PATHOPHYSIOLOGY AND TREATMENT OF VARICEAL HEMORRHAGE

Portal hypertension results from increases in portal flow and portal v ascular resistance, Factors increasing portal blood flow are predomina ntly humoral, Resistance to portal flow has a fixed component due to d istortion of the vasculature by cirrhotic nodules and a variable compo nent that is related to vasoactive substances, Varices result from an increase in portal pressure, Factors predicting the risk of variceal b leeding include continued alcohol use, poor liver function, large vari ces, and red wale markings on varices at endoscopy, Octreotide is prob ably the drug of choice for pharmacologic management of bleeding esoph ageal varices, Propranolol has an established role in the prevention o f variceal hemorrhage, and variceal band ligation may be the preferred endoscopic technique. Transjugular intrahepatic portosystemic shunts have emerged as an important treatment for patients in whom pharmacolo gic and endoscopic therapies have failed and are an effective bridge t o liver transplantation.