Variceal bleeds are uncommon, even in patients with a known alcohol related liver disease. Mortality is high and up to 30% of patients with known varices are likely to re-bleed [VREEBURG].
A variceal bleed is suggested by evidence of decompensated liver disease, such as jaundice, ascites or encephalopathy.
Known or suspected variceal bleeds should always be considered high risk as, in hospital, mortality is approximately 50% [JALAN].
All patients should be referred for urgent endoscopy and should undergo a critical care review to determine need for admission to a high dependency area.