In emergency situations, care is directed at stopping blood loss, maintaining plasma volume, correcting disorders in coagulation induced by cirrhosis, and appropriate use of antibiotics such as quinolones or ceftriaxone. Blood volume resuscitation should be done promptly and with caution. The goal should be hemodynamic stability and hemoglobin of<unk> er 8 g/dl. Resuscitation of all lost blood leads to increase in portal pressure leading to more bleeding. Volume resuscitation can also worsen ascites and increase portal pressure. (AASLD guidelines) Therapeutic endoscopy is considered the mainstay of urgent treatment. The two main therapeutic approaches are<unk> l ligation (banding) and sclerotherapy. In cases of refractory bleeding, balloon tamponade with a Sengstaken-Blakemore tube may be necessary, usually as a bridge to further endoscopy or treatment of the underlying cause of bleeding (ie: portal hypertension). Esophageal devascularization operations such as the Sugiura procedure can also be used to stop complicated bleeding. Methods of treating the portal hypertension include: transjugular intrahepatic portosystemic shunt (TIPS), distal splenorenal shunt procedure, or liver transplantation. Nutritional supplementation is necessary if the person has been unable to eat for more than four days. Terlipressin and octreotide for one to five days have also been used.
Esophageal varices
Nosebleed
Gastric varices
Esophageal stricture
Nutcracker esophagus
Anorectal varices
Esophageal web
Esophageal disease