Bleeding Varices
What are bleeding varices?
Varices are dilated blood vessels usually in the esophagus or stomach. They
cause no symptoms unless they rupture and bleed. Bleeding from varices is a
life-threatening complication of portal hypertension. Portal hypertension is an
increase in the pressure within the portal vein (the vein that carries blood
from the digestive organs to the liver) due to blockage of blood flow throughout
the liver.
This increased pressure in the portal vein causes the development of large,
swollen veins (varices) within the esophagus and stomach. The varices are
fragile and can rupture easily, resulting in a large amount of blood loss.
What causes bleeding varices?
The most common cause of portal hypertension is cirrhosis of the liver.
Cirrhosis is scarring that accompanies the healing of liver injury caused by
hepatitis, alcohol, or other less common causes of liver damage. In cirrhosis,
the scar tissue blocks the flow of blood through the liver and slows its
processing functions.
What are the symptoms of bleeding varices?
Symptoms of bleeding varices include:
- Vomiting of blood
- Black, tarry, or bloody stool
- Low blood pressure
- Rapid heart rate
- Shock (in severe cases)
How are bleeding varices treated?
Bleeding from varices is a medical emergency and treatment should be
immediate. If the bleeding is not controlled quickly, a patient may go into
shock or die. In severe cases, a patient may need to be placed temporarily on a
ventilator to prevent the lungs from filling with blood. Aside from the urgent
need to stop the bleeding, treatment is also aimed at preventing future
bleeding. The following procedures help treat bleeding varices by reducing the
pressure in these veins.
- Banding: This procedure is performed by a gastroenterologist
who places small rubber bands directly over the blood vessels (varices).
This will stop the bleeding and eradicate the varices.
- Sclerotherapy: This is a procedure in which a gastroenterologist
directly injects the varices with a blood-clotting solution instead of
banding them.
- Transjugular Intrahepatic Portosystemic Shunt (TIPS): This is a
radiological procedure in which a stent (a tubular device) is placed in the
middle of the liver. The stent connects the hepatic vein with the portal
vein. This procedure is done by placing a catheter through a vein in the
neck. The TIPS relieves the high blood pressure that has built up in the
liver.
- Distal Splenorenal Shunt (DSRS): This surgical procedure connects the splenic vein to the left kidney vein in order to reduce
pressure in your varices and control bleeding.
- Liver transplant: A liver transplant may be done in
cases of end-stage liver disease.
- Devascularization: This surgical procedure removes the
bleeding varices. This procedure is done when a TIPS or a surgical shunt is
not possible or is unsuccessful in controlling the bleeding.
Can bleeding varices be prevented?
Treating the underlying cause of bleeding varices can help prevent their
recurrence and treating liver disease earlier on may prevent their development.
Certain medications, including the class of heart drugs called beta blockers, may
reduce elevated portal pressure and reduce the likelihood of bleeding. Long-acting nitroglycerines are also sometimes used for this purpose.
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Copyright 1995-2005 The Cleveland Clinic Foundation. All rights reserved
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