A 62-year-old woman with hereditary hemochromatosis and biopsy-proven cirrhosis presents for screening upper endoscopy. She reports no prior variceal bleeding or hematemesis. Vital signs are normal. Physical examination reveals spider angiomas and splenomegaly. Endoscopy identifies small esophageal varices without red wale markings or active bleeding. Laboratory studies show: platelet count 98,000/μL, INR 1.3, albumin 3.2 g/dL, total bilirubin 1.8 mg/dL, and hemoglobin 11.2 g/dL. Abdominal ultrasound confirms cirrhosis with portal vein patency. Which of the following is the most appropriate next step in management?
- A)Endoscopic variceal ligation
- B)Immediate TIPS placement
- C)Transjugular liver biopsy to assess iron overload
- D)Propranolol to reduce portal venous pressureGABARITO
- E)Observation without pharmacologic prophylaxis
Explicação
For primary prophylaxis of variceal bleeding in a patient with small esophageal varices and no prior bleeding, nonselective beta-blockade with propranolol or carvedilol is indicated. Beta-blockers reduce portal pressure gradient (target: reduction of >20% from... Ver explicação completa e trilha adaptativa →