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FORO DIGESTIVO

FORO DIGESTIVO . DR. ELIAS GÓRRIZ LAS PALMAS 3-MARZO-2005. Hipertensión portal. Rotura de varices gastro-esofágicas. Hemorragia digestiva. MÉTODOS DESCOMPRESIVOS - FARMACOLÓGICOS - QUIRÚRGICOS - TIPS MÉTODOS ESCLEROSANTES - ESCLEROTERAPIA ENDOSCÓPICA - LIGADURA ENDOSCÓPICA

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FORO DIGESTIVO

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  1. FORO DIGESTIVO DR. ELIAS GÓRRIZ LAS PALMAS 3-MARZO-2005

  2. Hipertensión portal • Rotura de varices gastro-esofágicas • Hemorragia digestiva

  3. MÉTODOS DESCOMPRESIVOS - FARMACOLÓGICOS - QUIRÚRGICOS - TIPS MÉTODOS ESCLEROSANTES - ESCLEROTERAPIA ENDOSCÓPICA - LIGADURA ENDOSCÓPICA - EMBOLIZACIÓN TRANS-TIPS MÉTODOS CURATIVOS - TRANSPLANTE

  4. Crafoord y Frenckner 1939

  5. ransjugular ntrahepatic TIPS ortosystemic hunt

  6. 1969 RÖSCH 1982 COLAPINTO 1985 PALMAZ 1987 RÖSCH 1989 RICHTER

  7. PUNCIÓN PORTAL

  8. DILATACIÓN

  9. ENDOPRÓTESIS

  10. % 100 Encefalopatía 90 80 70 60 50 40 30 20 10 meses 0 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 0 19 20 21 22 23 24 25 26 27 28 29

  11. Resultados Encefalopatía pacientes 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 28 meses

  12. Resangrado % 100 90 80 70 60 50 40 30 20 10 meses 0 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 Kaplan - Meier

  13. Resultados Resangrado pacientes 24 23 22 21 20 19 18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 meses

  14. Disfunción hemodinámica % 100 90 80 70 60 50 40 30 20 10 meses 0 9 12 15 18 21 24 27 30 33 36 39 42 45 48 0 3 6

  15. GPC Evolución mm Hg 30 GPC pre TIPS GPC post TIPS GPC Control GPC post Tto. 25 21,6 20 % 20 17 15,4 15,8 15,7 16,4 13,6 15,2 16,6 15,7 15 11,1 10,3 10,3 9 10 11 11,5 10,5 12,1 12 10 5 0 4º 8º 13º 18º 24º 29º 35º 39º GPC GPC meses PRE POST Controles TIPS

  16. EMBOLIZACIÓN - GELFOAM - ETANOL - ACRILATOS - ESPIRALES METÁLICAS

  17. VARICES GASTRICAS PEOR PRONÓSTICO GPC INFERIOR A 12 mm HG SHUNT ESPLENO-RENAL TAMAÑO DE VARICES / TENSIÓN DE PARED INDICACIÓN DE TIPS ? Gut 2002;51:270-274. The role of the transjugular intrahepatic portosystemic stent shunt (TIPSS) in the management of bleeding gastric varices: clinical and haemodynamic correlations D Tripathi1, G Therapondos1, E Jackson2, D N Redhead3 and P C Hayes1 1 Centre for Liver and Digestive Disorders and Department of Medicine, Royal Infirmary of Edinburgh, UK

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