Causes:

• Cirrhosis of liver 
• Portal hypertension

Symptoms:

• Blood vomits
• Black tarry stool  or bloody stool
• Hypotension (low blood pressure)
• Decrease urination  from low blood pressure
• Excessive thirst
• Syncope or lightheadedness
• Shock ( because of hypovolemia)

Diagnosis:

Endoscopy:

• If any dilated veins are found in esophagus, they're graded according to their size and checked for red streaks, which usually indicate a significant risk of bleeding.

Imaging studies:

CT and MRI - These tests  are not substitues for endoscopy. But they are mmost often used in addition to endoscopy or when endoscopy cannot be performed.

Treatment :

1. Variceal ligation:

• Ssnares the varices with an elastic band  Under endoscopiuc guidance .

2.Endoscopic injection therapy:

Bleeding varices are injected with a solution that shrinks them.There are few complications with this procedure like perforation and scarring which sometimes leads to trouble swallowing .

3.Medical treatment:

Octreotide

• decrease pressure in varices
• decreases splanchnic blood flow. Usually it is used often in combination with  endoscopic therapy.

4.Ballon tamponade:

This is the temporary procedure to stop sever bleeding while waiting for a more permanent procedure.

5.Shunt procedure:

Shunt is placed in between portal vein and hepatic vein ,which carries blood from liver to heart. So shunt can control bleeding through esophageal varices. This procedure may lead  to serious complications liver failure and encephalopathy.

6.Liver transplant:

Liver transplant is preferred in patients who has recurrent or severe bleeding of esophageal varices.

 Prevention:

• Treatment of underlying  primary medical problem.
• Prophylactic treatment of patients with large varices who have never bled, with non-selective beta-blockers like propranolol has been shown to significantly decrease the risk of future bleeding. Propranolol should be administered in doses sufficient to decrease the resting pulse by 25%. Beta-blockers have also been shown to be useful in the secondary prevention of recurrent bleeds.