Variceal Hemorrhage

  • Elizabeth A. BelloliEmail author
  • Steven E. Gay


Acute variceal hemorrhage is one of the most common reasons for intensive care unit admission of patients with cirrhosis, with mortality rates improved in recent years to 15–20 %. Patients with variceal bleeding require immediate and aggressive resuscitation, with the goals of maintaining end-organ perfusion and achieving hemostasis as soon as possible. The critical care practitioner must be familiar with recommended medications and transfusion parameters, and indications for more invasive procedures should endoscopic measures fail to halt bleeding. Complications such as infection and hepatic encephalopathy should be given attention. In this chapter, we will discuss typical management of a patient with suspected variceal bleeding and more controversial aspects in their care.


Varices Bleeding Cirrhosis Vasoconstrictors Resuscitation Intubation Coagulopathy Surgery TIPS BRTO 

Supplementary material

Video 62.1

Following TIPS placement, angiography demonstrates a large gastric coronary varix (seen on the righthand portion of the screen) (Images courtesy of Dr. Bill Majdalany of the University of Michigan. (MP4 330 kb))


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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Internal Medicine, Division of Pulmonary & Critical Care MedicineUniversity of Michigan Health SystemAnn ArborUSA
  2. 2.Division of Pulmonary & Critical Care MedicineUniversity of Michigan Health SystemAnn ArborUSA

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