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Variceal Bleeding

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The dilated veins in the distal esophagus or proximal stomach are called as varices. These varices are caused by high pressure in the portal veins, mostly due to cirrhosis. These variceal veins do not cause any symptoms or complications, unless they rupture and lead to bleeding. This could lead to a life-threatening condition.'

The veins in the lower esophagus region tend to get dilated due to liver conditions. The portal vein in the gastrointestinal tract, carries blood to many important organs such as the stomach, intestine, liver, etc. The increase in pressure called as portal hypertension, causes these veins to get dilated and develop swelling.

What Are the Symptoms of Variceal Bleeding?

Bleeding of the varices is a case of medical emergency. The bleeding has to be controlled soon, or else the patient may go into shock and die. Some of the symptoms of variceal bleeding include:

  • Hematemesis, that is, bloody vomit
  • Abdominal Pain
  • Lightheadedness
  • Melena, that is, black, tarry stools
  • Rapid heart rate
  • Blood in stools, in extreme cases
  • Shock, due to extreme blood loss

The patient may develop complications, even after the bleeding stops or is controlled. These complications include:

  • Pneumonia
  • Sepsis
  • Liver failure
  • Kidney failure
  • Confusion
  • Coma

What Causes Variceal Bleeding?

Varices occur due to portal hypertension, which is the most common complication of liver cirrhosis. The condition that causes scarring of the liver due to hepatitis or excessive alcohol consumption is called as cirrhosis of the liver. In some cases, portal vein obstruction or portal vein thrombosis can lead to portal hypertension. In a few cases, when the cause of excessive pressure is unknown, it is referred to as idiopathic portal hypertension.

The portal hypertension causes the blood to move away from the liver to smaller blood vessels. These small vessels are not able to handle the increase in blood flow and thus get swollen (varices). This occurs in the esophagus, stomach, rectum, around the umbilical region. As the walls of the smaller blood vessels are thin, it leads to rupture and bleeding.

Diagnosing Variceal Bleeding

The doctor will conduct a physical examination and take medical history and symptoms of the patients. The diagnostic tests that help determine variceal bleeding includes:

  • Blood test
  • Endoscopy
  • CT Scan
  • MRI

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Treatment for Variceal Bleeding

The first step in treatment is controlling the risk for bleeding, if the varices have not yet ruptured. This is done with the help of beta blockers such as propranol. Another method includes endoscopic sclerotherapy, wherein an endoscope is used to look at the varices and inject a medication that helps in shrinking the dilated veins. Endoscopic variceal ligation is another way to tie the veins using an elastic band with the help of an endoscope.

In case of bleeding, doctor may prescribe the drug octreotide. It helps in lowering the pressure in the portal vein by stopping the flow of blood from organs that flow blood into it.

Transjugular intrahepatic portosystemic shunt (TIPS) is another treatment option that helps in connecting the portal vein with hepatic vein using a small tube. This connection helps divert the blood flow from the bleeding site. In severe cases, a liver transplantation may be necessary.

The varices can bleed again, thus, one needs to undergo regular checkups. One can prevent variceal bleeding by maintaining a healthy weight, eating a healthy diet, avoiding alcohol and loweing the risk for hepatitis by avoiding using used needles, razors or avoiding sexual contact without protection.

Speak to your healthcare provider for more details related to bleeding varices.

Written by: healthplus24.com team

Date last updated: January 20, 2015