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Introduction to Bleeding Varices
Varices are dilated blood vessels usually in the esophagus or stomach. They cause no symptoms unless they rupture and bleed.
Bleeding from varices is a life-threatening complication of portal hypertension. Portal hypertension is an increase in the pressure within the portal vein (the vein that carries blood from the digestive organs to the liver) due to blockage of blood flow throughout the liver.
This increased pressure in the portal vein causes the development of large, swollen veins (varices) within the esophagus and stomach. The varices are fragile and can rupture easily, resulting in a large amount of blood loss.
The most common cause of portal hypertension is cirrhosis of the liver. Cirrhosis is scarring which accompanies the healing of liver injury caused by hepatitis, alcohol, or other less common causes of liver damage. In cirrhosis, the scar tissue blocks the flow of blood through the liver and slows its processing functions.
How Are Bleeding Varices Treated?
Bleeding from varices is a medical emergency and treatment should be immediate. If the bleeding is not controlled quickly, a person may go into shock or die. In severe cases, a person may need to be placed temporarily on a ventilator to prevent the lungs from filling with blood. Aside from the urgent need to stop the bleeding, treatment is also aimed at preventing future bleeding. Procedures that help treat bleeding varices include:
- Banding: A procedure performed by a gastroenterologist in which small rubber bands are placed directly over the varices. This will stop the bleeding and eradicate the varices.
- Sclerotherapy: A procedure in which a gastroenterologist directly injects the varices with a blood-clotting solution instead of banding them.
- Transjugular Intrahepatic Portosystemic Shunt (TIPS): A radiological procedure in which a stent (a tubular device) is placed in the middle of the liver. The stent connects the hepatic vein with the portal vein. This procedure is done by placing a catheter through a vein in the neck. It is performed to relieve the high blood pressure that has built up in the liver.
- Distal Splenorenal Shunt (DSRS): A surgical procedure that connects the splenic vein to the left kidney vein in order to reduce pressure in the varices and control bleeding.
- Liver transplant: A liver transplant may be done in cases of end-stage liver disease.
- Devascularization: A surgical procedure that removes the bleeding varices. This procedure is done when a TIPS or a surgical shunt is not possible or unsuccessful in controlling the bleeding.
Can Bleeding Varices Be Prevented?
Treating the underlying cause of bleeding varices can help prevent their recurrence and treating liver disease earlier on may prevent their development. Certain medications including the class of heart drugs called "beta-blockers" may reduce elevated portal pressure and reduce the likelihood of bleeding. Long acting nitroglycerines are also used for this purpose.
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Reviewed by Venkat Mohan, MD on March 01, 2010
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Beta blockers are a class of drugs that block beta-adrenergic substances such as adrenaline (epinephrine), a key agent in the "sympathetic" portion of the autonomic (involuntary) nervous system and activation of heart muscle. By blocking the action of the involuntary nervous system on the heart, beta blockers relieve stress on the heart.
Beta blockers are used for the treatment of irregular heart rhythms, chest pain, heart attack, hypertension, migraine headaches, social phobias, tremors, and glaucoma.
Common side effects of beta blockers are nausea, vomiting, abdominal cramps, diarrhea, and weight gain if you are taking medicine for diabetes (type 1 and type 2). There are other important side effects and serious adverse effects of this drug class that include, blurred vision, insomnia, hair loss, disorientation, CNS system effects, and serious heart problems.
Beta blockers interact with several other drugs, for example, chlorpromazine (Thorazine), clonidine (Catapres), Phenobarbital, nonsteroidal anti-inflammatory drugs (NSAIDs) including aspirin, and diabetes medications, including insulin.
Examples of generic and brand names available for beta blockers in the US include acebutolol (Sectral), atenolol (Tenormin), bisoprolol (Zebeta), metoprolol (Lopressor, Lopressor LA, Toprol XL), nadolol (Corgard), timolol (Blocadren). Talk with your doctor, pharmacist, or other medical professional if you have questions about beta-blockers.
CirrhosisCirrhosis of the liver refers to a disease in which normal liver cells are replaced by scar tissue caused by alcohol and viral hepatitis B and C. This disease leads to abnormalities in the liver's ability to handle toxins and blood flow, causing internal bleeding, kidney failure, mental confusion, coma, body fluid accumulation, and frequent infections.
Symptoms include yellowing of the skin (jaundice), itching, and fatigue.
The prognosis is good for some people with cirrhosis of the liver, and the survival can be up to 12 years; however the life expectancy is about 6 months to 2 years for people with severe cirrhosis with major complications.
Hepatitis AHepatitis means inflammation of the liver. Hepatitis A (HAV, Hep A) is one type of liver disease caused by a virus. Since hepatitis A is a virus, it can pass from person to person from eating or drinking contaminated food or coming into contact with contaminated materials containing the virus. Symptoms of hepatitis A include stomach pain, diarrhea, dark yellow urine, jaundice, and more. There is a vaccine to prevent contracting hepatitis A.
The hepatitis B virus (HBV, hep B) is a unique, coated DNA virus belonging to the Hepadnaviridae family of viruses. The course of the virus is determined primarily by the age at which the infection is acquired and the interaction between the virus and the body's immune system. Successful treatment is associated with a reduction in liver injury and fibrosis (scarring), a decreased likelihood of developing cirrhosis and its complications, including liver cancer, and a prolonged survival.
Hepatitis CHepatitis C is an inflammation of the liver due to the hepatitis C virus (HCV), which is usually spread by blood transfusion, hemodialysis, and needle sticks, especially with intravenous drug abuse. Symptoms of chronic hepatitis include fatigue, fever, muscle aches, loss of appetite, and fever. Chronic hepatitis C may be cured in most individuals with drugs that target specific genomes of hepatitis C.
Liver (Anatomy and Function)The liver is the largest gland and organ in the body. There are a variety of liver diseases caused by liver inflammation, scarring of the liver, infection of the liver, gallstones, cancer, toxins, genetic diseases, and blood flow problems. Symptoms of liver disease generally do not occur until the liver disease is advanced. Some symptoms of liver disease include jaundice, nausea and vomiting, easy bruising, bleeding excessively, fatigue, weakness, weight loss, shortness of breath, leg swelling, impotence, and confusion. Treatment of diseases of the liver depends on the cause.
Liver disease can be cause by a variety of things including infection (hepatitis), diseases, for example, gallstones, high cholesterol or triglycerides, blood flow obstruction to the liver, and toxins (medications and chemicals). Symptoms of liver disease depends upon the cause and may include nausea, vomiting, upper right abdominal pain, and jaundice. Treatment depends upon the cause of the liver disease.
Liver TransplantA liver transplant may be needed when the liver functions inadequately. Patients on the waiting list for a liver transplant are given a priority score based on their creatinine, bilirubin, and INR. Complications of liver transplantation include rejection of the donor organ and infection.
Low Blood Pressure
Low blood pressure, also referred to as hypotension, is blood pressure that is so low that it causes symptoms or signs due to the low flow of blood through the arteries and veins. Some of the symptoms of low blood pressure include light-headedness, dizziness, and fainting if not enough blood is getting to the brain.
Diseases and medications can also cause low blood pressure. When the flow of blood is too low to deliver enough oxygen and nutrients to vital organs such as the brain, heart, and kidneys; the organs do not function normally and may be permanently damaged.
Nausea and Vomiting
Nausea is an uneasiness of the stomach that often precedes vomiting. Nausea and vomiting are not diseases, but they are symptoms of many conditions. There are numerous cases of nausea and vomiting. Some causes may not require medical treatment, for example, motion sickness, and other causes may require medical treatment by a doctor, for example, heart attack, lung infections, bronchitis, and pneumonia.
Some causes of nausea and vomiting may be life threatening, for example, heart attack, abdominal obstruction, and cancers.
Treatment of nausea and vomiting depends upon the cause.
Portal HypertensionPortal hypertension is most commonly caused by cirrhosis, a disease that results from scarring of the liver. Other causes of portal hypertension include blood clots in the portal vein, blockages of the veins that carry the blood from the liver to the heart, and a parasitic infection called schistosomiasis. Symptoms of portal hypertension include varices (enlarged veins), vomiting blood, blood in the stool, black and tarry stool, ascites (abnormal fluid collection within the peritoneum, the sac that contains the intestines within the abdominal cavity), confusion and lethargy, splenomegaly or enlargement of the spleen, and decreased white blood cell counts.
Stool Color ChangesStool color changes can very from green, red, maroon, yellow, white, or black. Causes of changes of stool color can range from foods a person eats, medication, diseases or conditions, pregnancy, cancer, or tumors. Stool can also have texture changes such as greasy or floating stools. Stool that has a uncharacteristically foul odor may be caused by infections such as giardiasis or medical conditions.
Transjugular Intrahepatic Portosystemic ShuntTransjugular intrahepatic portosystemic shunt or (TIPS) is a procedure in which a shunt is placed between the portal vein and the hepatic vein. TIPS is primarily used in individuals who have cirrhosis of the liver. Complications of cirrhosis may result in portal hypertension. There are several types of portosystemic shunts. Two complications of the TIPS procedure include hepatic encephalopathy and/or heart failure.
Hepatitis is most often viral, due to infection with one of the hepatitis viruses (A, B, C, D, E, F (not confirmed), and G) or another virus (such as those that cause infectious mononucleosis, cytomegalovirus disease). The main nonviral causes of hepatitis are alcohol and drugs. Many patients infected with hepatitis A, B, and C have few or no symptoms of illness. For those who do develop symptoms of viral hepatitis, the most common are flu- like symptoms including: loss of appetite, nausea, vomiting, fever, weakness, tiredness, and aching in the abdomen. Treatment of viral hepatitis is dependant on the type of hepatitis.