Taking the tension out of portal hypertension

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South African Journal of Surgery

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Health and Medical Publishing Group


University of Cape Town

Bleeding from oesophageal varices is the most serious complication of portal hypertension and accounts for most cirrhosis-related deaths. A quarter of high-risk cirrhotic patients with liver decompensation who present with a first major variceal bleed die as a consequence of the bleed. After control of the index bleed, there is a 70% chance of rebleeding with a similar mortality if further effective treatment is not given. Mortality is related to several factors, including failure of rapid control of initial bleeding, early rebleeding, presence and severity of underlying liver disease and functional hepatic reserve. Optimal emergency management requires an efficient and organised team to provide accurate initial assessment of the patient, effective resuscitation, rapid endoscopic diagnosis, successful intervention with control of bleeding, and prevention of early rebleeding as well as the anticipated complications of liver decompensation including spontaneous bacterial peritonitis, progressive liver and renal failure and hepatic encephalopathy. The modern management of acute, persistent variceal bleeding is therefore best accomplished by a skilled, knowledgeable and well-equipped team that can offer the full spectrum of treatment options.