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Gastrointestinal - Esophageal Varices
In this episode, we review esophageal varices, a life-threatening complication of portal hypertension most commonly seen in patients with cirrhosis. We break down the pathophysiology of increased portal venous pressure leading to fragile, dilated submucosal veins at high risk of rupture. The discussion highlights the dramatic presentation of upper GI bleeding, the critical role of emergent endoscopy, and evidence-based management including fluid resuscitation, band ligation, octreotide, antibiotics, and TIPS for refractory cases. A focused, high-yield review emphasizing early stabilization, prevention of rebleeding, and risk reduction strategies in patients with chronic liver disease.
References
1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817.
2) Meseeha M, Attia M. Esophageal Varices. [Updated 2023 Aug 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448078/
3) Pallio S, Melita G, Shahini E, Vitello A, Sinagra E, Lattanzi B, Facciorusso A, Ramai D, Maida M. Diagnosis and Management of Esophagogastric Varices. Diagnostics (Basel). 2023 Mar 8;13(6):1031. doi: 10.3390/diagnostics13061031. PMID: 36980343; PMCID: PMC10047815.
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By Kristopher Maday, PA-C, DFAAPAIn this episode, we review esophageal varices, a life-threatening complication of portal hypertension most commonly seen in patients with cirrhosis. We break down the pathophysiology of increased portal venous pressure leading to fragile, dilated submucosal veins at high risk of rupture. The discussion highlights the dramatic presentation of upper GI bleeding, the critical role of emergent endoscopy, and evidence-based management including fluid resuscitation, band ligation, octreotide, antibiotics, and TIPS for refractory cases. A focused, high-yield review emphasizing early stabilization, prevention of rebleeding, and risk reduction strategies in patients with chronic liver disease.
References
1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817.
2) Meseeha M, Attia M. Esophageal Varices. [Updated 2023 Aug 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448078/
3) Pallio S, Melita G, Shahini E, Vitello A, Sinagra E, Lattanzi B, Facciorusso A, Ramai D, Maida M. Diagnosis and Management of Esophagogastric Varices. Diagnostics (Basel). 2023 Mar 8;13(6):1031. doi: 10.3390/diagnostics13061031. PMID: 36980343; PMCID: PMC10047815.