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Continuing Education in Anaesthesia, Critical Care & Pain 2007 7(6):191-194; doi:10.1093/bjaceaccp/mkm038
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© The Board of Management and Trustees of the British Journal of Anaesthesia [2007]. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Variceal bleeding

Rebecca McKay, MBChB MRCP and Nigel R Webster, PhD MB ChB FRCA FRCP FRCS
Specialist Registrar Gastroenterology
Aberdeen Royal Infirmary
Institute of Medical Sciences
Foresterhill
Aberdeen AB25 2ZD
UK
Aberdeen Royal Infirmary
Institute of Medical Sciences
Foresterhill
Aberdeen AB25 2ZD
UK
Tel: +44 1224 555869 Fax: +44 1224 555766 E-mail: n.r.webster@abdn.ac.uk

Key Words: Mortality from gastro-oesophageal variceal haemorrhage is high. • Primary prophylaxis with ß-blockers is crucial. • Band ligation is the endoscopic procedure of choice to treat an acute bleed. • Antibiotics during an acute episode reduce mortality. • Liver transplantation should be considered in all cases.

The first 150 words of the full text of this article appear below.

Approximately 90% of patients with cirrhosis will have developed gastro-oesophageal varices within 10 yr. Oesophageal variceal haemorrhage is a devastating complication of cirrhosis with mortality as high as 25–50%.1 Therefore, prophylactic measures before the first bleed are crucial. If patients survive a variceal bleed, there is approximately a 70% risk that they will have a further bleed within the following 2 yr. Measures to minimize the risk of re-bleeding have been investigated and hospital mortality has decreased from 42% in 1980 to 14% in 2000. This review describes the factors involved in variceal haemorrhage, management of an acute bleed, and current opinions on appropriate prophylactic measures.


   Pathophysiology
 
Portal hypertension

Portal hypertension develops as a consequence of increased intrahepatic vascular resistance and increased blood flow through the portal system. Hepatic stellate cells in the space of Disse (subendothelial space between the sinusoids and hepatocytes) are activated and produce collagen that replaces the normal matrix. . . . [Full Text of this Article]

Predictors of variceal haemorrhage


   Primary prophylaxis
 

   Management of an acute variceal bleed
 
Resuscitation

Pharmacotherapy

Vasoconstrictors

Antibiotics

Endoscopy

Sclerotherapy

Band ligation

Glue

Balloon tamponade

Transjugular intrahepatic porto-systemic shunt

Surgery


   Complications of variceal bleeding
 

   Prevention of recurrent variceal bleeding
 
Pharmacotherapy

Endoscopy

Transjugular intrahepatic porto-systemic shunt


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