A 59 year old female, who presented with abdominal pain, diarrhea, and ascites, developed major bleeding from esophageal varices. [ncbi.nlm.nih.gov]

• Internal Bleeding

  The risk of bleeding from esophageal varices is 30% in the first year after identification. Bleeding from esophageal varices accounts for approximately 10% of episodes of upper gastrointestinal bleeding. [emedicine.com]

• Gastropathy

  Four (8%) patients rebled, three from esophageal varices, and one from portal hypertensive gastropathy. Esophageal varices were eradicated in 47 (94%) patients (3.1 +/- 1.3 sessions). Time needed till eradication was 6.2 +/- 1.9 weeks. [ncbi.nlm.nih.gov]

  Bleeding from ectopic varices and due to hypertensive gastropathy should be treated individually either by endoscopy, TIPS or drug therapy. © 2005 S. [doi.org]

  […] present in patients with cirrhosis Asterixis ("flapping tremor," "liver flap") Complications of portal hypertension may present with the following symptoms: Hematemesis or melena: May indicate gastroesophageal variceal bleeding or bleeding from portal gastropathy [emedicine.com]

Diagnostic workup was completed within 6 hours and EST or EPCS was initiated within 8 hours of initial contact. Longterm EST was performed according to a deliberate schedule. [ncbi.nlm.nih.gov]

Ligation should therefore be considered the endoscopic treatment of choice in the treatment of esophageal varices. [ncbi.nlm.nih.gov]

Pregnancy does not appear detrimental to the maternal prognosis despite the theoretical probability of raised portal pressure. About 70% of those with demonstrable varices will bleed during pregnancy; the overall mortality rate is 20%. [ncbi.nlm.nih.gov]

Incidence, predictive factors, and prognosis of the hepatorrenal syndrome in cirrhosis with ascites. Gastroenterology 1993;105:229-36. Bañares R, Albillos A, Rincón D, et al. [sapd.es]

Etiology of portal hypertension was bilharziasis in 54.9% and posthepatitic in 14.8%. Child-Pugh grading on admission was A: 47.2%, B: 28.8%, and C: 14%. Hemorrhage was controlled in all cases. [ncbi.nlm.nih.gov]

Etiology and Pathophysiology Increase in vascular resistance The initial factor in the etiology of portal hypertension is an increase in the vascular resistance to the portal blood flow. [emedicine.com]

Epidemiology of Hepatit is Virus B and C. Archives of Medical Research 2007; 38:606-11. Naveau S, Perlemuter G, Balian A. Epidemiology and natural hist ory of cirrhosis.Rev Prat 2005; 55(14):1527-32. [medigraphic.com]

[…] bacterial infection could also trigger variceal bleeding through a number of mechanisms, including the following: The release of endotoxin into the systemic circulation Worsening of hemostasis Vasoconstriction induced by the contraction of stellate cells Epidemiology [emedicine.com]

Successful control requires knowledge of the pertinent anatomy, underlying pathophysiology of portal hypertension, and natural history of gastro-esophageal varices. [ncbi.nlm.nih.gov]

Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 20. Weinberg AJ. Esophageal varices. In: Ferri FF, ed. Ferri's Clinical Advisor 2018. [nlm.nih.gov]

(See Etiology and Pathophysiology .) The response to increased venous pressure is the development of collateral circulation that diverts the obstructed blood flow to the systemic veins. [emedicine.com]

Bleeding must be controlled quickly to prevent shock and death. If massive bleeding occurs, a person may need to be put on a ventilator to protect their airway and prevent blood from going down into the lungs. [nlm.nih.gov]

To prevent further bleeding the drug should be continued for two to five days after endoscopic variceal ligation. [ncbi.nlm.nih.gov]

Their effectiveness in preventing varices is unknown. [doi.org]