THERAPEUTIC MODALITIES IN PORTAL-HYPERTENSION

Optimal medical management is with octreotide or terlipressin (Glypres sin) for acute variceal bleeding and combined beta-blocker and nitrate prophylaxis for prevention of rebleeding. Injection sclerotherapy is necessary to arrest acute bleeding, with variceal banding preferred fo r the obliteration of large varices. Transjugular intrahepatic portosy stemic shunts (TIPS) are best used for uncontrolled or recurrent bleed ing episodes which fail to respond to endoscopic or drug therapy. They can also rarely be used to treat refractory ascites. Surgical portosy stemic shunting and devascularization techniques have now been superse ded. Hepatic transplantation should be considered where overall hepati c function is poor.