SIR 2024
Portal Hypertension
Daniel Burke, IV, BS (he/him/his)
Medical Student
Kaiser Permanente School of Medicine
Financial relationships: Full list of relationships is listed on the CME information page.
Kavenpreet Bal, MS
Medical Student
Kaiser Permanente Bernard J. Tyson School of Medicine
Financial relationships: Full list of relationships is listed on the CME information page.
Sophia M. Durney, BS (she/her/hers)
Medical Student
Kaiser Permanente Bernard J Tyson School of Medicine
Financial relationships: Full list of relationships is listed on the CME information page.
Alok Bhatt, MD
Assistant Program Director of Vascular and Interventional Integrated Residency
Kaiser Permanente physician
Financial relationships: Full list of relationships is listed on the CME information page.
To provide a review of updated guidelines for the medical management of variceal hemorrhage, including vasoactive medication and antibiotic prophylaxis, and how medical management fits in the paradigm of endoscopic, surgical, and percutaneous interventions for variceal bleeds.
Background:
Varices are abnormally engorged vessels that can manifest throughout the circulatory system secondary to increased distal pressure and congestion. In the gastrointestinal system, varices with portosystemic collaterals are a compensatory mechanism for portal hypertension {1}. Greater flow rate and engorgement with prolonged portal hypertension increases the risk of variceal hemorrhage, which represents a major cause of morbidity and death in patients with cirrhosis. Medical management of acute variceal bleeds is critical for preventing hemorrhagic shock in conjunction with endoscopic, surgical, and percutaneous options {2-4}. In this educational exhibit, we will present the mechanism of GI variceal bleeding, overview of resuscitative and hemostatic medical interventions, and treatment considerations for maximizing survival.
Clinical Findings/Procedure Details:
This exhibit will:
Review the etiology of gastrointestinal varices and mechanism of variceal hemorrhage
Describe the various medical interventions in the setting of variceal bleeding
Describe the indications, most common complications, and efficacy of each medical intervention in achieving hemostasis
Review the impact of interventions on morbidity and mortality
Gastrointestinal variceal bleeding represents a medical emergency that may require pharmacologic stabilization, visualization of the bleeder with endoscopy, surgical ligation, and percutaneous vein embolization. This exhibit provides a foundation in the medical management of variceal bleeds, and can inform practices in hemorrhage prevention and intervention for at-risk patients.