-Esophageal varices are dilated submucosal veins that develop in patients with underlying portal hypertension.
-About half of the patients with cirrhosis develop esophageal varices.
-They may result in upper gastrointestinal bleeding.
Symptoms and Signs: When bleeding, the varices present with acute gastrointestinal hemorrhage, hypovolemia.
Treatment: Most patients with cirrhosis should undergo diagnostic endoscopy to document the presence or absence of varices and to determine their risk for variceal hemorrhage.
Prophylactic Treatment: Nonselective beta blockers, nitrates, endoscopic variceal ligation, cyanoacrylate injection of gastric varices
Acute hemorrhage: Variceal hemorrhage is life-threatening. Hemodynamic resuscitation using IV fluids, Fresh frozen plasma, platelets.
Vasoactive drugs: Portal hypertension is a consequence of liver disease. Drugs designed to reduce portal hypertension are useful to treat variceal hemorrhage: Somatostatin and their analogues (terlipressin, octreotide), Vasopressin
Endoscopic Treatment: Endoscopic variceal ligation, sclerotherapy
Shunt procedures: Transjugular intrahepatic portosystemic shunt (TIPS), Emergency Shunt Surgery
Balloon procedures: Balloon Tamponade, Balloon-Occluded Retrograde Transvenous Obliteration (BRTO)
Antibiotic prophylaxis: fluoroquinolones or cephalosporins
Q: What are the most common cause of gastrointestinal bleeding due to portal hypertension? Esophageal varices
Q: What is the most common cause of portal hypertension? Cirrhosis
Q: What is the definitive treatment of choice for active variceal hemorrhage? Endoscopic therapy.
Q: Which medications seems to be effective for both primary and secondary prophylaxis of variceal hemorrhage? Nonselective beta blockers