA CON 1 mg
CADA 4 HORAS POR 5 DIAS
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
© 2013 Baishideng. All rights reserved.

29. 
• vasopresina
• + nitrato
+
• Terlipresina
similar • somatostatina
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
© 2013 Baishideng. All rights reserved.

30. 
Mejor perfil de seguridad
Su combinacion con terlipresina no la hace
superior
Beneficio similar a terlipresina
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
© 2013 Baishideng. All rights reserved.

31. 
80-90%
•Se controlan con
endoscopia.
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
© 2013 Baishideng. All rights reserved.

32. 
Ethoxysklerol Cianoacrilato
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
© 2013 Baishideng. All rights reserved.

33. 
•Tratamiento de segunda línea
•Cuando falla la ligadura
•complicaciones
•Ulceras superficial y estenosis esofágica.
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
© 2013 Baishideng. All rights reserved.

34. 
FINALMENTE
ES UN PUENTE HASTA TERAPIA DEFINITIVA DISPONIBLE
REDUCIRS COMPLICACIONES
Desinflar en 6 horas Aplicación son flouroscopio
COMPLICACIONES
Necrosis + rotura de esofago + Neumonia por aspiracion
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
© 2013 Baishideng. All rights reserved.

35. 
Alternativa al Balón, no necesita flouroscopio
Dura hasta 2 semanas
Es un procedimiento de reserva para hemorragia
refractaria a Tx medico-endoscópico
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
© 2013 Baishideng. All rights reserved.

36. 
Indicado en pacientes
con falla en Tx anteriores
8-18% de resangrado
anual
Riesgo de encefalopatía
hepatica
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
© 2013 Baishideng. All rights reserved.

37. 
63 pacientes child B o C
STEN
normal
PTFE
Recidiva
97%
50%
Mortalidad
86%
61%
politetrafluoroetileno

38. 
Derivacion •Portosistemica
Trasnseccion •Del esófago
mortalidas • 80%
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
© 2013 Baishideng. All rights reserved.

39. World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
© 2013 Baishideng. All rights reserved.

40. 
Sobrevivencia
a 1er episodio
60% de
recidiva
Mortalidad
de 33%
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
© 2013 Baishideng. All rights reserved.

41. 
ESCLEROTERAPIA
B-BLOQUEADORES
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
© 2013 Baishideng. All rights reserved.
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)

42. 
LIGADURA
ESCLEROTERAPIA
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
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43. 
B-BLOQ
+
NITRATOS
LIGADURA
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
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44. SI EL PACIENTE TOLERA
EL TRATAMIENTO
MEDICO
TERAPIA DE
COMBINACION.
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
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45. World J Gastroenterol 2013 August 21; 19(31): 5035-5050
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46. 

47. 
•Curvatura menor
TIPO I
•Curvatura mayor
TIPO II
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
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48. 
Diagnostico por endoscopia o Doppler
20% de pacientes con hipertension
portal la presentan
Riesgo de sangrado depende de
ubicación de la variz
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
© 2013 Baishideng. All rights reserved.

49. 
53%
•FONDO GASTRICO
19%
•CURVATURA MAYOR
6%
•CURVATURA MENOR
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
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50. 
Inyeccion cianoacrilato
Seguro y eficas en profilaxis primaria
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
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51.  NO
EFICACIA
SEGURO Y
EFICAZ
NO HAY
ESTUDIOS
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
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52. World J Gastroenterol 2013 August 21; 19(31): 5035-5050
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53. 
INCIDENCIA
80% DE CIRROTICOS 8% HTDA NO VARICEAL
HALLAZGO
Piel de serpiente Patron de eritema
DIAGNOSTICO
endoscopia
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
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54. 
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
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55. 
RESULTADOS
9 PACIENTES 3 PACIENTES
ESTUDIO DOBLE CIEGO
ENDOSCPIA
24 PACIENTES
PROPANOLOL PLACEBO
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
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56. 
HEMORRAGIA
CESÓ 2N 13 PACIENTES 93%
EN TRES DIAS
14 PACIENTES CON HTP Y SANGRADO DIFUSO
PROPANOLOL 24 A 480 mg POR DIA
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
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57. 
PROFILAXIS
PRIMARIA
INNECESARIA
SECUNDARIA
PROPANOLOL
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
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58. World J Gastroenterol 2013 August 21; 19(31): 5035-5050
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59. 
DILATACION DE VASOS DE LA
MUCOSA GASTROINTEESTINAL
FUERA DEL ESOFAGO Y ESTOMAGO
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
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60. 
RESPONSABLE DEL 1-5% DEL SANGRADO
ENDOSCOPIA DIGESTIVA ALTA NEGATIVA
RESLIZAR COLONOSCOPIA
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
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61. 
1.- ESCLEROTERAPIA
2.- CIRUGIA
3.- TX. MEDICO
World J Gastroenterol 2013 August 21; 19(31): 5035-5050
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