Introduction
Liver cirrhosis can cause portal hypertension, which is unusually elevated in portal-venous pressure. Many complications can be resulted from portal hypertension and the most frequent one is esophageal variceal bleeding.
Definition and Pathogenesis
Liver cirrhosis is the most common cause of esophageal variceal bleeding. Commonly, normal pressure in the portal vein is approximately 5-10mmHg.When portal hypertension is >12mmHg, it can result in collateral flow, esophageal varices, and hyperactivity of visceral venous system. It most commonly results from increased resistance to portal blood flow.
Clinical features and Diagnosis
It is not necessarily to have rupture and hemorrhage occurred in patients with esophageal varices. Once there is bleeding, it usually presents with hematemesis, melena, tarry stool or even bloody stool. Additionally, there could be associated signs ranging from mild postural tachycardia and unstable blood pressure to profound shock, depending on the extent of blood loss and degree of hypovolemia.
Diagnosis is essential according to the finding of endoscopic examination and whether there is a cirrhosis history before. Endoscopy is the best approach to evaluate upper gastrointestinal hemorrhage in patients with known or suspected portal hypertension.
In patients with known liver disease, the development of portal hypertension is usually revealed by the appearance of splenomegaly, ascites, encephalopathy, and/or esophageal varices. Commonly, the finding of any of these features should prompt evaluation of the patient for the presence of underlying portal hypertension and liver disease.
Treatment
Treatment includes non-surgical and surgical intervention.
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non-surgical intervention:
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vasoconstrictors: like pitressin and somatostatin. Acute treatment with these medications may help control acute variceal bleeding.
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balloon tamponade: control bleeding by compress the gastric or esophageal bleeder.
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endoscopic variceal sclerosis of varices (sclerotherapy): sclerosant solution is injected into esophageal varices to achieve efficacy of reducing or stop bleeding.
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endoscopic variceal ligation (EVL) of varices: after identifying the bleeding site of esophageal varices by endoscopy, ligation is performed. Because ligation has less recurrence of bleeding, there should be fewer local complications; and it requires fewer treatment sessions to achieve variceal eradication as compared to sclerotherapy, it now becomes the major therapeutic method.
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transjugular intrahepatic portosystemic shunt (TIPS): decompression can be accomplished without surgery through the percutaneous stent placement of a portal-systemic shunt.
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direct surgical decompression to esophageal or gastric varices.
Notices
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pay attention to whether there is hematemesis or melena.
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avoid too hot or too cold food. Additionally, rigid medication should be powdered to reduce the rupture of esophageal varices.
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adequate exercise and enough time to rest and sleep.
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avoid strong cough, heavy things, and hard defecation.
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if there is the signs of syncope, thirsty, tachycardia or dyspnea, call for help soon.
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regular endoscopic evaluation and intervention if needed.
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