Overview Esophageal varices develop in patients with portal hypertension, most commonly secondary to hepatic cirrhosis (see Chapters 74 , 76 , and 80 ). They occur most frequently in the distal esophagus, although they may be accompanied by gastric varices.…
Treatment of esophagogastric varices This chapter addresses the role of devascularization procedures in the management of portal hypertensive bleeding. The management of variceal bleeding is based on the underlying cause, liver function, presentation, and the patient’s clinical condition. Several nonsurgical…
Overview The most important aspect of care in patients with suspected variceal or other portal hypertensive hemorrhage is adequate resuscitation and stabilization while directed diagnostic maneuvers and therapies are being coordinated (see Chapters 26 and 80 ). Although this chapter…
Introduction The presence of portal hypertension is a prerequisite for the development of, and bleeding from, varices. Portal hypertension is defined by a portal venous pressure exceeding the inferior vena cava pressure by more than 5 mm Hg (see Chapters…
A brief history of ascites and portal hypertension Ascites is the pathologic accumulation of fluid in the peritoneal cavity. It is both the most frequent and prominent clinical sign of liver disease. Notwithstanding the near reflexive association of ascites with…
Failing liver A failing liver is a serious condition that warrants a multimodal approach (see Chapter 77 ). The best treatment for a failing liver in the setting of acute liver failure (ALF; no history of liver disease) or acute-on-chronic…
Acute liver failure (ALF), a term that is equivalent to the now archaic “fulminant hepatic failure,” evolves after a catastrophic insult to the liver and results in the development of the dual characteristics of coagulopathy and encephalopathy within a matter…
Normal pressure in the portal venous system ranges from 5 to 10 mm Hg. Portal hypertension is defined as portal venous pressure exceeding 10 mm Hg. Hepatic venous pressure gradient (HVPG) is a surrogate marker of portal hypertension. Normal HVPG…
Overview Chronic liver disease and cirrhosis were the eleventh leading cause of death in the United States and resulted in more than 44,358 deaths in 2019. Chronic viral infection (see Chapter 68 ) and alcohol abuse account for the majority…
Overview Cirrhosis, the final stage of untreated chronic liver disease (see Chapter 7 ), is primarily attributable to alcohol abuse, viral hepatitis C (see Chapter 68 ), and, increasingly, nonalcoholic steatohepatitis (NASH; see Chapter 69 ) in the United States…