Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents for follow-up/evaluation of known portal hypertension. Reports symptoms of [epigastric pain/nausea/melena/hematemesis]. History significant for cirrhosis (Child-Pugh [A/B/C]) with known portal hypertensive gastropathy. Current medications include non-selective beta-blockers. Denies recent NSAID use or alcohol consumption.
Clinical Examination Findings
Vitals stable. Abdomen: soft, non-tender, distended with shifting dullness suggestive of ascites. Caput medusae noted. EGD findings: Severe portal hypertensive gastropathy characterized by diffuse mosaic-like mucosal pattern with prominent cherry-red spots/hemorrhagic lesions in the [fundus/body/antrum]. No active bleeding noted at time of procedure.
Treatment Protocol
Initiate/optimize non-selective beta-blocker therapy (e.g., Propranolol/Nadolol) titrated to heart rate of 55-60 bpm. Consider endoscopic therapy if active bleeding or high-risk stigmata persist. Monitor hemoglobin/hematocrit levels. Avoid hepatotoxic agents and NSAIDs. Schedule repeat EGD in [X] months.