Variceal Haemorrhage

Question 1

Acute management of variceal haemorrhage

Answer 1

• Resuscitation (ABCDE)
• Blood, FFP, Vit K, platelets
  (activate major haemorrhage protocol)
• Terlipressin
• prophylactic IV Abx
• endoscopy for band ligation or
  Sengstaken-Blakemore tube if uncontrolled haemorrhage
• Transjugular Intrahepatic Portosystemic Shunt (TIPSS) if above measures fail

Question 2

Prophylaxis of variceal bleed

Answer 2

• propranolol
• endoscopic variceal band ligation (EVL)
• Transjugular Intrahepatic Portosystemic Shunt (TIPSS) if above measures fail

Question 3

What happens during a TIPSS procedure?

Answer 3

connects the hepatic vein to the portal vein

Question 4

Common complication following TIPSS procedure

Answer 4

exacerbation of hepatic encephalopathy