Duodenal Varices
Bibliographic record
Abstract
Duodenal varices are a rare but potentially serious consequence of portal hypertension in the event of a bleed. We report two patients with duodenal varices secondary to portal hypertension The first is a 19-year-old female with significant portal hypertension with cavernous transformation of the portal vein secondary to portal vein thrombosis acquired as a child following umbilical vein cannulation. Multiple esophageal varices, a small fundal varix and a solitary post-bulbar duodenal varix approximately 2cm in diameter were noted at endoscopy. The esophageal varices were successfully obliterated by band ligation after a total of seven sessions and she is on a beta-blocker. The size of duodenal varix was unchanged at follow up endoscopies. Abdominal CT also demonstrated several large intraabdominal varices (mesenteric and splanchnic) not visible at endoscopy. The second patient was a 56-year-old gentleman with severe coronary artery disease and decompensated liver disease with portal and splenic vein thrombosis. He presented with an episode of severe upper gastrointestinal bleeding and was found at endoscopy to have large duodenal varices. He underwent a mesocaval shunt that successfully controlled the bleeding but he died several days post-operatively due to a cardiac event. Two-thirds of all reported cases of duodenal varices have portal venous hypertension caused by hepatic cirrhosis. In the remaining one-third, prehepatic portal hypertension as a consequence of either a compromised portal venous circulation (portal vein thrombosis) or a primary hematological disease is the underlying cause. There is currently no consensus with regards to management and very little evidence on which to base clinical decision-making. Isolated case reports have reported treatment of active hemorrhage with variceal obliteration (i.e. injection of sclerosant or band ligation) whereas others have reported treatment with decompressive shunting. We note that there is no reported literature on prophylaxis of patients who have yet to have a first bleed. A review of the literature and possible management strategies will be discussed.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.020 | 0.007 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".