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Variceal Bleeding

What is variceal bleeding?

Varices are veins that are abnormally dilated. Esophageal varices can rupture and bleed, and this type of bleeding is usually a medical emergency with a significant risk of fatality. Variceal hemorrhage is the term used to describe bleeding from varices in the esophagus, stomach, and rectum, among other places in the gastrointestinal tract. There is a significant chance that the varices will bleed again in the future if they have already done so.

Veins often transport deoxygenated blood back to the heart from an organ. Varices happen when a blockage or restricted veins prevent blood from exiting an organ. Variceal hemorrhage is most frequently caused by portal hypertension.

The portal system, a network of veins that drains blood from the belly, has increased pressure in portal hypertension. Because the portal vein cannot function, the blood attempts to exit the abdomen through other veins, which causes the blood pressure to elevate. These veins expand, are weak, and are easily prone to bleeding. These aberrant veins can cause esophageal varices, rectal varices, retroperitoneal hemorrhage, and caput medusae (distended veins under the skin on the belly), depending on where they are located.

Risk Factors

Portal hypertension, which frequently follows liver illness, frequently results in variceal hemorrhage. The following are risk factors for portal hypertension, which may lead to varices:

  • Cirrhosis (liver scarring), which can be caused by:
    • History of alcohol use
    • Hepatitis B or C infection
    • Long term inflammation of the liver
    • Hemochromatosis, or iron overload
  • Congestive heart failure
  • Arteriovenous malformations (AVMs)
  • Hypercoagulable states

Symptoms

Varices are not visible without endoscopy, with the exception of caput medusae (dilated veins under the skin of the belly), and are frequently asymptomatic if they don't bleed. Variceal hemorrhage signs include:

  • Vomiting blood
  • Bloody or black stools
  • Lightheadedness
  • Pale skin
  • Low blood pressure

Conditions that cause variceal hemorrhage have the following symptoms:

  • Ascites (fluid in the abdomen)
  • Hepatic encephalopathy (confusion)
  • Splenomegaly, or an enlarged spleen
    • May have decreased platelets or left abdominal pain or fullness as a result
  • Jaundice, or yellowing skin
  • Easy bruising or bleeding
  • Weakness
  • Weight loss
  • Abdominal pain

Diagnosis

Vomiting blood or bloody/black stools can indicate gastrointestinal bleeding, especially if there is also a history of liver disease or risk factors for liver disease. Varices can be diagnosed before they bleed by undergoing endoscopy, a procedure where a camera is passed down through the mouth to directly inspect the esophagus, stomach, and duodenum.

Treatments

  • TIPS
  • BRTO or PARTO