Cirrhosis and its ComplicationsPortal hypertension and variceal bleeding
 Renal : Ascites, Hepatorenal syndrome
 CNS: Encephalopathy
 Cardiovascular: Hyperdynamic circulation
                               Cirrhotic cardiomyopathy
                               Electrophysiological abnormalities
 Pulmonary: Hepatopulmonary syndrome
                       Porto-pulmonary hypertension
                       Hepatic hydrothorax
 Bacterial infection

Risk Factors for Variceal Bleeding
Endoscopic Appearance
      Size of varices, Presence of red signs
      (red wale markings, cherry red spots)
Severity of liver cirrhosis
HVPG > 12 mmHg
Continuous alcohol consumption

Treatment of Acute Variceal Bleeding
Drug therapy
Endoscopic  treatments
Balloon Tamponade
Transjugular intrahepatic portal-systemic shunt
   (TIPS)
Surgery

Accepted indications
Failed to control acute variceal bleeding after standard medical and endoscopic treatment
Bleeding gastric varices
Bleeding varices prior to liver transplantation
Refractory ascites

Experimental indications
Long-term treatment of portal hypertension
Cirrhotic hydrothorax
Budd-Chiari syndrome
Hepatorenal syndrome

Baveno IV (2005) Consensus Statement of International Portal Hypertension Workshop for Acute Variceal Bleeding
Blood volume restitution should be done cautiously and conservatively.
Antibiotics prophylaxis is an integral part of therapy for patients presenting with variceal bleeding and should be instituted from admission.
Vasoactive drugs should be started as soon as possible, before endoscopy and maintained for 2-5 days.
Ligation is the recommended form of endoscopic therapy for acute EV bleeding although sclerotherapy may be used if ligation
is technically difficult.
Endoscopic treatments are best used in association with pharmacological therapy, which preferably should be started
before endoscopy.
Failure of initial therapy with combined drug and endoscopic therapy are best managed by a second attempt at endoscopic therapy or TIPS.

Prevention of Recurrent Variceal Bleeding
Drug therapy (Non-selective Beta Blockers)
Endoscopic  treatments (Band Ligation)
Transjugular intrahepatic portal-systemic shunt
   (TIPS)
Surgery

Primary Prophylaxis of Variceal Bleeding
Drug therapy (Non-selective Beta Blockers)
Endoscopic  treatments (Band Ligation)

Baveno IV (2005) Consensus Statement of International Portal Hypertension Workshop for Primary Prophylaxis
Beta-blockers reduce the risk of first variceal bleeding.
Prophylactic band ligation is useful in preventing variceal bleeding in patients with medium and large varices.
Band ligation is more effective than beta-blockers in preventing  first variceal bleeding but does not improve survival. However, the long-term benefits of band ligation are uncertain because of the short duration of follow-up.
Band ligation should be offered to patients with medium/large varices and contraindications or intolerance to beta-blockers.

Share Medical Presentations