Esophageal Varices




Normal
Abnormal
  • 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
  • Usually, there are signs of Cirrhosis
  • Swollen abdomen, red hands, enlarged breasts in males, yellow eyes or skin


  • Laboratory:
    1. Complete blood count (first blood test may not be indicative of degree of blood loss)
    2. Prothrombin time (PT) and Partial thromboplastin time (PTT)
    3. Serum Electrolytes, albumin, BUN, Creatinine, Bilirubin, AST, ALT
  • Emergency endoscopy once individual medically stabilized

  • Initial emergency management:
    1. Adequate IV access (usually two large-bore IV catheters)
    2. Intravenous fluids
    3. Blood transfusions often necessary
    4. Fresh frozen plasma if INR > 1.5
    5. Platelet transfusion if platelet count < 50K
    6. Nasogastric tube placement to evacuate stomach and monitor further bleeding
    7. 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).
    8. Balloon tamponade: balloon -- type device used to put pressure on bleeding sites
    9. Intravenous antibiotics usually given for 3 - 10 days
    10. Octreotide/somatostatin can be used to control bleeding
    11. Vasopressin can be used to help control bleeding
    12. Vitamin K
    13. 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