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Related Concept Videos

Disorders of Hemostasis01:24

Disorders of Hemostasis

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Hemostasis, the process that stops bleeding after a blood vessel injury, is crucial for maintaining the integrity of the circulatory system. However, disorders of hemostasis can disrupt this delicate balance, leading to either excessive clotting or bleeding. These disorders can be broadly classified into thromboembolic disorders and bleeding disorders.
Thromboembolic Disorders
Two factors primarily cause thromboembolic conditions.
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Esophageal Varices-I: Introduction01:24

Esophageal Varices-I: Introduction

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Esophageal varices are dilated, tortuous veins which are found mainly in the submucosa of the lower esophagus but which may also appear higher up or extend into the stomach. They develop due to increased pressure in the portal venous system, often as a result of liver cirrhosis. This condition scars and damages the liver, impeding normal blood flow through the portal vein. To compensate, blood seeks alternative pathways, forming fragile new vessels (varices) in the esophagus and stomach. These...
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Introduction to Hemostasis01:05

Introduction to Hemostasis

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Hemostasis is a complex physiological process that prevents excessive bleeding when a blood vessel is injured. It's crucial for maintaining the integrity of the circulatory system, as it ensures that our blood remains fluid while still within the vascular network and yet clots to prevent blood loss upon vessel injury.
The three phases of hemostasis involve many clotting factors present in plasma and several substances released by platelets and injured tissue cells. It is a fast, localized,...
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Bleeding in Fresh Concrete01:22

Bleeding in Fresh Concrete

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Bleeding in fresh concrete occurs when water from the mix rises to the surface. This happens because the mix's solid components fail to retain all the water as they settle, leading to separation where water collects at the top. The severity of bleeding can be measured by assessing the total settlement or by noting the decrease in height per unit height of concrete.
Bleeding can cause several issues in the concrete structure. Sometimes, the rising water gets trapped beneath large aggregate...
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Esophageal Varices-II: Clinical Features and Management01:28

Esophageal Varices-II: Clinical Features and Management

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Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
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Extrinsic and Intrinsic Pathways of Hemostasis01:20

Extrinsic and Intrinsic Pathways of Hemostasis

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Blood clotting or coagulation involves extrinsic and intrinsic pathways, which ultimately merge into the common pathway, forming a fibrin clot.
The Extrinsic Pathway
The extrinsic pathway of coagulation is typically initiated by tissue damage that exposes blood to tissue factor (TF), a protein released by the damaged tissue cells outside the blood vessels—this interaction with TF triggers biochemical reactions involving specific clotting factors. The key player here is Factor VII, which...
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Related Experiment Video

Updated: Jan 23, 2026

Endoscopic Injection Sclerotherapy Assisted by Cyanoacrylate and Clips for Gastroesophageal Varices
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APSPGHAN Statement on Endoscopic Variceal Bleeding Hemostasis.

Nuthapong Ukarapol1, Ujjal Poddar2, Tak Yau Stephen Lui3

  • 1Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.

Pediatric Gastroenterology, Hepatology & Nutrition
|January 22, 2026
PubMed
Summary
This summary is machine-generated.

Pediatric gastroenterologists now have evidence-based guidelines for managing variceal bleeding. Endoscopic variceal ligation is preferred for prophylaxis and treatment in children over 10 kg.

Keywords:
ChildEndoscopyHemorrhageHemostasisVaricose veins

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Area of Science:

  • Pediatric Gastroenterology
  • Hepatology
  • Endoscopy

Background:

  • Endoscopic variceal hemostasis is a vital intervention in pediatric care.
  • The Asian Pacific Society for Pediatric Gastroenterology, Hepatology and Nutrition developed guidelines for safe and effective practices.

Purpose of the Study:

  • To establish a consensus-based position statement on endoscopic variceal hemostasis in children.
  • To provide an evidence-based framework for managing pediatric variceal bleeding.

Main Methods:

  • A comprehensive literature review focused on pediatric evidence.
  • Nineteen draft statements were formulated and refined through electronic votes and virtual meetings.
  • Consensus was reached on statements with ≥80% agreement, with evidence certainty evaluated.

Main Results:

  • Nineteen position statements covering screening, acute management, and surgical options were endorsed.
  • Endoscopic variceal ligation is the preferred treatment for children ≥10 kg, outperforming sclerotherapy and beta-blockers.
  • Standard acute management includes octreotide, restrictive transfusions, and endoscopy within 24 hours; Meso-Rex stunt or TIPS for refractory cases.

Conclusions:

  • The findings offer an evidence-based framework for pediatric variceal bleeding management.
  • Individualized care is crucial, emphasizing the need for more high-quality pediatric studies.