Esophageal varices form as result of increased portal hypertension and reversal of flow into the esophageal submucosal veins. Bleeding from esophageal varices is a life-threatening complication of portal hypertension. Key aspects of management include simultaneously resuscitating the patient while obtaining focused information from history and physical exam. Once stable, endoscopy and a repeat endoscopy (if needed) are the primary form of diagnosis and management. Sengstaken-Blakemore tube can be used as a temporizing measure, but its use should be limited to less than 24 h. Important pharmacologic agents to start including Vasopressin, Octreotide, and a proton pump inhibitor (a non-selective beta blocker can be considered if blood pressure allows). Transjugular intrahepatic portosystemic shunt (TIPS) should be considered for uncontrolled bleeding.