A 59-year-old man presented with recurrent attacks of hematemesis and melena and was admitted to the hospital. The patient gives a history of band ligation for esophageal varices and liver cirrhosis. The patient was admitted to the hospital and received resuscitation and a blood transfusion. The platelet count is 30.000. Hemoglobin level is 7.7 gm/dl. Albumin was 2.5. serum creatinine is 1.5 mg/dl/. the international normalized ratio was 1.76. questions: what about the decision of upper GI endoscopy in this patient with prolonged INR, elevated creatinine level, and severe thrombocytopenia? What is the cause of active bleeding after an injection?
1- the amount of amacrylate is small in comparison to the size of varix
2- the patient’s low platelet count and prolonged INR
3- high portal hypertension
4- the tip of the injector puts extra pressure on the varix
What are your lines of treatment?
1- Conservative treatment
2- Reinjection with amacrylate
3- Clips
4- Eus guided injection
5- interventional radiology consultation
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