Etiology

• Suspected if Pt has Hx of Cirrhosis (Portal Hypertension)
  • Can be triggered by Post parandial, Peritonitis, Valsalva maneuver

Pathogenesis

• Porto-caval venous anastomosis and collaterals exist at lower esophagus
• Portal hypertension → collaterals getting used → develop varices → easy to bleed

Classification

• Esophageal (more common)
• Gastric (less common)

Presentation

• No pain
• N/V - Nausea/vomitting
• Hematemesis (coffee-ground emesis RARE)
• Melena
• !Shock
  • Low BP + High HR, Light-headed, !Syncope

Acute Management

1. ABCs (primary survey) (resuscitation)
   • ETT - Endotracheal Intubation to protect airway from blood
   • IV Fluid Resuscitation for !Hypovolemia ↓ (not too much for too little)
     • Over-resuscitation can prolong bleeding
   • RBC transfusion if indicated (<70)
2. Pharmacotherapy
   • IV bolus or infusion of PPI (”-prazole”) → higher pH = better clot stability
   • Octreotide → constriction of splanchnic arterioles = decrease blood flow into the portal system
   • Prophylatic Anti-Microbial (IV CTX - Ceftriaxone (3 gen IV) ) for Cirrhosis patient who present with Ascites
     • Risk of SBP - Spontaneous bacterial peritonitis
3. Correct coagulopathy if applicable
4. Upper Endoscopy → within 12 h for sus. variceal cause
   • Confirm diagnosis
   • Determine Prognosis
   • Treatment: Esophageal varices
     • EVL - Endoscopic Varicial Ligation (Band) (more common)
     • Sclerotherapy (less common) → rarely used due to complications
   • Treatment: Gastric varices
     • Gluing (cyanoacrylate)