I - General Resuscitation: 1.Central venous access. 2.Blood preparation. 3. Vit. K injection (10 mg I.V.). 4.Correction of coagulopathy. 5.Correction of thrombocytopenia. 6.Endoscopic evaluation. 7.Avoid bronchial aspiration. 8.Sengestaken – Blakemore tube.
N.B. Severity of bleeding. Liver cirrhosis. Sengestaken – Blakmore tube. Oesophageal aspiration channel Oesophageal balloon 20-30 mmHg greater than predetermined pressure Gastric balloon at least 300 ml at 300 ml Gastric aspiration channel
II - Drugs for variceal bleeding: 1.Vasopressin / 20 units in 10ml 5% D/W. over 10 minutes. 2.Nitroglycerine / 40 g/min. 3.Octreotide. III - Endoscopic treatment of varices: 1.Sclerotherapy. 2.Banding.
IV - Tipss -Indication. -Procedure. -Complications. -Contraindication. V - Surgical shunts - Indication. - Types: 1. Selective (splenorenal). 2. Non selective (portosystemic). Perforation of liver. Occlusion. Encephalopathy. Stenosis
Surgical shunts (a-d). Surgical treatments for portal hypertension involve shunting portal blood into the systemic veins. This commonly involves (a) a side-to-side proto-caval anastomosis. (b) end-to-side porto-caval, (c) meso-caval or (d) spleno-renal.
N.B. Prophylactic shunting. Emergency shunts. VI - Oesophageal stapled transection. VII- Variceal bleeding and liver transplant.