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Bleeding Esophageal Varices

Overview

Varices is a condition where the veins get dilated and look like varicosities. Esophagus is a muscular tube which runs from oropharynx to the the stomach at the cardiac end. Here the food passes and enters into the stomach. In this passage, digestion in the tube does not take place as there is no secretion of juices. The mucus membrane of the passage contains many veins, which drain the blood from it. Esophageal varices are mainly due to portal hypertension caused by liver cirrhosis and rarely due to the spleenectomy; which is due to spleenic thrombosis. Varices can also form in other areas of the body, including the stomach (gastric varices), duodenum (duodenal varices), and rectum (rectal varices).The superficial veins in the esophagus, which are just 1mm in diameter, become distended so much that they become 1-2 cm in diameter which causes haemtemesis (blood in vomiting).
The liver problem of a person suffering with esophageal varices can often lead to serious medical problems. Unless a liver transplant is performed, the outcome is generally poor. Even after treatment, bleeding again from esophageal varices is common and may lead to death.

 


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Causes

The esophageal vein drain the blood from the esophagus to the azygous vein which then drains it into the superior vena cava. But these veins have nothing to do with the varices. The superficial veins which are present in the mucosa drain the remaining blood apart from esophageal vein. These superficial veins drain the blood in the left gastric vein which gets drains into the portal vein. When there is liver cirrhosis, lung parenchyma gets damaged causing increased pressure on the portal vein. This leads to increase in the pressure on the superficial vein making it dilate. The condition in which the portal pressure increases is called as portal hypertension. The veins become dilated too much as they are not designed for bearing too much pressure.


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Signs & Symptoms

These include mainly blood in vomiting; black coloured stools, caused due to blood in the stools and the acids in the stomach changes its colour into black and paleness.

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Prevention

There are several ways to prevent bleeding esophageal varices. They can be avoided by controlling liver diseases that are caused by long-term alcohol abuse and viral hepatitis. Many cases of hepatitis can be prevented by not using intravenous drugs, following safer sex practices, such as condom use and being vaccinated for hepatitis B.


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Treatments
Endoscopy Modern Medicine

Endoscopy is to be done as a part of emergency treatment in which a tube is inserted into the oesophagus and doctor look inside the tube and perform minor surgeries since it has a part which allows the entrance of instrument in the tube to perform surgeries and a light illuminating system.Two procedures are done : 
  
*Ligation in which the vessels get ligate to stop the bleeding                     

*Sclerotherapy in which a medicine is injected into the blood that causes the arteries to get shrink and hence prevent blood loss.

 

Medication to Prevent Blood Loss Modern Medicine

During emergency, the major attention is on preventing blood loss and treating the coagulated blood, which is caused due to cirrhosis. Antibiotics are given which treat the infections caused. If there is excessive bleeding then, proper ventilation is given to the patient to prevent the blood from passing through the airways and then to the lungs.

When an acute bleeding gets stopped, other medications are given that reduces the cardiac output and splanchnic blood flow (blood to the intestine) and hence reducing the blood flow towards the intestine. These drugs include B-blockers like timilol,  propranalol and nadolol. Non selective beta blockers can also be used.

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