Algorithm for the Management of Bleeding Esophageal Varices - Flowchart
Algorithm for the Management of Bleeding Esophageal Varices - Flowchart Esophageal Varices Esophageal Varices
«Flowchart»

Acute bleeding from esophageal varices

Acute bleeding from esophageal varices

Acute bleeding from esophageal varices

Resuscitation
Vasoactive agent (e.g., octreotide)
Antibiotic (e.g., norfloxacin)
Transfusion to hematocrit value of 24%

Resuscitation
Vasoactive agent (e.g., octreotide)
Antibiotic (e.g., norfloxacin)
Transfusion to hematocrit value of 24%

Resuscitation
Vasoactive agent (e.g., octreotide)
Antibiotic (e.g., norfloxacin)
Transfusion to hematocrit value of 24%




Upper endoscopy
Variceal ligation (or sclerotherapy)

Upper endoscopy
Variceal ligation (or sclerotherapy)

Upper endoscopy
Variceal ligation (or sclerotherapy)


Repeat endoscopic therapy

Repeat endoscopic therapy

Repeat endoscopic therapy

Bleeding controlled

Bleeding controlled

Bleeding controlled

Yes

Yes

Yes

No

No

No

TIPS

TIPS

TIPS

Secondary prophylaxis

Secondary prophylaxis

Secondary prophylaxis

End

End

End

Balloon tamponade

Balloon tamponade

Balloon tamponade

Bleeding controlled

Bleeding controlled

Bleeding controlled

Yes

Yes

Yes

No

No

No

MELD, Model end state liver disease; RBC, red blood cell; TIPS, transjugular intrahepatic portosystemic shunt.

MELD, Model end state liver disease; RBC, red blood cell; TIPS, transjugular intrahepatic portosystemic shunt.

MELD, Model end state liver disease; RBC, red blood cell; TIPS, transjugular intrahepatic portosystemic shunt.

MELD RBC TIPS

Child-Pugh class B or C
or
MELD score >18 with transfusion requirement for >4 units of RBCs

Child-Pugh class B or C
or
MELD score >18 with transfusion requirement for >4 units of RBCs

Child-Pugh class B or C
or
MELD score >18 with transfusion requirement for >4 units of RBCs


or or

Yes

Yes

Yes

No

No

No