Bleeding Esophageal varices

Result from dilated veins in the walls of the lower part of the esophagus and sometimes the upper part of the stomach.
are a life-threatening complication of portal hypertension.
Tests to visualize the varices include EGD (esophagogastroduodenoscopy).
symptoms are

1) Vomiting
2) Vomiting blood
3) Black, tarry stools
4) Bloody stools
5) Decreased urine output
6) Symptoms of chronic liver disease (such as cirrhosis)
7) Excessive thirst
8) Paleness
9) Light-headedness


Physical examination:

1) Signs of chronic liver disease or cirrhosis
2) Low blood pressure
3) Rapid heart rate
4)Bloody or black stool on rectal exam

Tests to visualize the varices include EGD (esophagogastroduodenoscopy).

manage persistent varices with medical and procedural therapies:
1) endoscopic therapy
2) balloon tamponade
3) the transjugular intrahepatic portosystemic shunt (TIPS) procedure
4) Octreotide and vasopressin are medications that may be used to decrease portal blood flow and slow bleeding.
5) Emergency surgery may rarely be used to treat patients if other therapy fails

Bleeding esophageal varices are a serious complication of liver disease and carry a poor prognosis.

Liver transplantation should be considered.

Complication
1) Recurrence of bleeding after treatment
2) Hypovolemic shock
3) Esophageal stricture after surgery or endoscopic therapy
4) Worsening encephalopathy (confusion)
5) Infection (pneumonia, blood stream infection, peritonitis

Prevention

Treatment of the underlying causes of liver disease may prevent bleeding.

Category: Gastroenterology Notes