In addition to prophylaxis or therapy of variceal hemorrhage, treatment of the underlying disease is the primary concern.
General measures
- Alcohol abstinence (complete abstinence from alcohol).
- Nicotine restriction (refrain from tobacco use) – smoking promotes fibrosis (proliferation of connective tissue fibers) of the liver.
Conventional non-surgical therapy methods
- For acute variceal hemorrhage:
- Monitoring or observation of vital signs (respiration, body temperature, circulation).
- Volume administration – compensation of blood losses
- If necessary, intubation (insertion of a tube through the mouth or nose to secure the airway) – Caveat (Attention!): risk of aspiration (danger of inhaling stomach contents).
- Optimization of blood clotting
Operative therapy
In cases of unstoppable bleeding (failure of conservative therapy) and for secondary prophylaxis (lowering of portal pressure), the following shunt procedures (shunt = vascular connection) may be considered:
- TIPSS (transjugular intrahepatic portosystemic shunt stent) – angiographically created connection between the portal vein (vena portae) and the hepatic vein, through the liver, allowing blood stagnated in the portal system to drain via the great circulation; recurrent bleeding risk and mortality (mortality) are reduced.
- Shunt surgery (backup procedure):
- Selective portosystemic shunt (distal splenorenal shunt (Warren shunt)) – connection of the splenic vein to the renal vein (renal vein) to selectively relieve bypass circulation while maintaining hepatic perfusion.
- Complete portosystemic shunt (portocaval end-to-side anastomosis (PCA)) – complete drainage of the portal vein into the inferior vena cava (inferior vena cava) with elimination of the liver to completely relieve pressure in the bypass circuits (rarely performed)
The procedures are not suitable for primary prophylaxis!
Regular control examinations
- Regular medical checkups
Nutritional medicine
- Nutritional counseling based on nutritional analysis
- Nutritional recommendations according to a mixed diet taking into account the disease at hand. This means, among other things:
- A total of 5 servings of fresh vegetables and fruit daily (≥ 400 g; 3 servings of vegetables and 2 servings of fruit).
- Once or twice a week fresh sea fish, i.e. fatty marine fish (omega-3 fatty acids) such as salmon, herring, mackerel.
- High fiber diet (whole grains, vegetables) – Caveat for esophageal varices: no hard foods like rolls or bread crumbs. They can injure the esophageal varices.
- Observe the following special dietary recommendations:
- The diet should be liquid or mushy:
- Mashed potatoes
- Vegetable purees
- Compote purees
- Soups
- Yogurts
- The diet should be liquid or mushy:
- Provided that liver cirrhosis (liver shrinkage) is the cause of portal hypertension, you will also receive from us “dietary recommendations in liver cirrhosis”.
- Selection of suitable food based on the nutritional analysis.
- See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
- Detailed information on nutritional medicine you will receive from us.
