How do you control variceal bleeding?

Treatments used to stop bleeding and reverse the effects of blood loss include:

1. Using elastic bands to tie off bleeding veins.
2. Medications to slow blood flow into the portal vein.
3. Diverting blood flow away from the portal vein.
4. Placing pressure on varices to stop bleeding.
5. Restoring blood volume.
6. Preventing infection.

What is the recommended treatment for active variceal hemorrhage?

Treatment of acute variceal hemorrhage involves careful volume resuscitation, administration of antibiotics, drugs to reduce portal hypertension and prompt endoscopy therapy. Combination of pharmacologic and endoscopy therapy is employed for secondary prevention of variceal hemorrhage.

How do you manage acute variceal bleeding?

If variceal bleeding is suspected, medical therapy with vasopressors should be initiated immediately, and as there is a high risk of bacterial infection due to bleeding, prophylactic antibiotics should be administered.

How is variceal bleeding diagnosed?

Red lines on the veins are a sign of bleeding. The physician may also use the endoscope to examine the stomach and the upper part of the small intestine. This is called an esophogastroduodenoscopy (EGD). Imaging by CT or MRI scan is also used to diagnose esophageal varices, often in combination with endoscopy.

What causes variceal bleeding?

Esophageal varices develop when normal blood flow to the liver is blocked by a clot or scar tissue in the liver. To go around the blockages, blood flows into smaller blood vessels that aren’t designed to carry large volumes of blood. The vessels can leak blood or even rupture, causing life-threatening bleeding.

How long can you live with bleeding varices?

Mean survival in these 147 patients who had variceal eradication was 47.1 months (median, 36.8 months) with the mean survival in Child-Pugh grades A, B, and C of 40.2, 37.4, and 24.0 months, respectively.

What therapy is recommended for this patient to reduce his risk of esophageal variceal hemorrhage?

Beta blockers — Beta blockers, which are traditionally used to treat high blood pressure, are the most commonly recommended medication to prevent bleeding from varices. Beta blockers decrease pressure inside of the varices, which can reduce the risk of bleeding by 45 to 50 percent [1].

What antibiotics are used for variceal bleeding?

AASLD and ACG practice guideline in 2007 recommended the use of short term prophylactic antibiotics in cirrhotics and GI bleeding with or without ascites[44,45]. Oral Norfloxacin 400 mg q12h for 7 d was the suggested schedule, with oral or iv ciprofloxacin the alternative.

How long can you live with esophageal varices?

Why does portal pressure rise in variceal bleeding?

The outcome for patients with variceal bleeding depends on achieving hemostasis and avoiding complications related to bleeding or underlying chronic liver disease. A rise in portal pressure (portal hypertension) occurs when there is resistance to outflow from the portal vein.

Is it safe to use proton pump inhibitors for variceal bleeding?

Proton pump inhibitors (PPI) It is not recommended to use PPI during variceal bleeding. A randomized trial has studied the effect of PPI administration after endoscopic band ligation (EBL) [17]. The size of post-banding ulcers was smaller in the PPI group but their number and clinical repercussions were similar.

How is a balloon tamponade used to treat variceal bleeding?

Balloon tamponade through a nasogastric tube equipped with inflatable balloons (esophagus and stomach), usually named Blakemore’s tube, is effective to control variceal bleeding [42,43]. It is associated with severe complications such as necrosis or perforation of the esophagus and aspiration pneumonia.

Is it safe to take Terlipressin for variceal bleeding?

Terlipressin is a vasopressin analog. It is an arterial vasoconstrictor with splanchnic and general effect. It should not be used in high-cardiovascular-risk patients. Early administration of terlipressin against placebo during variceal bleeding has led to an improved survival [ 28, 29 ].