Veins in the lower oesophagus bulge into the lumen and are liable to bleed.
Pathognomic of portal hypetension. Blood from the postal circulation
enters the systemic circulation via portosystemic anastomoses. In the
oesophagus, this is between the left gastric and the azygous system via the
oesophageal venous plexus.
Large bore cannula. Crossmatch blood. Infuse colloid until blood arrives or use
O− blood. Vit-K.
Desmopressin or octreotide to promote splanchnic arteriolar constriction.
Endoscopy sclerotherapy. Sengstaken tube (baloon tamponade).
Transjugular intrahepatic stenting (TIPS). The risk is portosystemic encephalopathy.