Same processes (portal hypertension) that leads to esophageal varices
Post-hepatic: budd-chiari (hepatic vein thrombosis); Constrictive pericardial disease; Advanced left/right sided heart failure
Hepatic: cholestatic or inflammatory/fibrotic liver disease that leads to cirrhosis (alcohol, hep b/c, fatty liver, other); Can be chronic, acute, or acute on chronic
Pre-hepatic: portal vein thrombosis (associate w/hypercoaguable states); parasitic blockage of portal vein (e.g. clonorchis, schistosomiasis)
Splenic vein thrombosis: from pancreatitis, hypercoaguable states; unusual problem, typically w/o ascites
Anything that leads to cirrhosis: ETOH (most common), Hep C, Hep B, NASH, other
Nausea, vomiting blood
Confusionif co-existing encephalopathy
Abdominal discomfort
Bleeding can also occur more slowly, presenting w/fatigue and weakness
Signs of severe illness w/tachycardia and hypotension (blood loss can be rapid and profound)
Jaundice, ascites, edema--> underlying liver disease
Confusion from encephalopathy
Coffee-ground emesis or frank blood; melena, guaiac + stool on rectal exam
Upper endoscopy needed to make dx
Labs may indicate anemia, thrombocytopenia, coagulopathy (elevated INR/PT), liver dysfunction (elevated bilirubin, alt/ast, low albumin)