Medications such as beta blockers or nitrates may be prescribed
alone or in combination with endoscopic therapy to reduce the pressure in your
varices and further reduce the risk of recurrent bleeding.
Medications such as propranolol and isosorbide may be prescribed
to lower the pressure in the portal vein and reduce the risk of recurrent
bleeding.
The drug lactulose can help treat confusion and other mental
changes associated with encephalopathy.
Dietary and lifestyle changes
Maintaining good nutritional habits and keeping a healthy lifestyle will
help your liver function properly. Some of the things you can do to improve the
function of your liver include the following:
- Do not use alcohol or street drugs.
- Do not take any over-the-counter or prescription drugs without first
consulting with your physician or nurse. Some medications may make liver
disease worse, and they may interfere with the positive effects of your
other prescription medications.
- Follow the dietary guidelines given to you by your physician or nurse.
Follow a low-sodium (salt) diet. You will probably be required to consume no
more than 2 grams of sodium per day. Reduced protein intake is required only
if confusion is a symptom. Your dietitian will help you create a meal plan
that helps you follow these dietary guidelines.
Second level of treatment
If the first level of treatment does not successfully control your variceal
bleeding, you may require one of the following decompression procedures to
reduce the pressure in these veins.
- Transjugular intrahepatic portosystemic shunt (TIPS), a radiological
procedure in which a stent (a tubular device) is placed in the middle of the
liver.
- Distal splenorenal shunt (DSRS), a surgical procedure that connects the
splenic vein to the left kidney vein in order to reduce pressure in your
varices and control bleeding.
What tests are required before the TIPS and DSRS procedures?
Before receiving either of these procedures, you will have the following
tests to determine the extent and severity of your portal hypertension:
- Evaluation of your medical history
- A physical examination
- Blood tests
- Angiogram
- Ultrasound
- Endoscopy
Before either the TIPS or DSRS procedure, your physician may ask
you to have other pre-operative tests, which may include an electrocardiogram
(also called an EKG), chest X-ray, or additional blood tests. If your physician
thinks you will need additional blood products (such as plasma), they will be
ordered at this time.
More about the TIPS procedure
During the TIPS procedure, a radiologist makes a tunnel through the liver
with a needle, connecting the portal vein (the vein that carries blood from the
digestive organs to the liver) to one of the hepatic veins (the three veins that
carry blood from the liver). A metal stent is placed in this tunnel to keep the
tunnel open.