Esophageal Varices

-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

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