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BLEEDING VARICES

Men's Health, Women's Health / By

BLEEDING VARICES

Bleeding varices is a condition characterized by bleeding in abnormal vessels.

  • Varices are abnormal connections between the systemic and portal circulation present in the body.
  • The system circulation takes blood to and from the heart to supply all other organs in the body, while the portal circulation drains blood from the small intestine to pass through the liver before the rest of the body.
  • The abnormal connections are weak and prone to more rupture, which is usually a medical emergency and can be life-threatening.
  • Varices commonly occur in the venous system, but they may sometimes occur in arterial or lymphatic vessels.
  • The most common site of varices is the esophagus although they can appear at other sites in the gastrointestinal such as the stomach, rectum, or around the belly button.
  • If the bleeding is not controlled fast, a person may go to shock and eventually die.
  • Serious complications such as coma, pneumonia, kidney failure, liver failure may occur even after the bleeding has been stopped.

CAUSES

Bleeding varies is a life-threatening complication of high blood pressure in the portal vein, a condition referred to as portal hypertension.

An increased pressure occurs in the portal vein as a result of blockage of blood flow throughout the liver. This causes the development of large swollen veins (varices) within the esophagus and stomach.

Normally, blood pressure in the portal vein is only about 5-10mm Hg. However, this blockage can cause pressures to exceed 10mm Hg causing the blood vessels to dilate and form varices between different vessels, this happens so the blood can bypass the obstruction and flow back to the systemic circulation and the heart.

If the blood pressure continues to increase and rise beyond 12mm Hg, bleeding will occur at the varices because they have weaker walls as compared to normal blood vessels.

The most common cause of portal hypertension is cirrhosis (scarring of the liver).  Cirrhosis is caused by excessive consumption of alcohol, or serious infections such as hepatitis. 90% of cirrhosis patient will develop varices, and about 30% will have a bleeding varices

Another condition that causes portal hypertension is portal vein thrombosis, a condition where blood clots inside the portal vein.

SYMPTOMS

  • Excessive thirst
  • Vomiting, which may contain blood
  • Paleness
  • Lightheadedness
  • Black, tarry or bloody stools
  • Reduced urine output
  • Low blood pressure
  • Shock in some cases
  • Rapid heart rate

DIAGNOSIS AND TREATMENT

It is generally recommended that patient with cirrhosis undergo screening for varices at the time of diagnosis and periodically if none or small varices are detected.

To make a diagnosis, the doctor may perform:

An endoscope exam of the upper gastrointestinal tract to look for dilated veins. If found, the doctor will check for red streaks and red spots which may be indicative of a significant risk of bleeding.

Imaging tests such as CT scans and ultrasounds

TREATMENT

The goal of treatment options is to stop bleeding and prevent future bleeding.

Treatment options may include:

Banding, in which elastic bands are used to tie off bleeding varices

Transjugular intrahepatic portosystemic shunt (TIPS), a procedure in which X-ray is used to guide the placement of a tubular device (shunt) between the portal and hepatic vein, creating a diversion for blood flow.

Liver transfer for cases of an end-stage liver disease

Distal splenorenal shunt (DSRS) procedure to connect the splenic vein to the left kidney vein to control bleeding.

Devasculation to remove the bleeding varices

Blood transfusion to replace lost blood and clotting factor to stop bleeding

To prevent infections, your doctor may prescribe antibiotics.