Causes and Risks:

Bleeding varices are a life-threatening complication of portal hypertension (increased blood pressure in the portal vein caused by liver disease). Increased pressure causes the veins to balloon outward. The vessels may rupture, causing vomiting of blood and tarry black stools. If a large volume of blood is lost, signs of shock will develop. Any cause of chronic liver disease can cause this condition.

Prevention:

Treatment of the underlying causes of cirrhosis may prevent bleeding. Preventative treatment of varices with medications such as Beta blockers or with endoscopic banding may be helpful in preventing bleeding.

Symptoms:

• vomiting
• vomiting blood
• black, tarry stools
• decreased urine output
• symptoms of chronic liver disease (such as cirrhosis)
• thirst, excessive
• paleness
• lightheadedness

Signs and Tests:

Vital signs:

• low blood pressure
• rapid heart rate

Tests to visualize the varices:

• EGD (esophagogastroduodenoscopy)

Treatment:

The objective of therapy is to stop acute bleeding as soon as possible and manage persistent varices with medical and procedural therapies. Bleeding must be controlled quickly to prevent shock and death.

In endoscopic therapy, an endoscope (a device with a light that can look inside of a body cavity) is used. The health care provider may directly inject the varices with a clotting agent, or may place a rubber band around the bleeding veins. This procedure is used in acute bleeding episodes and as prophylactic (preventive) therapy.

Acute bleeding may also be treated by a balloon tamponade-- a tube that is inserted through the nose into the stomach and inflated with air to produce pressure against the bleeding veins.

In transjugular intrahepatic portosystemic shunting, a catheter is extended through a vein into the liver where it connects the portal system to the systemic venous system and decreases portal venous pressure.

Octreotide and vasopressin are medications that may be used to decrease portal blood flow and slow bleeding.

Emergency surgery for patients refractory to medical treatment may be necessary. Portacaval shunts (that pass blood to the vena cava from the portal vein by a graft) or resection of part of the esophagus are two treatment options, but these procedures have a high death rate.

Prognosis:

Bleeding recurs frequently. Bleeding esophageal varices are a serious complication of liver disease and carry a poor prognosis (probable outcome).

Complications:

• recurrence of bleeding after treatment
• hypovolemic shock
• esophageal stricture after surgery or endoscopic therapy

Call your health care provider if significant episodes of vomiting blood or black tarry stools occur.