Variceal hemorrhage



  • Variceal hemorrhage is a common and at times fatal complication of liver cirrhosis. Initial screening of patients with cirrhosis for varices is indicated at the time of diagnosis followed by continued surveillance as needed. This chapter encompasses a review of the primary prevention of variceal hemorrhage, management of acute variceal hemorrhage, and secondary prevention of variceal hemorrhage. In terms of primary prevention, nonselective beta blockers are almost as effective as endoscopic variceal ligation (EVL) in the prevention of bleeding from large varices, though without any difference in survival. In cases of acute variceal hemorrhage, resuscitation measures and pharmacologic therapy-including the use of antibiotic prophylaxis against spontaneous bacterial peritonitis-are administered in an intensive care setting. Upper endoscopy and EVL should be performed within 12 hours. The transjugular intrahepatic portosystemic shunt (TIPS) serves as a rescue procedure for patients that develop recurrent bleeding after EVL, the introduction of drug coated TIPS has been associated with a lower incidence of shunt dysfunction. The combination of non-selective beta blockers and EVL is the most effective approach in the prevention of rebleeding (secondary prevention).
  • International Standard Book Number (isbn) 13

  • 9781631173332
  • Start Page

  • 145
  • End Page

  • 158