Esophageal varices.

1. ESOPHAGEAL VARICES
Esophageal varices are abnormal, enlarged veins in the tube
that connects the throat and stomach (esophagus). This
condition occurs most often in people with serious liver
diseases.
Esophageal varices develop when normal blood flow to the
liver is blocked by a clot or scar tissue in the liver. To go
around the blockages, blood flows into smaller blood vessels
that aren't designed to carry large volumes of blood. The
vessels can leak blood or even rupture, causing life-
threatening bleeding.
A number of drugs and medical procedures can help prevent
and stop bleeding from esophageal varices.

2. Symptomsand Causes
• Symptoms
• Esophageal varices usually don't cause signs and symptoms
unless they bleed. Signs and symptoms of bleeding
esophageal varices include:
• Vomiting and seeing significant amounts of blood in your
vomit
• Black, tarry or bloody stools
• Lightheadedness
• Loss of consciousness (in severe case)
signs of liver disease, including:
• Yellow coloration of your skin and eyes (jaundice)
• Easy bleeding or bruising
• Fluid buildup in your abdomen (ascites)

3. Causes
Esophageal varices sometimes form when blood flow to your liver is blocked, most often
by scar tissue in the liver caused by liver disease. The blood flow begins to back up,
increasing pressure within the large vein (portal vein) that carries blood to your liver.
This pressure (portal hypertension) forces the blood to seek other pathways through
smaller veins, such as those in the lowest part of the esophagus. These thin-walled veins
balloon with the added blood. Sometimes the veins can rupture and bleed.
Causes of esophageal varices include:
Severe liver scarring (cirrhosis). A number of liver diseases — including hepatitis
infection, alcoholic liver disease, fatty liver disease and a bile duct disorder called
primary biliary cirrhosis — can result in cirrhosis.
Blood clot (thrombosis). A blood clot in the portal vein or in a vein that feeds into the
portal vein (splenic vein) can cause esophageal varices.
A parasitic infection. Schistosomiasis is a parasitic infection found in parts of Africa,
South America, the Caribbean, the Middle East and Southeast Asia. The parasite can
damage the liver, as well as the lungs, intestine and bladder

4. Riskfactors
Althoughmanypeoplewithadvancedliverdiseasedevelop
esophagealvarices,mostwon'thavebleeding.Varicesaremore
likelytobleedif
• High portal vein pressure. The risk of bleeding increases with
the amount of pressure in the portal vein (portal
hypertension).
• Large varices. The larger the varices, the more likely they are
to bleed.
• Red marks on the varices. When viewed through an
endoscope passed down your throat, some varices show long,
red streaks or red spots. These marks indicate a high risk of
bleeding.
• Severe cirrhosis or liver failure. Most often, the more severe
your liver disease, the more likely varices are to bleed.
• Continued alcohol use. Your risk of variceal bleeding is far
greater if you continue to drink than if you stop, especially if
your disease is alcohol related.

5. Complications
• Complications
• The most serious complication of esophageal varices is
bleeding. Once you have had a bleeding episode, your risk of
another bleeding episode greatly increases. If you lose enough
blood, you can go into shock, which can lead to death.

6. Diagnosis
• Main tests used to diagnose esophageal varices are:
• Endoscope exam. A procedure called upper gastrointestinal
endoscopy is the preferred method of screening for varices. Your
doctor inserts a thin, flexible, lighted tube (endoscope) through your
mouth and into your esophagus, stomach and the beginning of your
small intestine (duodenum).
• The doctor will look for dilated veins, measure them, if found, and
check for red streaks and red spots, which usually indicate a
significant risk of bleeding. Treatment can be performed during the
exam.
• Imaging tests. Both abdominal CT scans and Doppler ultrasounds of
the splenic and portal veins can suggest the presence of esophageal
varices.
• Capsule endoscopy. In this test, you swallow a vitamin-sized capsule
containing a tiny camera, which takes pictures of the esophagus as it
goes through your digestive tract. This might be an option for people
who are unable or unwilling to have an endoscope exam. This
technology is more expensive than regular endoscopy and not as
available.

7. Treatment :
• In emergency situations, care is directed at stopping blood
loss, maintaining plasma volume, correcting disorders in
coagulation induced by cirrhosis, and appropriate use
of antibiotics such as quinolone or ceftriaxone. Blood volume
resuscitation should be done promptly and with caution. The
goal should be hemodynamic stability and hemoglobin of over
8 g/dl. Resuscitation of all lost blood leads to increase in portal
pressure leading to more bleeding. Volume resuscitation can
also worsen ascites and increase portal pressure.
Therapeutic endoscopy is considered the mainstay of urgent
treatment. The two main therapeutic approaches are variceal
ligation or banding and sclerotherapy.

8. Treatment
• Treatment to prevent bleeding
• Treatments to lower blood pressure in the portal vein may
reduce the risk of bleeding esophageal varices. Treatments
may include:
• Medications to reduce pressure in the portal vein. A type of
blood pressure drug called a beta blocker may help reduce
blood pressure in your portal vein, decreasing the likelihood of
bleeding. These medications include propranolol (Inderal,
Innopran) and nadolol (Corgard).
• Using elastic bands to tie off bleeding veins. If your
esophageal varices appear to have a high risk of bleeding, your
doctor might recommend a procedure called band ligation.
• Using an endoscope, the doctor snares the varices and wraps
them with an elastic band, which essentially "strangles" the
veins so they can't bleed. Esophageal band ligation carries a
small risk of complications, such as scarring of the esophagus.

9. Treatment :
• Using elastic bands to tie off bleeding veins.
• Medications to slow blood flow into the portal vein. A drug
called octreotide (Sandostatin) is often used with endoscopic
therapy to slow the flow of blood from internal organs to the
portal vein. The drug is usually continued for five days after a
bleeding episode.
• Diverting blood flow away from the portal vein. Your doctor
might recommend a procedure called transjugular
intrahepatic portosystemic shunt (TIPS) to place a shunt. The
shunt is a small tube that is placed between the portal vein
and the hepatic vein, which carries blood from your liver to
your heart. The shunt reduces pressure in the portal vein and
often stops bleeding from esophageal varices.

10. Treatment :
• Restoring blood volume. You might be given a transfusion to
replace lost blood and clotting factor to stop bleeding.
• Preventing infection. There is an increased risk of infection
with bleeding, so you'll likely be given an antibiotic to prevent
infection.
• Replacing the diseased liver with a healthy one. Liver
transplant is an option for people with severe liver disease or
those who experience recurrent bleeding of esophageal
varices. Although liver transplantation is often successful, the
number of people awaiting transplants far outnumbers the
available organs.

11. Self-management
• Prevention
• Currently, no treatment can prevent the development of esophageal
varices in people with cirrhosis. While beta blocker drugs are
effective in preventing bleeding in many people who have
esophageal varices, they do not prevent esophageal varices from
forming.
• Don't drink alcohol. People with liver disease are often advised to
stop drinking alcohol, since the liver processes alcohol. Drinking
alcohol may stress an already vulnerable liver.
• Eat a healthy diet. Choose a plant-based diet that's full of fruits and
vegetables. Select whole grains and lean sources of protein. Reduce
the amount of fatty and fried foods you eat.
• Use chemicals sparingly and carefully. Follow the directions on
household chemicals, such as cleaning supplies and insect sprays. If
you work around chemicals, follow all safety precautions. Your liver
removes toxins from your body, so give it a break by limiting the
amount of toxins it must process.
• Reduce your risk of hepatitis. Sharing needles and having
unprotected sex can increase your risk of hepatitis B and C.

12. References :
• http://www.mayoclinic.org/
• https://www.google.co.in/search?sourceid=chrome-
psyapi2&ion=1&espv=2&ie=UTF-
8&q=esophageal%20varices&oq=esophageal&rlz=1C1CHBD_e
nIN724IN725&aqs=chrome.1.69i57j69i59l2j0l3.3504j0j4
• https://en.wikipedia.org/wiki/Esophageal_varices