Bleeding from esophageal varices Stopping the bleeding Bleeding may occur anywhere along the digestive gastrointestinal [GI] tract, from the mouth to the anus. Drugs such as vasopressin or octreotide may be given intravenously to make the bleeding veins contract and thus slow the bleeding.
Blood transfusions are given to replace lost blood. Doctors usually use a flexible viewing tube endoscope , inserted through the mouth into the esophagus to confirm that the bleeding is from varices. Working through the endoscope, doctors can use rubber bands to tie off the veins. To reduce the risk of bleeding from esophageal varices, doctors may try to reduce pressure in the portal vein. One way is to give beta-blocker drugs, such as timolol , propranolol , nadolol , or carvedilol.
If the bleeding continues or recurs repeatedly, a procedure called portosystemic shunting may be done to connect the portal vein or one of its branches to a vein in the general circulation. This procedure reroutes most of the blood that normally goes to the liver so that it bypasses the liver. This bypass called a shunt lowers pressure in the portal vein because pressure is much lower in the general circulation. There are various types of portosystemic shunt procedures.
In one type, called transjugular intrahepatic portosystemic shunting TIPS , doctors, using x-rays for guidance, insert a catheter with a needle into a vein in the neck and thread it to veins in the liver. The catheter is used to create a passage shunt that connects the portal vein or one of its branches directly with one of the hepatic veins. Less commonly, portosystemic shunts are created surgically. Shunt procedures are usually successful in stopping the bleeding but pose certain risks, particularly hepatic encephalopathy Hepatic Encephalopathy Hepatic encephalopathy is deterioration of brain function that occurs in people with severe liver disease because toxic substances normally removed by the liver build up in the blood and reach The procedure may have to be repeated because the shunt may become blocked.
Some people require liver transplantation Liver Transplantation Liver transplantation is the surgical removal of a healthy liver or sometimes a part of a liver from a living person and then its transfer into a person whose liver no longer functions. Merck and Co. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world. The Manual was first published in as a service to the community.
Learn more about our commitment to Global Medical Knowledge. This site complies with the HONcode standard for trustworthy health information: verify here. Common Health Topics. Control of bleeding Portosystemic shunting Liver transplantation. Manifestations of Liver Disease. Test your knowledge. Jaundice is a condition in which the skin and white parts of the eyes appear yellow. It occurs when there is too much bilirubin, a yellow waste product, in the blood.
Which of the following is NOT a common cause of jaundice? More Content. Click here for the Professional Version. View of the Liver and Gallbladder. It most often results from high gut protein or acute metabolic stress eg, gastrointestinal Venous congestion within visceral organs due to portal hypertension contributes to ascites via altered Starling forces. Splenomegaly and hypersplenism Splenomegaly Splenomegaly is abnormal enlargement of the spleen.
See also Overview of the Spleen. Splenomegaly is almost always secondary to other disorders. Causes of splenomegaly are myriad, as are the Thrombocytopenia Overview of Platelet Disorders Platelets are cell fragments that function in the clotting system. Thrombopoietin helps control the number of circulating platelets by stimulating the bone marrow to produce megakaryocytes, Sequelae include opportunistic infections and an increased risk of Hemolysis is defined as premature destruction and hence a shortened RBC life span read more may result.
Portal hypertension is often associated with a hyperdynamic circulation. Mechanisms are complex and seem to involve altered sympathetic tone, production of nitric oxide and other endogenous vasodilators, and enhanced activity of humoral factors eg, glucagon.
Portal hypertension is asymptomatic; symptoms and signs result from its complications. The most dangerous is acute variceal bleeding Varices Varices are dilated veins in the distal esophagus or proximal stomach caused by elevated pressure in the portal venous system, typically from cirrhosis. Patients typically present with sudden painless upper gastrointestinal bleeding, often massive. Bleeding from portal hypertensive gastropathy is often subacute or chronic. Ascites Ascites Ascites is free fluid in the peritoneal cavity.
The most common cause is portal hypertension. Symptoms usually result from abdominal distention. Diagnosis is based on physical examination and Portal hypertension is assumed to be present when a patient with chronic liver disease has collateral circulation, splenomegaly, ascites Ascites Ascites is free fluid in the peritoneal cavity. Proof requires measurement of the hepatic venous pressure gradient, which approximates portal pressure, by a transjugular catheter; however, this procedure is invasive and usually not done.
Imaging may help when cirrhosis is suspected. Ultrasonography or CT often reveals dilated intra-abdominal collaterals, and Doppler ultrasonography can determine portal vein patency and flow. Esophagogastric varices and portal hypertensive gastropathy are best diagnosed by endoscopy, which may also identify predictors of esophagogastric variceal bleeding eg, red markings on a varix.
Prognosis is predicted by the degree of hepatic reserve and the degree of bleeding. Ongoing endoscopic or drug therapy lowers the bleeding risk but decreases long-term mortality only marginally. For treatment of acute bleeding, Overview of Gastrointestinal Bleeding Overview of Gastrointestinal Bleeding Gastrointestinal GI bleeding can originate anywhere from the mouth to the anus and can be overt or occult. The manifestations depend on the location and rate of bleeding.
See also Varices Nonselective beta-blockers with or without isosorbide mononitrate. In patients with esophagogastric varices that have bled, combined endoscopic and drug treatment decreases mortality and reduces risk of rebleeding better than either therapy used alone.
A series of endoscopic banding sessions are done to obliterate residual varices, then periodic endoscopic surveillance is done to identify and treat recurrent varices. This can cause abdominal discomfort and, because the enlarged spleen holds blood cells, reduce circulating platelets and white blood cells.
In addition to a physical exam, your doctor may order several tests to help diagnose cirrhosis or portal hypertension:. Your health information, right at your fingertips. Read the Latest. Overview Cirrhosis Overview Portal hypertension is increased pressure in the portal vein — the main vein that receives blood from the: Stomach Small intestines Spleen The increased pressure is most often a symptom of liver disease and is most commonly caused by scarring in the liver cirrhosis.
Variceal bleeding Pressure on the portal vein causes blood flow to be restricted or pushed backward. Other complications Portal hypertension may cause the spleen to become enlarged.
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