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The white nipple sign: please do not disturb
1Department of Medicine, Section of Gastroenterology, Advocate Lutheran General Hospital, Park Ridge, Ill., USA.
Case Reports in Gastroenterology
|July 30, 2011
Summary
Variceal hemorrhage diagnosis relies on identifying bleeding signs. The less recognized "white nipple sign" indicates recent bleeding and potential rebleeding risk in patients with esophageal varices.
Area of Science:
- Gastroenterology
- Endoscopy
- Hepatology
Background:
- Variceal hemorrhage is a serious complication of portal hypertension.
- Diagnosis often relies on endoscopic identification of stigmata of recent hemorrhage.
- Red color signs are well-known indicators, but less recognized signs also exist.
Observation:
- Endoscopic examination for variceal hemorrhage often reveals cessation of bleeding by the time of the procedure.
- The 'white nipple sign' is a less recognized endoscopic finding associated with variceal hemorrhage.
- Manipulation of the white nipple sign in this study resulted in active hemorrhage.
Findings:
- The white nipple sign is a distinct stigma of recent variceal hemorrhage.
- This sign can be indicative of active bleeding or recent hemorrhage.
- Its presence may help predict the risk of rebleeding.
Implications:
- Recognition of the white nipple sign can improve diagnostic accuracy for variceal bleeding.
- It provides an additional tool for endoscopists to assess bleeding risk.
- Further research may elucidate the pathophysiology and prognostic significance of this sign.
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