Gastroesophageal varices. Management of hemorrhage in the cirrhotic patient.
The appropriate management of the cirrhotic patient with bleeding gastroesophageal varices presents a continuing challenge for the primary care physician. These patients demand rapid assessment and skillful resuscitation. Confirmation of the suspected diagnosis should be sought by endoscopy. Endoscopic sclerotherapy currently is the treatment of choice for acute variceal hemorrhage. Unfortunately, despite prevention of recurrent hemorrhage, neither sclerotherapy nor portosystemic shunting has effected any significant alteration in the poor long-term survival of these patients. Newer approaches such as the use of propranolol offer some hope but doubtless will be hampered by the failure to alter the underlying liver disease.
D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*