Esophageal varices

Esophageal varices.

1. ESOPHAGEAL VARICES Esophageal varices are abnormal, enlarged veins in the tube that connects the throat and stomach (esophagus). This condition occurs most often in people with serious liver diseases. 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. A number of drugs and medical procedures can help prevent and stop bleeding from esophageal varices .

2. Symptoms and Causes Symptoms Esophageal varices usually don't cause signs and symptoms unless they bleed. Signs and symptoms of bleeding esophageal varices include: Vomiting and seeing significant amounts of blood in your vomit Black, tarry or bloody stools Lightheadedness Loss of consciousness (in severe case)   signs of liver disease, including: Yellow coloration of your skin and eyes (jaundice) Easy bleeding or bruising Fluid buildup in your abdomen (ascites)

3. Causes Esophageal varices sometimes form when blood flow to your liver is blocked, most often by scar tissue in the liver caused by liver disease. The blood flow begins to back up, increasing pressure within the large vein (portal vein) that carries blood to your liver. This pressure (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 can rupture and bleed. Causes of esophageal varices include : Severe liver scarring (cirrhosis).  A number of liver diseases — including hepatitis infection, alcoholic liver disease, fatty liver disease and a bile duct disorder called primary biliary cirrhosis — can result in cirrhosis . Blood clot (thrombosis).  A blood clot in the portal vein or in a vein that feeds into the portal vein (splenic vein) can cause esophageal varices . A parasitic infection.   Schistosomiasis is a parasitic infection found in parts of Africa, South America, the Caribbean, the Middle East and Southeast Asia. The parasite can damage the liver, as well as the lungs, intestine and bladder

4. Risk factors Although many people with advanced liver disease develop esophageal varices , most won't have bleeding. Varices are more likely to bleed if High portal vein pressure.  The risk of bleeding increases with the amount of pressure in the portal vein (portal hypertension). Large varices .  The larger the varices , the more likely they are to bleed. Red marks on the varices .  When viewed through an endoscope passed down your throat, some varices show long, red streaks or red spots. These marks indicate a high risk of bleeding. Severe cirrhosis or liver failure.  Most often, the more severe your liver disease, the more likely varices are to bleed. Continued alcohol use.  Your risk of variceal bleeding is far greater if you continue to drink than if you stop, especially if your disease is alcohol related.

5. Complications Complications The most serious complication of esophageal varices is bleeding. Once you have had a bleeding episode, your risk of another bleeding episode greatly increases. If you lose enough blood, you can go into shock, which can lead to death.

6. Diagnosis Main tests used to diagnose esophageal varices are: Endoscope exam.  A procedure called upper gastrointestinal endoscopy is the preferred method of screening for varices . Your doctor inserts a thin, flexible, lighted tube (endoscope) through your mouth and into your esophagus, stomach and the beginning of your small intestine (duodenum). The doctor will look for dilated veins, measure them, if found, and check for red streaks and red spots, which usually indicate a significant risk of bleeding. Treatment can be performed during the exam. Imaging tests.  Both abdominal CT scans and Doppler ultrasounds of the splenic and portal veins can suggest the presence of esophageal varices . Capsule endoscopy.  In this test, you swallow a vitamin-sized capsule containing a tiny camera, which takes pictures of the esophagus as it goes through your digestive tract. This might be an option for people who are unable or unwilling to have an endoscope exam. This technology is more expensive than regular endoscopy and not as available.

7. Treatment : In emergency situations, care is directed at stopping blood loss, maintaining plasma volume, correcting disorders in coagulation induced by cirrhosis, and appropriate use of  antibiotics  such as  quinolone  or  ceftriaxone . Blood volume resuscitation should be done promptly and with caution. The goal should be hemodynamic stability and hemoglobin of over 8 g/dl. Resuscitation of all lost blood leads to increase in portal pressure leading to more bleeding. Volume resuscitation can also worsen ascites and increase portal pressure. Therapeutic   endoscopy  is considered the mainstay of urgent treatment. The two main therapeutic approaches are variceal ligation or  banding  and  sclerotherapy .

8. Treatment Treatment to prevent bleeding Treatments to lower blood pressure in the portal vein may reduce the risk of bleeding esophageal varices . Treatments may include: Medications to reduce pressure in the portal vein.  A type of blood pressure drug called a beta blocker may help reduce blood pressure in your portal vein, decreasing the likelihood of bleeding. These medications include propranolol (Inderal, Innopran ) and nadolol ( Corgard ). Using elastic bands to tie off bleeding veins.  If your esophageal varices appear to have a high risk of bleeding, your doctor might recommend a procedure called band ligation. Using an endoscope, the doctor snares the varices and wraps them with an elastic band, which essentially "strangles" the veins so they can't bleed. Esophageal band ligation carries a small risk of complications, such as scarring of the esophagus.

9. Treatment : Using elastic bands to tie off bleeding veins. Medications to slow blood flow into the portal vein.  A drug called octreotide ( Sandostatin ) is often used with endoscopic therapy to slow the flow of blood from internal organs to the portal vein. The drug is usually continued for five days after a bleeding episode. Diverting blood flow away from the portal vein.  Your doctor might recommend a procedure called transjugular intrahepatic portosystemic shunt (TIPS) to place a shunt. The shunt is a small tube that is placed 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 .

10. Treatment : Restoring blood volume.  You might be given a transfusion to replace lost blood and clotting factor to stop bleeding. Preventing infection.  There is an increased risk of infection with bleeding, so you'll likely be given an antibiotic to prevent infection. Replacing the diseased liver with a healthy one.  Liver transplant is an option for people with severe liver disease or those who experience recurrent bleeding of esophageal varices . Although liver transplantation is often successful, the number of people awaiting transplants far outnumbers the available organs.

11. Self-management Prevention Currently, no treatment can prevent the development of esophageal varices in people with cirrhosis. While beta blocker drugs are effective in preventing bleeding in many people who have esophageal varices , they do not prevent esophageal varices from forming. Don't drink alcohol.  People with liver disease are often advised to stop drinking alcohol, since the liver processes alcohol. Drinking alcohol may stress an already vulnerable liver. Eat a healthy diet.  Choose a plant-based diet that's full of fruits and vegetables. Select whole grains and lean sources of protein. Reduce the amount of fatty and fried foods you eat. Use chemicals sparingly and carefully.  Follow the directions on household chemicals, such as cleaning supplies and insect sprays. If you work around chemicals, follow all safety precautions. Your liver removes toxins from your body, so give it a break by limiting the amount of toxins it must process. Reduce your risk of hepatitis.  Sharing needles and having unprotected sex can increase your risk of hepatitis B and C.

12. References : http://www.mayoclinic.org / https:// www.google.co.in/search?sourceid=chrome-psyapi2&ion=1&espv=2&ie=UTF-8&q=esophageal%20varices&oq=esophageal&rlz=1C1CHBD_enIN724IN725&aqs=chrome.1.69i57j69i59l2j0l3.3504j0j4 https:// en.wikipedia.org/wiki/Esophageal_varices