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Bleeding Esophageal Varices

Bleeding Esophageal Varices

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Published by Naveen Eldose RN
Bleeding esophageal varices
Cirrhosis - discharge Bleeding esophageal varices are very swollen veins in the walls of the lower part of the esophagus (the tube that connects your throat to your stomach) that begin to bleed. Causes Scarring (cirrhosis) of the liver is the most common cause of esophageal varices. This scarring prevents blood from flowing through the liver. As a result, more blood flows through the veins of the esophagus. This extra blood flow causes the veins in the esophagus to ba
Bleeding esophageal varices
Cirrhosis - discharge Bleeding esophageal varices are very swollen veins in the walls of the lower part of the esophagus (the tube that connects your throat to your stomach) that begin to bleed. Causes Scarring (cirrhosis) of the liver is the most common cause of esophageal varices. This scarring prevents blood from flowing through the liver. As a result, more blood flows through the veins of the esophagus. This extra blood flow causes the veins in the esophagus to ba

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Published by: Naveen Eldose RN on Jun 10, 2012
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Bleeding esophageal varices
Cirrhosis - discharge Bleeding esophageal varices are very swollen veins in the walls of the lower part of the esophagus(the tube that connects your throat to your stomach) that begin to bleed.
 
Causes
Scarring (cirrhosis) of the liver is the most common cause of esophageal varices. This scarringprevents blood from flowing through the liver. As a result, more blood flows through the veins of theesophagus.This extra blood flow causes the veins in the esophagus to balloon outward. If these veins breakopen (rupture), they can cause severe bleeding. Any cause of chronic liver disease can cause varices.The swollen veins (varices) can also occur in the upper part of the stomach.
Symptoms
People with chronic liver disease and esophageal varices may have no symptoms.If there is only a small amount of bleeding, the only symptom may be dark or black streaks in thestools.If larger amounts of bleeding occur, symptoms may include:
Black, tarry stools
Bloody stools
Paleness
Symptoms of chronic liver disease (such as cirrhosis)
Exams and Tests
Physical examination:
Bloody or black stool on rectal exam
Signs of chronic liver disease or cirrhosisTests to determine where the bleeding is coming from and detect active bleeding include:
Esophagogastroduodenoscopy (EGD)
Tube through the nose into the stomach (nasogastric tube) to look for signs of bleeding
 
Some doctors recommend EGD for patients who are newly diagnosed with mild-to-moderatecirrhosis to screen for esophageal varices and treat them before there is bleeding.
Treatment
The goal of treatment is to stopacutebleeding as soon as possible, and treat varices withmedicines and medical procedures. Bleeding must be controlled quickly to prevent shock and death.If massive bleeding occurs, the patient may be placed on a ventilator to protect the airways andprevent blood from going down into the lungs.Treatments for acute bleeding:
 A small lighted tube called anendoscopemay be used. The health care provider may injectthe varices directly with a clotting medicine, or place a rubber band around the bleedingveins.
 A medication that tightens blood vessels (vasoconstriction)may be used. Examples include octreotide or vasopressin. 
 A tube may be inserted through the nose into the stomach and inflated with air. Thisproduces pressure against the bleeding veins (balloon tamponade).Once the bleeding is stopped, varices can be treated with medicines and medical procedures toprevent future bleeding:
Drugs called beta blockers, such as propranolol and nadolol, are used to reduce the risk of bleeding.
 A small lighted tube called an endoscope may be used to place a rubber band around thebleeding veins.
Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure to create newconnections between two blood vessels in your liver. This can decrease pressure in theveins and prevent bleeding episodes from happening again.Emergency surgery may be used (rarely) to treat patients if other therapy fails. Portocaval shunts or surgery to remove the esophagus are two treatment options, but these procedures are risky.Patients with bleeding varices from liver disease may need additional treatment of their liver disease, including a liver transplant.
Outlook (Prognosis)
Bleeding often comes back without treatment. Bleeding esophageal varices are a seriouscomplication of liver disease and have a poor outcome.
Possible Complications
Encephalopathy (sometimes calledhepatic encephalopathy)
Esophageal strictureafter surgery or endoscopic therapy
Infection (pneumonia, bloodstream infection, peritonitis)
Return of bleeding after treatment

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