pituitrin and Varicose-Veins

Vasopressin and terlipressin, a long-acting V1a analogue, are increasingly used in intensive care. The main clinical indications are the treatment of patients with septic shock and of patients with cirrhosis, who develop variceal bleeding, the hepatorenal syndrome or both. In this review, we summarize the effects of these drugs on splanchnic hemodynamics and organ function.. A recent systematic meta-analysis of randomized trials suggests that terlipressin may improve renal function in hepatorenal syndrome and thereby reduce mortality by 34%. Moreover, a recent study reported that association of terlipressin and albumin was more effective than terlipressin alone. In patients with variceal bleeding, the bleeding control is significantly improved by early administration of terlipressin. The place of vasopressin in the treatment of patients with septic shock is still discussed, but compared with norepinephrine, vasopressin showed at least an equal efficacy.. The use of vasopressin and its synthetic analogues has shown beneficial effects in the management of patients with cirrhosis, especially in the context of variceal bleeding, the hepatorenal syndrome or both. In both cases, the use of terlipressin improved survival. Therefore, in these clinical indications, terlipressin is a part of recommendations. The role of vasopressin in patients with septic shock remains to be precisely evaluated.

Topics: Critical Care; Critical Illness; Hemodynamics; Hepatorenal Syndrome; Humans; Intensive Care Units; Liver; Liver Cirrhosis; Lypressin; Risk Factors; Shock, Septic; Terlipressin; Varicose Veins; Vasoconstrictor Agents; Vasopressins

Portal hypertension is an increase in pressure in the portal vein and its tributaries. It is defined as a portal pressure gradient (the difference in pressure between the portal vein and the hepatic veins) greater than 5 mm Hg. Although this gradient defines portal hypertension, a gradient of 10 mm Hg or greater defines clinically significant portal hypertension, because this pressure gradient predicts the development of varices, decompensation of cirrhosis, and hepatocellular carcinoma. The most direct consequence of portal hypertension is the development of gastroesophageal varices that may rupture and lead to the development of variceal hemorrhage. This article reviews the pathophysiologic bases of the different pharmacologic treatments for portal hypertension in patients with cirrhosis and places them in the context of the natural history of varices and variceal hemorrhage.

Topics: Adrenergic beta-Antagonists; Fibrosis; Hemorrhage; Humans; Hypertension, Portal; Liver; Randomized Controlled Trials as Topic; Somatostatin; Varicose Veins; Vasoconstrictor Agents; Vasodilator Agents; Vasopressins

Angiography has become an integral tool in the management of patients with gastrointestinal bleeding. It is used for localizing the site of bleeding and then for controlling the bleeding when more conservative methods of treatment are unsuccessful.

Topics: Angiography; Blood Vessels; Endoscopy; Erythrocytes; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Hemostatic Techniques; Humans; Intestine, Small; Mesenteric Veins; Peptic Ulcer Hemorrhage; Postoperative Complications; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Varicose Veins; Vasopressins

Topics: Embolization, Therapeutic; Emergencies; Endoscopy; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Hemostatic Techniques; Humans; Portasystemic Shunt, Surgical; Recurrence; Sclerosing Solutions; Stomach; Varicose Veins; Vasopressins

From July 1975 to November 1976 25 patients with bleeding esophagogastric varices documented by endoscopy who failed to respond to conservative medical treatment were transferred to the Surgical Service. These patients, who were mainly Child's Class "C" alcoholic cirrhotic patients, were treated with vasopressin infused continuously using a standardized dose into either a peripheral vein or the superior mesenteric artery (SMA) according to a predetermined randomization. No significant difference in efficacy for control of bleeding (average rate = 56%) related to route of administration was found. Because catheter-related complications in the SMA group were significantly greater, we concluded that the method of choice in vasopressin treatment of esophagogastric variceal bleeding is a continuous infusion by way of a peripheral vein.

Topics: Catheterization; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Mesenteric Arteries; Prospective Studies; Stomach Diseases; Varicose Veins; Vasomotor System; Vasopressins

Topics: Adult; Female; Gastrointestinal Hemorrhage; Humans; Infusions, Intra-Arterial; Mesenteric Arteries; Mesenteric Veins; Varicose Veins; Vasopressins

Topics: Acute Disease; Adult; Aged; Diverticulum, Colon; Duodenal Ulcer; Gastritis; Gastrointestinal Hemorrhage; Humans; Infusions, Intra-Arterial; Mallory-Weiss Syndrome; Middle Aged; Peptic Ulcer Hemorrhage; Radiography; Stomach; Stomach Ulcer; Varicose Veins; Vasopressins

Peripheral intravenous Pitressin infusion, use of the Sengstaken-Blakemore tube, or both effectively controlled variceal hemorrhage in 69 percent of patients, allowing an interval of medical management before elective portasystemic shunt surgery. Prolonged preoperative in-hospital management significantly improved hepatic function in initially poor risk patients. This improvement in hepatic function appeared to result in decreased postoperative morbidity and an operative mortality equal to that of good risk patients.

Topics: Adult; Aged; Digestive System; Female; Gastric Lavage; Gastrointestinal Hemorrhage; Humans; Liver Function Tests; Male; Middle Aged; Portacaval Shunt, Surgical; Splenorenal Shunt, Surgical; Stomach; Tampons, Surgical; Varicose Veins; Vasopressins

The presence of mesenteric varices was demonstrated angiographically in 7 patients with portal hypertension. In 4 of these cases the mesenteric varices were the source of lower gastrointestinal bleeding which was successfully controlled by intra-arterial infusion of vasopressin. The radiological diagnosis and management of mesenteric varices is discussed and the pertinent literature is briefly reviewed.

Topics: Adult; Angiography; Celiac Artery; Female; Gastrointestinal Hemorrhage; Humans; Male; Mesenteric Arteries; Mesenteric Veins; Middle Aged; Varicose Veins; Vasopressins

Topics: Angiography; Female; Hemoperitoneum; Humans; Infusions, Intra-Arterial; Mesenteric Arteries; Middle Aged; Rupture, Spontaneous; Splenic Vein; Varicose Veins; Vasopressins

Topics: Blood Transfusion; Esophageal Diseases; Gastrointestinal Hemorrhage; Humans; Injections, Intra-Arterial; Liver Cirrhosis; Peptic Ulcer Hemorrhage; Recurrence; Stomach Ulcer; Varicose Veins; Vasopressins

Angiography has added a new dimension to the management of hemorrhage from the large bowel. In patients with diverticular hemorrhage, mesenteric angiography not only localizes the bleeding site but, in addition, the bleeding can be acutely controlled with intraarterial infusion of vasopressin, making an emergency colectomy unnecessary. Similarly in patients bleeding from inflammatory bowel disease or in patients with post-operative hemorrhage, angiography provides information about the nature of the lesion and selective arterial infusions of vasopressin can control the bleeding. At times intestinal varices have angiographically been demonstrated as a potential source of rectal hemorrhage while in patients with unexplained lower gastrointestinal bleeding and repeatedly negative barium and endoscopic examinations, angiography has been valuable for the diagnosis of angiodysplasia of the colon.

Topics: Acute Disease; Aged; Angiography; Blood Vessels; Colitis, Ulcerative; Colon; Colonic Neoplasms; Diverticulum, Colon; Endoscopy; Gastrointestinal Hemorrhage; Humans; Intestinal Polyps; Intestine, Large; Male; Mesenteric Arteries; Middle Aged; Varicose Veins; Vasopressins

Endoscopy, barium studies and angiography are all valuable diagnostic procedures in gastrointestinal bleeding. They are not mutually exclusive procedures but the correct sequence of investigation varies. Correct localization can be achieved in 84% of cases of massive gastrointestinal bleeding by their combined use. Vasoconstrictive therapy is also possible in severely ill patients and other poor surgical risk candidates.

Topics: Adult; Angiography; Barium Sulfate; Endoscopy; Epinephrine; Gastrointestinal Hemorrhage; Humans; Male; Varicose Veins; Vasopressins