ESOPHAGEAL AND GASTRIC VARICES MANAGMENT IN PATIENTS WITH CIRRHOSIS: SCREENING, PROPHYLAXIS AND ACUTE BLEEDING TREATMENT

Usually there are collaterals between the portal venous system and the systemic circulation. In normal circumstances the blood circulation is directed from collaterals to the portal vein; however, in the presence of portal hypertension, this is reversed resulting in the appearance of esophageal and gastric varices. The standard diagnostic is practiced with digestive system endoscopy and every patient with cirrhosis should be checked with this procedure within the twelve months following the diagnosis in a period not exceeding three months if presents a decompensated cirrhosis. The varices can be classified like small (< 5 mm) or big (< 5 mm) based on their size, likewise must report the presence of red spots in the wall because this information, also the Child Pugh Turcotte test, are essential for risk stratification and defining the need for the use of prophylaxis in the variceal bleeding. The nonselective beta blockers and endoscopic elastic band ligation are the two treatments currently accepted to prevent the variceal hemorrhage. The choice of method depends on each patient characteristics and the available resources. During the acute hemorrhage the treatment has as a goal to restore the volemia, prevent the complications and the use of splanchnic vasoconstrictors to diminish the portosystemic collaterals circulation. In case of refractory bleeding, the intrahepatic portosystemic derivation and surgical portosystemic shunt can be used, but they use is limited because these treatments are only available in advanced hospitals. Rev.cienc.biomed. 2015;6(2):381-389. KEYWORDS Esophageal varices; Liver cirrhosis; Bleeding; Screening