Acute variceal bleeding (AVB) is a known complication of decompensated cirrhosis and carries with it a high mortality rate. Understanding the basic underlying pathophysiologic processes that lead to the development of varices and how to prevent progression of this disease is crucial for an intensivist. Once bleeding occurs, intensivists must be able to navigate a complex presentation of impending respiratory failure and hemorrhagic shock. A multidisciplinary approach to AVB including medical therapies combined with procedural interventions such as endoscopy, balloon tamponade, and emergency surgery must all be considered in severe cases. In this narrative review, we aim to provide an updated and comprehensive overview of the prevention and management of variceal bleeding in patients with cirrhosis.
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