Portal hypertension causes dilation of the visceral and superficial veins causing varices at various areas of the body via portosystemic shunting. There are a variety of causes including pre hepatic, intrahepatic, and post hepatic causes. Diagnosis may be accomplished via hepatic pressure monitoring (hepatic wedge pressure >12 mmHg) and imaging. Varices are a sign of severe liver disease, with a high risk of bleeding. Bleeding varices is a dreaded complication of portal hypertension with associated morbidity and mortality. Bleeding varices are associated with a high rate of bacterial infections. Screening EGDs are required every 2–3 years. When varices form, screening is required annually. Nonselective beta-blockers reduce the risk of recurrent bleeding and decrease their evolution. Banding of varices and TIPS decrease bleeding recurrence which are refractory to banding. Acute variceal hemorrhage requires emergent interventions including escalation of care to the ICU, adequate resuscitation, protection of the airway, vascular access, endoscopic interventions (banding, sclerotherapy), medical therapies (octreotide, antibiotics), balloon tamponade (Blakemore, Minnesota), and possible TIPS. Historically, there were indications for non/selective shunts. Bleeding could be from other sources, i.e., ulcers.