Management

The treatment for acute bleeding from esophageal varices includes initial resuscitation. When the patient is stable, endoscopic sclerosis or ligation are effective means of controlling the bleeding. Drugs such as vasopressin and octreotide are also effective as temporizing measures in controlling the bleeding. Sengstaken-Blakemore balloon tamponade can be used to stop exsanguinating hemorrhage when the patient is nonresponsive to endoscopic or pharmacologic attempts. TIPS (transjugular intrahepatic portosystemic shunt) can also be used should initial treatments fail.

Emergency surgery is indicated when the above mentioned treatments have failed to stop the bleeding. The most effective emergent procedure is the portacaval shunt as it can rapidly decompresses the portal venous circulation.

Table 13.3. Child-Pugh classification

Criteria

A

B

C

Bilirubin

< 2

2-3

> 3

Albumin

> 3.5

2.8-3.5

< 2.8

Prothrombin time

7-3

4-6

> 6

Ascites

None

Mild

Moderate

Neurologic disorder

None

Mild

Severe

0 0

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