Management of Portal Hypertension
A 37-year-old woman with a history of hepatitis C, cirrhosis, and esophageal varices presented with hematemesis and melena. The patient had a history of a prior esophageal variceal bleeding episode 7 years ago, which required transfusion of four units of packed red blood cells (PRBC) and had been treated with endoscopic sclerotherapy. She was placed on nadolol at that time.
Endoscopic treatment: sclerotherapy or band ligation.
Transjugular intrahepatic portal systemic shunt (TIPS).
A surgical shunt.
The patient re-presents 1 year prior to her current admission with a further variceal bleed documented at endoscopy, which required five units of PRBC. The acute episode of bleeding was managed with variceal banding, and the patient underwent a course of banding on an outpatient basis. She had...
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