Clinical evaluation

A. Variceal bleeding should be considered in any patient who presents with significant upper gastrointestinal bleeding. Signs of cirrhosis may include spider angiomas, palmar erythema, leukonychia, clubbing, parotid enlargement, and Dupuytren's contracture. Jaundice, lower extremity edema and ascites are indicative of decompensated liver disease.

B. The severity of the bleeding episode can be assessed on the basis of orthostatic changes (eg, resting tachycardia, postural hypotension), which indicates one-third or more of blood volume loss.

C. If the patient's sensorium is altered because of hepatic encephalopathy, the risk of aspiration mandates endotracheal intubation. Placement of a large-caliber nasogastric tube (22 F or 24 F) permits lavage for removal of blood and clots in preparation for endoscopy.

D. Nasogastric lavage should be performed with tap water, because saline may contribute to retention of sodium and water.

How To Deal With Rosacea and Eczema

How To Deal With Rosacea and Eczema

Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.

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