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Variceal haemorrhage occurs from dilated veins at the junction between the portal and systemic venous systems. Varices tend to be in the distal oesophagus and/or the proximal stomach, but isolated varices may be found in the distal stomach, large and small intestine. The majority of patients with variceal bleeding have chronic liver disease. Bleeding is characteristically severe and may be life-threatening. The size of the varices and their tendency to bleed are directly related to the portal pressure, which is usually directly related to the severity of underlying liver disease. Large varices with red spots are at highest risk of rupture. Esophageal varices occur most often in people with serious liver diseases.
Esophageal varices develop when normal blood flow to the liver is obstructed by scar tissue in the liver or a clot. Seeking a way around the blockages, blood flows into smaller blood vessels that are not designed to carry large volumes of blood. The vessels may leak blood or even rupture, causing life-threatening bleeding. Esophageal varices usually don't cause signs and symptoms unless they bleed. Signs and symptoms of bleeding esophageal varices are vomiting blood, black, tarry or bloody stools and shock. A doctor may suspect varices if patient have yellow coloration of skin and eyes (jaundice), A cluster of tiny blood vessels on the skin, shaped like a spider (spider nevi), Reddening of the skin on the palm of hand, dupuytren's contracture, shrunken testicles, swollen spleen, fluid buildup in your abdomen.
The goal of treatment is to stop acute bleeding as soon as possible. Bleeding must be controlled quickly to prevent shock and death. If massive bleeding occurs, a person may need to be put on a ventilator to protect the airways and prevent blood from going down into the lungs.
To treat acute bleeding the health care provider may inject the varices directly with a clotting medicine, or place a rubber band around the bleeding veins. This procedure is done using a small lighted tube called an endoscope. A medication that tightens blood vessels (vasoconstriction) may be used. Examples include octreotide or vasopressin. Rarely, a tube may be inserted through the nose into the stomach and inflated with air. This produces pressure against the bleeding veins (balloon tamponade).
