Management of portal hypertension and Budd-Chiari syndrome

Rik of variceal bleeding can be estimated by the size of varices, presence of endoscopic red signs and degree of liver dysfunction. All cirrhotic patients with large varices and severe liver disease should receive primary prophylaxis with non-selective β-blockers. Banding ligation is equivalent and is used if there are contraindications or intolerance to these drugs. Acute variceal bleeding should be managed in a gastrointestinal bleeding unit. Prophylactic quinolone antibiotics and administration of vasoactive drugs should always be given. Ligation and sclerotherapy should take place at diagnostic endoscopy. Secondary prophylaxis of variceal bleeding is mandatory with either β-blockers or ligation. Preliminary evidence suggests the combination is best. Hepatic outflow obstruction syndromes have a wide spectrum of presentation; underlying thrombophilic conditions should be sought. Fulminant failure requires liver transplantation, decompression with transjugular intrahepatic stent shunt is effective in many cases. Hepatic and other venous webs can be treated with interventional radiological techniques. Anticoagulation is first-line therapy and should be continued lifelong.