What is the nonendoscopic management of variceal bleeding?
- If a variceal etiologic factor is suspected, octreotide bolus (50 mcg) with subsequent infusion (50 mcg/h) should be initiated to decrease portal pressures and ongoing bleeding.
- Antibiotics (typically a fluoroquinolone or ceftriaxone if there is a high local prevalence of quinolone-resistant organisms) should be given for 7 days in all patients with cirrhosis who present with UGI bleeding (variceal or nonvariceal) to decrease the risk of rebleeding, infection, and mortality.
- Patients with cirrhosis are more likely to require correction of coagulopathy and thrombocytopenia, and may develop hepatic encephalopathy, which can be treated with lactulose or rifaximin.
