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© 2011 Esophageal Varices
Esophageal varices happen when the esophagus undergoes a dilation of the sub-mucosal vein. Hypertension or high blood pressure is often cited as one of the most common causes of this disorder. Most of the time individuals with this illness tend to experience heavy bleeding.
The goal in the treatment of this disorder is to prevent these bleedings to happen in the future. The main areas that are affected by such are mostly the duodenum and the gastric ulcer. Doctors and other medical research have already certified that the bleeding of the lower esophagus can be life-threatening, thus people suffering from it must secure the help of an experienced physician as soon as possible. The good news is that this is not considered benign during its early stages. It is as curable as other internal conditions out there.
To begin the treatment of esophageal varices, doctors may opt to pinpoint the cause of the disorder. Oftentimes focusing on the patient’s blood pressure may reduce any risk of bleeding in the future. The patient might be ordered to undergo medication that slows the flow of the blood through the veins by taking drugs such as nadolol or propranolol.
In other cases, a scope can be used to gain access to the bleeding part of the esophagus. If the varices are said to have a high chance of severe bleeding, a doctor can use an endoscope by inserting it inside the body and tying off the affected veins using an elastic band. During this process, the endoscope snares the varices and strangles the veins in order to prevent further bleeding. This ligation method, on the other hand, often carries with it a few complications such as the permanent scarring of the internal parts of the esophagus.
A medical process called the endoscopic injection therapy involves the vaccinating of a solution right inside the wounds of the vein. The result is the shrinking of the esophageal varices. The only downside to this treatment is that the esophagus is placed under the risk of perforation and further scarring, giving the patient a difficult time swallowing hard food, a disorder known as dysphagia.
Another common treatment method is the transjugular intrahepatic portosystemic shunt or TIPS, which is a small tube placed in the middle of the portal and the hepatic vein, which is responsible for the transportation of the blood from the liver into the heart. The shunt provides an extra path for the flow of the blood, thereby controlling the bleeding of the esophagus. Although liver malfunction and mental confusion can occur during the operation of the patient, TIPS is still widely used if on the occasion other possible methods have failed in the past. It is a temporary treatment process wherein the patient’s physical efforts are highly needed.
Of course, the patient can opt to cure esophageal varices by replacing his or her liver with a healthier one. It is an option for those who have harsher cases or those who are undergoing nonstop bleeding almost every day.
Esophageal varices are inflammations of the veins on the lower esophagus’ lining near the stomach. Most of the time, these swellings are caused by liver disorder. These veins resemble the varicose veins of the legs but are often considered more life-threatening depending on the state of the disorder. As a result of the proximity of these swollen veins to the surface of the stomach and the esophagus, bleeding and other internal rupture are highly likely to occur.
Esophageal Varices
Esophageal varices treatment can range from simple to complex. The diagnosis of the disorder is reliant on the use of a tool called an endoscope. It is a thin, small tube that has a camera attached on its tip. The tube is then inserted inside the mouth of the patient in order to view the internal areas of the esophagus and pinpoint the source of the bleeding. If it happens that bleeding is in fact present in the walls of the esophagus, then the esophageal varices treatment will be done as soon as possible.
In the process of the insertion of the endoscope, the doctors may opt to attach along the camera other additional instruments which can aid in the treatment process. A medical method known as vasoconstriction might be performed. This involves the tightening of the blood vessels that are affected by the bleeding. Another tube may be attached to the endoscope’s tip which can inflate the air directly towards the wound. The procedure is often referred to as balloon tamponade. Most cases involve the doctor injecting the varices with clotting medicine. The veins can even be tied using an elastic band.
Other esophageal varices treatment can be solved using drugs referred to as beta blockers. Examples of these are nadolol and propranolol. A transjugular intrahepatic portosystemic shunt or TIPS procedure can even allow additional blood vessels for the freer flow of the blood to prevent hypertension. The process is said to stop other further complications brought about by the bleeding.
The good news is that people can actually prevent the emergence of esophageal varices. The first step is to be aware how to reduce the risk of cirrhosis, which is the scarring of the liver due to chronic liver disorder. The primary cause of this illness is alcohol abuse. It is therefore important for people to limit their alcohol intake in order to avoid the poor functioning process of the liver. Also, people with hepatitis have a huge risk of developing cirrhosis, so it is important to be vaccinated in order to maintain the liver and prevent hypertension in the process.
Esophageal varices treatment is no laughing matter. Once the patient begins to exhibit the symptoms it is wise to seek the help of a doctor in order to prevent any further bleeding. With proper discipline in terms of alcohol intake and the right awareness of the proper steps to avoid hypertension, the individual is sure to prevent his or her esophagus veins from rupturing that may lead to esophageal varices.
An esophageal varice is a dilated vein in the lower part of the esophagus or in the upper section of the stomach. Commonly caused by liver disease, these swollen blood vessels can burst open and cause extreme bleeding.
Esophageal varices do not always have symptoms before they rupture. For this reason, many medical professionals prefer to screen all patients who have liver diseases, such as cirrhosis of the liver. Cirrhosis is a medical condition in which the liver becomes scarred. With the scarring, comes a decreased capacity of blood flow through the liver. This extra blood is sidetracked to the esophageal area and this increased blood flow is what causes the vein dilation.
Some of the most common symptoms of an esophageal varice are black and tarry stools, visible blood in the stools, a feeling of faintness, paleness, vomiting, or perhaps dark streaks in the stools. For people who have cirrhosis it is recommended that you discuss having a screening to determine if there are signs of varices in the esophagus.
Screening methods include the use of nasogastric tubes to look for signs of active bleeding and the source of the bleeding. If bleeding is recognized at the time of screening, the health care provider will be able to treat the bleeding at that time.
Common treatments include the use of an endoscope to place a rubber band around the swollen and bleeding veins to stop the bleeding. The health care professional might instead opt to inject a clotting medication or a blood vessel restriction medication directly into the vein. A balloon tamponade procedure can be carried out to create pressure on the bleeding vein. This course of action requires a tube to be inserted through the nose and down to the stomach where it is then inflated with air.
If the bleeding is acute, the doctor might need to place the patient on a ventilator to prevent blood from entering the lungs and to protect the patient’s airway. As massive bleeding can cause shock and imminent death, it is vital to get the bleeding under control as quickly as possible.
If the doctor does not see active bleeding during the screening, but observes the varices, treatment can be carried out to prevent bleeding. Medications known as beta blockers reduce the chance of future bleeding from the varices. Rubber banding the veins is another option and can be carried out with only the use of an endoscope.
Surgical means of treatment include a procedure called TIPS in which new associations are created between blood vessels in the liver. When the liver is capable of transporting the blood on its own instead of sending it through the esophagus veins, there is a greatly diminished risk of varices and bleeding.
Treatment of the underlying cause of the esophageal varices is imperative to overcoming the varices itself. When a patient is suffering from severe liver disease, it is recommended that they receive a liver transplant. Without treatment, the prognosis is very poor.
An esophageal varice is a swollen vein in the lower section of the esophagus. The esophagus is the tube that runs from the back of the throat to the stomach. Esophageal varices can also transpire in the top section of the stomach.
Many times esophageal varices are caused by cirrhosis, which is scarring of the liver. If the liver becomes scarred, blood is prevented from passing through the liver and therefore will flow through the esophagus veins. The added blood flow through the esophagus from a scarred liver can result in those esophageal veins ballooning out. The veins can potentially rupture and result in relentless bleeding.
Common symptoms that arise from esophageal varices are black and tarry stools, bloody stools, pale skin, vomiting (perhaps with blood), and a feeling of light-headedness. If the esophageal varices are not bleeding very much there may be only dark streaks in the stool.
Chronic liver diseases such as cirrhosis of the liver are the leading cause of esophageal varices. Because of this, doctors commonly prefer to screen all patients suffering from liver disease for esophageal varices as there are not always clear symptoms.
Screening for esophageal varices includes running a nasogastric tube through the nose and down into the stomach to check for bleeding or signs of bleeding. Esophagogastroduodenoscopy (EGD) is another screening tool, which essentially checks for varices with or without bleeding. EGD tests are routinely ordered for patients who have recently been diagnosed with liver diseases such as cirrhosis.
Because esophageal varices can rupture and bleed profusely, this is the most important aspect of treatment. Profuse bleeding can cause shock and ultimately death if not controlled quickly. If the event of excessive bleeding, medical professionals might place the patient on a ventilator so that the blood does not go into the lungs.
Doctors use an endoscope when they need to inject the varices with a medicine to cause clotting or to rubber band the veins that are bleeding. An endoscope is simply a small tube with a light on the end. Medications can also be delivered that constrict blood vessels as well.
Once the bleeding is under control or in the event bleeding has not yet occurred, health care professionals can treat the esophageal varices in a variety of ways. The most popular treatment is medication. Beta-blockers can be used to prevent future bleeding. Nadolol and propranolol are two drugs that are commonly prescribed for this use.
A medical procedure called TIPS might be carried out in which new links are made between the liver’s blood vessels. This procedure is done with the hope that extra blood flow will not be diverted to the esophageal area. Surgeries to place blood vessel shunts into the veins or to remove completely the esophagus are rarely attempted, as they are quite risky.
Without treatment of some sort, the esophageal varice is likely to return. In extreme cases, liver damage might be so great that a liver transplant might need to be carried out to prevent further harm to the esophagus.
Esophageal varices are swollen veins in the mucosa (lining) of the lower part of the esophagus occurring because of portal hypertension due to cirrhosis of your liver. This is often accompanied by varices of the stomach.
( Several causes of Cirrhosis tend to be alcohol liver disease, hepatitis B, C, drug treatments, glycogen storage diseases, autoimmune diseases)
Structure of the top Gastrointestinal tract. (see diagram in Wiki http://en.wikipedia.org/wiki/Gastrointestinal_tract )
Food consumed in the mouth is actually chewed, then enters your Esophagus (muscular pipe covered along with a mucosal membrane ) and is moved alongside through peristalsis on the stomach exactly where digestive function takes place.
Layers of esophagus from inside to exterior -
* Mucosa – innermost filling commonly of a solid cell layer
* Submucosa- has blood vessels arteries and also veins, lymphatic vessels and nerves
* Muscle mass – round and longitudinal muscle
* Adventitia – outermost lining
Physiology
The superficial veins draining the esophagus drains into the portal vein structure which usually goes by over the liver organ. Whenever cirrhosis (scarr tissue ) happens in the liver it occludes or even squeezes the veins decreasing circulation so there is a back-up of blood causing the veins to utilize a collateral systemic of veins higher than the liver organ. These types of collateral veins then turn out to be dilated and also sent in to the mucosa and also lumen of your wind pipe and abdominal forming problematic veins that are thin and may be destroyed without difficulty causing blood loss in to the lumen of your esophagus.
Symptoms
Result from your complication associated with destroyed vessels and so are the following:
Vomiting large amounts blood – (25 to 30% of persons with varices have got hemorrhage)
Dark colored sticky stools from swallowed blood
Dizziness, some weakness, loss of consciousness,
60% of sufferers having liver disease develop varices therefore signs of persistent liver disease (jaundice, edema, stomach irritation, pruritus, sexual disorder, psychological confusion )
Differential diagnosis connected with blood loss from your Higher gastro intestinal tract
Duodenal Ulcers (35%)
Gastric ulcers (20%)
Mallory weis tears(10%)
Esophgeal Varices(5-11%)
gastric or esophageal carcinoma (6%) unusual reason for considerable upper GI blood loss
Diagnosis
The prognosis is done generally by history ( alcoholic beverages use and also chronic liver illness ) and also the throwing up of massive amount of blood.
Gold standard – Confirmed simply by endoscopy – This procedure can be either diagnostic and therapeutic.
