Gave Syndrome - wi

advertisement
Why GIVE a Liver
Transplant to Patients
with GAVE Syndrome
GAVE
Gastric Antral Vascular Ectasia
Incidence and Etiology




More common in females (ratio reversed in
cirrhotic population)
Elderly-70’s
30% of patients diagnosed also have cirrhosis
Other 70% associated with autoimmune
diseases


5.7% of all sclerosis patients
Etiology commonly thought to be related to
abnormal antral motility and mucosal atrophy
GAVE vs PHG

Diagnosis and Symptoms

GAVE

lesions are restricted to antrum, diffuse or linear

chronic significant blood loss often resulting in transfusion dependency
Only 4% of acute GI bleeds are attributable to GAVE syndrome


Portal Hypertensive Gastropathy (PHG)


lesions throughout, lesions are diffuse
Treatment

PHG- responds to portal pressure reduction efforts



Beta-blocker
TIPS-Transjugular Intrahepatic Portosystemic Shunt
GAVE




Estrogen-Progesterone
Endoscopic Argon Plasma Coagulation (APC)
Antrectomy- high mortality in cirrhotic patients
Liver Transplant
Liver Transplant for GAVE

Study out of Mayo Clinic in Jacksonville FL



reviewed 597 patients transplanted from February
1998 to June 2003.
345 had EGD prior to OLT, 8 (2.3%) had GAVE
pre OLT
3 of 8 had post OLT EGD, GAVE absent in all 3,
other 5 had no post OLT gastrointestinal bleeding

J Clin Gatroenterol. 2004. Ward EM et al
Patient Demographics


49 y/o F
Cirrhosis secondary to NASH (Non-alcoholic
steatohepatitis



Portal hypertension
Hepatic Encephalopathy
GAVE syndrome
Clinical Data

Labs







Total Bilirubin 0.9-2.0
INR 1.4-1.8
Creatinine 1.2-2.4
Albumin 2.9
Sodium 130’s
Platelets 40’s
Hemoglobin 6.0-9.5

Interventions




H/H checks 2x/week,
scheduled outpatient
transfusions
PRBCs greater than 60
Units over 8 months
APC- 7 treatments
29 Hospitalizations in 1
years time-10 for
GIB/anemia
UNOS MELD exception request



MELD 15-25
Higher MELDs driven by AKI/HRS
MELD exception request denied for:




No increased mortality
Try APC
Recommend live liver donor
Not appropriate diagnosis for MELD exception
Patient Update



Patient recently transplanted
Post OLT course has been quite complicated
but no gastrointestinal bleeding
Has not had EGD post OLT to confirm
resolution
Nursing Implications




Correct diagnosis is key for treatment
Educating the patient and other care givers
about GAVE syndrome
Scheduling of serial H/H checks, transfusions,
Endoscopic APC
Resolves with Liver Transplantation though
exact mechanism is unknown
Download
Related flashcards
Blood disorders

44 Cards

Myeloid neoplasia

12 Cards

Hematology

56 Cards

Create flashcards