The esophagus is the tube in the chest that carries food from the mouth to the stomach. It has a system of veins that take blood from the esophagus back to the heart. This system is connected to the same venous system as the liver (called the portal veins). When the liver is damaged (most commonly by Cirrhosis), fluid
backs up in the portal veins, blocking the veins of the
esophagus. The esophageal veins then dilate (distended
much beyond their normal size); the walls weaken and burst
like a balloon. When this occurs, there may be massive
bleeding in the
esophagus.
Vomiting bright red blood or
coffee-ground material
Individual may pass tar/black stool
or blood in the stool
Emergency endoscopy once individual
medically stabilized
Initial emergency
management:
Adequate IV access (usually two
large-bore IV catheters)
Intravenous fluids
Blood transfusions often
necessary
Fresh frozen plasma if INR >
1.5
Platelet transfusion if platelet
count < 50K
Nasogastric tube placement to
evacuate stomach and monitor further bleeding
Emergency endoscopy -- scope is
moved down the esophagus to place rubber bands on bleeding
varices or inject them with medicine to stop the bleeding
(sclerotherapy).
Balloon tamponade: balloon --
type device used to put pressure on bleeding sites
Intravenous antibiotics usually
given for 3 - 10 days
Octreotide/somatostatin can be
used to control bleeding
Vasopressin can be used to help
control bleeding
Vitamin K
Lactulose if hepatic
encephalopathy (brain dysfunction from liver disease
occurs)
If the above treatments fail:
- Emergency portal vein decompression surgery procedures (shunting) may be necessary.
Endoscopic banding or sclerotherapy
Beta-blocker medications
Surgical shunting procedures --
designed to lower the pressure in the esophageal vein system
by lowering pressure in the portal system
Liver transplant if all of the above fail, and the varices continue to bleed
