Chapter 39: UGI Bleed- Esophageal Variceal Bleeding

Question 1

What is it?

Answer 1

Bleeding from formation of esophageal varices from back up of portal pressure via the coronary vein to the submucosal esophageal venous plexuses secondary to portal hypertension from liver cirrhosis

Question 2

What is the “rule of two thirds” of esophageal variceal hemorrhage?

Answer 2

• Two thirds of patients with portal hypertension develop esophageal varices
• Two thirds of patients with esophageal varices bleed

Question 3

What are the signs/symptoms?

Answer 3

1. Liver disease
2. portal hypertension
3. hematemesis
4. caput medusa
5. ascites

Question 4

How is the diagnosis made?

Answer 4

EGD

• (very important because only 50% of UGI bleeding in patients with known esophageal varices are bleeding from the varices; the other 50% have bleeding from ulcers, etc.)

Question 5

What is the acute medical treatment?

Answer 5

Lower portal pressure with octreotide or vasopressin

Question 6

What are the treatment options?

Answer 6

Sclerotherapy or band ligation via endoscope, TIPS, liver transplant

Question 7

What is the problem with shunts?

Answer 7

Decreased portal pressure, but increased encephalopathy