Oesophageal varices bleeding

Question 1

What is oesophageal varices bleeding?

Answer 1

Bleeding of dilated sub-mucosal veins (varices) of the distal oesophagus due to portal hypertension

Question 2

What are the clinical features of oesophageal varices?

Answer 2

Symptoms of upper GI bleed

Hematemesis, melena, and/or hematochezia

Question 3

How is oesophageal varices bleeding diagnosed?

Answer 3

Sudden onset severe GI bleed in patient with portal hypertension + possibly liver failure
Suspect Mallory Weiss tear if bleeding follows vomiting / retching

Question 4

What is the treatment for oesophageal varices?

Answer 4

(Acute management) Resuscitation and stabilization
(Medical therapy) Octreotide (indirect splanchnic vasoconstriction), Vit K (for any coagulation disorders), antibiotic prophylaxis
(Endoscopic management) Endoscopic band ligation
(Bleeding prevention) Primary prophylaxis (i.e. beta-blockers)
Endoscopic esophageal variceal ligation