Abnormal, enlarged veins in esophagus.
Esophageal varices develop when normal blood flow to the liver is blocked by a clot or scar tissue in the liver. To go around the blockages, blood flows into smaller blood vessels that aren’t designed to carry large volumes of blood. The vessels can leak blood or even rupture, causing life-threatening bleeding.
SYMPTOMS: esophageal varies usually don’t cause s/s unless they bleed
- Vomiting large amounts of blood
- Black, tarry or bloody stools
- Lightheadedness
- Loss of consciousness in severe cases
- Signs of shock, including pale, clammy skin, irregular breathing
Causes
- Portal hypertension forces the blood to seek other pathways through smaller veins, such as those in the lowest part of the esophagus. These thin-walled veins balloon with the added blood. Sometimes the veins rupture and bleed.
- Cirrhosis
- Thrombosis
- Parasitic infection.
Risk Factors
- High portal vein pressure.
- Large varices.
- Red marks on the varices. These marks indicate a high risk ofbleeding.
- Severe cirrhosis or liver failure.
- Alcohol use.
Diagnosis
- Endoscopic exam.
- Imaging tests. Both abdominal CT scans and Dopplerultrasounds of the splenic and portal veins can suggest thepresence of esophageal varices.
- Capsule endoscopy
Treatment to prevent bleeding
- Medications to reduce pressure in the portal vein. (Beta blockers).
- Endoscopic band ligation.
Treatment if you’re bleeding
- Using elastic bands to tie off bleeding veins.
- Vasopressin- slows the flow of blood to the portal vein.
- TIPS–The shunt is an opening that is created between the portal vein and the hepatic vein, which carries blood from your liver to your heart. The shunt reduces pressure in the portal vein and often stops bleeding from esophageal varices.
o Complications of TIPS including liver failure and mental confusion, which can develop when toxins that the liver normally would filter are passed through the shunt directly into the bloodstream.
TIPS is mainly used when all other treatments have failed or as a temporary measure in people awaiting a liver transplant
- Balloon tamponade
- Blood transfusion
- Antibiotics to prevent infection.
- Liver transplant as a last resort
Re-bleeding
Beta blockers and endoscopic band ligation are the recommended treatments to help prevent re-bleeding.