VARICEAL BLEEDING Clinical features Diagnosis and Treatment

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It results from portal systemic venous collaterals when portal hypertension is more than 12 mmHg.

Peptic ulcer and gastritis. Endoscopy is done for proper diagnosis.
Variceal bleeding is serious emergency
patients with varices will develop variceal hemorrhage, a major cause of morbidity and mortality in patients with cirrhosis

Numerous clinical and physiologic factors are useful in predicting the risk of variceal hemorrhage in patients with cirrhosis.
These include:
Location of varices
Size of varices
Appearance of varices
Clinical features of the patient
Variceal pressure

Blood transfusion Specific interventions
Fresh frozen plasma transfusion.
Admission to ICU with monitoring of central venous pressure, pulmonary capillary wedge pressure, urine output, mental status.
Endoscopy is advised.
Vasoconstrictors – somatostatin / octreotide or vasopressin
- Vasopressin is given 0.1 to 0.4 units / min. in IV infusion.
- Bleeding often recurs after stoppage of infusion. Side effects of vasopressin are acute renal failure, hyponatremia and coronary ischemia.
- Somatostatin is splanchnic vasoconstrictor. It is given 250IJg bolus followed by 250 IJg / hour.
- Octreotide is given 50 – 100 IJg/hour. These are preferred to vasopressin.
- Nitroglycerin drip or isosorbide-di-nitrate are given to prevent side effects.
- Balloon tamponade is done to stop bleeding Endoscopic ligation or sclerotherapy of varices may be done to check and pevent bleeding.
Endoscopic variceal Iigation (EVL)
- is the best method where circular rings are used to ligate the varices.
Surgical treatment
- is last resort because of high mortality.
- In TIPS (Trans Jugular Intrahepatic Portosystemic Shunt) a metal stent is used to create a portocaval channel. This is used in refractory bleeding only.
- Liver transplantation is being increasingly done nowadays.
- Gastric fundal bleeding is more difficult to manage.