Variceal Haemorrhage

Question 1

What causes it?

Answer 1

Complication of portal hypertension

Question 2

What is the most common cause of portal hypertension?

Answer 2

Cirrhosis: strangles the blood vessels in the liver resulting in blood backing up along the portal vein

Question 3

If they rupture, it is a medical emergency. What should be done?

Answer 3

Resuscitate patient
Good IV access
Blood transfusion as required
Emergency endoscopy (when patient is stabilised)
Endoscopic band ligation
Add Terlipressin for control
Sengstaken-Blakemore tube for uncontrolled bleeding
TIPS for rebleeding after banding

Question 4

What is the presentation of oesophageal variceal bleeding?

Answer 4

Vomiting large amounts of blood
Black, tarry or bloody stools
Lightheadedness
Loss of consciousness in severe cases