Oesophageal Varices

Question 1

What is this?

How does it present?

Answer 1

➊ Dilated collateral blood vessels in the oesophagus that develop as a complication of portal hypertension, usually in the setting of cirrhosis.

➋ * Haematemesis - typically fresh red blood
* Maleana
* Signs of chronic liver disease e.g. cirrhosis, ascites etc.

Question 2

Which investigations should be done?

Answer 2

• Bloods - FBC, U&Es, LFTs, CRP, INR, G&S + Crossmatch
• Endoscopy

N.B. Glasgow-Blatchford score is used pre-endoscopy. Rockall score used post-endoscopy.

Question 3

How is it managed in an acute bleed?

Answer 3

• A-E assessment
• Terlipressin (otcreotide 2nd line) - increases systemic vascular resistance, reduces CO, and reduces portal pressures (by ~20%)
• Prophylactic Abx e.g. Ceftriaxone
• Use Glasgow-Blatchford score to determine if to do endoscopy urgently or as an outpatient. Urgent after resuscitation if pt is unstable. Variceal band ligation done at the same time.

N.B. It’s important to stop the terlipressin once bleeding has stopped definitively.