Management of variceal bleeding

Abstract

Portal hypertension, a common clinical syndrome of chronic
liver disease, is characterised by a pathologic increase in
portal pressure, that causes dilation of portosystemic collateral
vessels, leading to the formation and bleeding of
oesophagogastric varices. Large varices, measuring more
than 5 mm in diameter, have a greater predisposition to
spontaneouse rupture than small varices below this level
(<10% bleeding risk at 2 years). At endoscopy, bleeding
can be attributed to varices if there is a venous spurt or a
venous ooze or an adherent clot (cherry red spots, red wale
markings, hemocystic spots) or if a .platelet aggregate.
(white in colour) is doserved. The management of variceal
bleeding includes surgical, endoscopical and medical procedures
and can be considered in three different distinct
situations: a) acute bleeding episodes (emergency treatment),
b) prevention of variceal rebleeding (secontary prophylaxis)
and c) prevention of the first variceal bleeding
episode (primary prophylaxis).
Key words: Variceal bleeding, Sclerotherapy, TIPS, Variceal
ligation, b-blockers, Shunt surgery, Octreotide.—