10. Treatment of Acute Bleeding

Treatment of the Acute Bleeding Episode

  1. Roberto de Franchis MD, AGAF Professor of Gastroenterology Head
  1. Loren Laine MD Professor1,
  2. Shahab Abid MD, MBBS, FCPS, FRCP (Edin.), FACG Associate Professor2,
  3. Agustin Albillos MD3,
  4. Patrick S Kamath MD Professor4,
  5. Jean-Pierre Vinel MD Professor Head5 and
  6. Juan Carlos García-Pagán MD, PhD Consultant6

Published Online: 17 NOV 2010

DOI: 10.1002/9781444393989.ch10

Portal Hypertension V: Proceedings of the Fifth Baveno International Consensus Workshop, Fifth Edition

Portal Hypertension V: Proceedings of the Fifth Baveno International Consensus Workshop, Fifth Edition

How to Cite

Laine, L., Abid, S., Albillos, A., Kamath, P. S., Vinel, J.-P. and García-Pagán, J. C. (2011) Treatment of Acute Bleeding, in Portal Hypertension V: Proceedings of the Fifth Baveno International Consensus Workshop, Fifth Edition (ed R. de Franchis), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444393989.ch10

Editor Information

  1. Department of Medical Sciences, University of Milan, and Gastroenterology 3 Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Mangiagalli and Regina Elena Foundation, Milan, Italy

Author Information

  1. 1

    Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

  2. 2

    Department of Gastroenterology, Aga Khan University Hospital, Karachi, Pakistan

  3. 3

    Department of Gastroenterology, Hospital Ramon y Cajal, University of Alcalà, Madrid, Spain

  4. 4

    Mayo Clinic College of Medicine, Rochester, MN, USA

  5. 5

    University Hospital Toulouse-Purpan, and Inserm U858, Toulouse, France

  6. 6

    Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Spain

Publication History

  1. Published Online: 17 NOV 2010
  2. Published Print: 14 JAN 2011

ISBN Information

Print ISBN: 9781444334494

Online ISBN: 9781444393989



  • treatment of acute bleeding;
  • acute variceal bleeding (AVB);
  • AVB management - into three phases;
  • goal of early resuscitation in variceal bleeding - tissue oxygenation with correction of intravascular volume depletion and anaemia;
  • fluid resuscitation, balancing risk of end-organ damage - decreased perfusion and risk of perpetuating bleeding with overexpansion;
  • correcting defects in haemostasis;
  • cirrhotics, simultaneous impairment in procoagulant factors - except for factor VIII and von Willebrand's and anticoagulants;
  • complications, prevention and management - of bacterial infection;
  • renal function, and fluid resuscitation - avoiding drugs, worsening hypovolaemia;
  • vasoactive medications, before endoscopy in patients - suspected/potential varices, as in cirrhotics


This chapter contains sections titled:

  • Introduction

  • General management

  • Primary therapy for acute variceal bleeding

  • Rescue therapy for acute treatment failure

  • References

  • Blood volume restitution

  • Antibiotic prophylaxis

  • Prevention of hepatic encephalopathy

  • Assessment of prognosis

  • Timing of endoscopy

  • Pharmacological treatment

  • Endoscopic treatment

  • Early TIPS placement

  • Use of balloon tamponade

  • Use of self-expandable metal stents

  • Management of treatment failures

  • Areas requiring further study