how to treatment hepatic varices

Medication

The score for cirrhosis determines the types, such as:

• Class A is relatively mild liver cirrhosis. Those with class A and a 5-6 score usually have a life expectancy predicted at 15-20 years.
• Class B is still considered mild liver cirrhosis. Those in this class with a point score of 7-9 tend to have a life expectancy between 6-10 years.
• Class C is the most severe class of liver cirrhosis. ...

Procedures

What are the 5 stages of liver disease?

• Causes of liver failure: The causes of liver disease may either chronic or acute. ...
• Acute liver failure: Acute liver failure is linked with various factors, even though the exact cause may unknown.
• Chronic liver failure: Chronic liver failure may even result in cirrhosis, which is inflammation in the liver cells. ...

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Therapy

Cause of Bleeding Varices It's often due to scarring of the liver, or cirrhosis. This increased pressure in the portal vein causes blood to be pushed away from the liver to smaller blood vessels, which are not able to handle the increased amount of blood.

Nutrition

Are esophageal varices fully curable? Initial treatment of bleeding esophageal varices is effective in 80 to 90% of cases but mortality remains approximately 15 to 20%, with the majority of deaths due to liver failure, hepatorenal syndrome, and infections, and occurring predominantly in Child class C cirrhotic patients.

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What is the life expectancy for decompensated cirrhosis?

What are the 5 stages of liver disease?

What causes varices to bleed?

Are esophageal varices fully curable?

What is used to treat varices?

Beta blockers — Beta blockers, which are traditionally used to treat high blood pressure, are the most commonly recommended medication to prevent bleeding from varices. Beta blockers decrease pressure inside of the varices, which can reduce the risk of bleeding by 45 to 50 percent [1].

How do you control variceal bleeding?

If variceal bleeding is suspected, medical therapy with vasopressors should be initiated immediately, and as there is a high risk of bacterial infection due to bleeding, prophylactic antibiotics should be administered.

What is the treatment of choice for bleeding esophageal and gastric varices?

Currently, the endoscopic treatment of choice for acute GV bleeding is GVO. However, the rebleeding rate of GVO remains high. When patients with GV bleeding are unresponsive to initial endoscopic treatment, a second endoscopic therapy should be attempted if possible.

Can varices heal on their own?

Varicose veins will not heal on their own, and delaying treatment may worsen the condition, leading to more serious ailments.

How long can you live with varices?

Varices recurred in 78 patients and rebled in 45 of these patients. Median follow-up was 32.3 months (mean, 42.1 months; range, 3–198.9 months). Cumulative overall survival by life-table analysis was 67%, 42%, and 26% at 1, 3, and 5 years, respectively.

Why is terlipressin used in variceal bleeding?

In patients with cirrhosis and variceal bleeding, the use of terlipressin reduces the portal vein pressure and decreases the pressure in esophageal varices.

Why is propranolol used for esophageal varices?

By slowing the heart rate and widening the blood vessels, beta-blocker medicines such as propranolol and nadolol appear to lower the blood pressure in varices that bypass the liver. In people who have esophageal varices, beta-blockers have been shown to reduce the risk of having a first episode of bleeding.

How do beta-blockers reduce portal hypertension?

Beta-blockers lower the cardiac output (via blockade of beta1 adrenoreceptors) and cause splanchnic vasoconstriction (via blockade of vasodilatory adrenoreceptors of the splanchnic circulation), reducing portal and collateral blood flow.

What stage of cirrhosis is portal hypertension?

Portal hypertension is the major driver in the transition from the compensated to the 'decompensated' stage of cirrhosis [5], defined by the presence of clinical complications, including ascites [6], bleeding from gastroesophageal varices [7], spontaneous bacterial peritonitis [8], hepatorenal syndrome [6], and hepatic ...

What is the best treatment for liver cirrhosis?

The main treatments are cutting out salt from your diet and taking a type of medicine called a diuretic, such as spironolactone or furosemide. If the fluid in your tummy becomes infected, you may need antibiotics. In severe cases, you may need to have the fluid drained from your tummy area with a tube.

How do you treat varicose veins without surgery?

Compression therapy is the most conservative treatment option. Compression stockings are designed to apply specific pressure to the legs to alleviate discomfort and swelling and do not require a prescription.

What happens when varices bleed?

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.

What Are Esophageal Varices?

Varices are veins that are enlarged or swollen. The esophagus is the tube that connects the throat to the stomach. When enlarged veins occur on the...

Who Is at Risk For Esophageal Varices That Break Open and Bleed?

Not everyone who develops esophageal varices will have bleeding. Factors that increase the risk for bleeding include: 1. High portal blood pressure...

What Causes Esophageal Varices?

The liver is the organ that cleanses toxins from the blood. The portal vein delivers blood to the liver. Esophageal varices usually occur in people...

What Liver Conditions Can Lead to Esophageal Varices?

Any type of serious liver disease can cause esophageal varices. Cirrhosis is the most common type of liver disease, and more than 90% of these pati...

What Are The Symptoms of Esophageal Varices?

Most people do not know they have esophageal varices until the varices start to bleed. When bleeding is sudden and severe, the person vomits large...

What are gastrointestinal varices?

Gastrointestinal varices are abnormally dilated submucosal veins in the digestive tract due to portal hypertension and can potentially cause life-threatening bleeding. Prevalence of varices increases with the severity of liver disease (Child-Pugh class A 42.7%, class B 70.7% and class C 75.5%) [ 2, 10 ]. The Child-Pugh score is described in Table#N#​ Table1.#N#1. The incidence of esophageal varices in cirrhotic patients is around 5% at the end of one year and 28% at the end of three years. Small varices progress to large varices at a rate of 10% to 12% annually [ 11 ]. Approximately 50% of all patients with a new diagnosis of cirrhosis have gastrointestinal varices [ 2 ]. Annual risk of variceal bleeding among small and large varices is 5% and 15% respectively [ 12 ]. The six-week mortality rate among patients with index variceal bleeding is approximately 20% [ 13 ]. Risk of rebleeding without endoscopic intervention is almost 60% with an increased mortality rate (33%) [ 14 ].

Why do varices bleed?

Large varices (> 5 mm) have a higher tendency to bleed due to increased wall tension as explained above.

What causes variceal formation?

Porto-systemic shunting due to portal hypertension causes diversion of the portal blood into systemic circulation and results in variceal formation. Presence of ongoing liver injury due to alcohol, viral hepatitis (hepatitis B and C), or NASH can lead to increase in the size of the varices, whereas elimination of etiological factor can lead to decrease in the size or disappearance of varices in patients with alcoholic cirrhosis[16,17].

What is the gold standard procedure for gastroesophageal varices?

Esophago-gastro duodenoscopy (EGD) is the gold standard procedure used in the diagnosis of gastroesophageal varices (GOVs). Based on the endoscopic assessment, GOVs are classified into small (< 5 mm), and large varices (> 5 mm) [ 38] for clinical management. Disadvantages of endoscopy include the risk of sedation, higher cost, bleeding and risk of aspiration.

Where do stoma varices occur?

Stomal varices. Stomal varices usually occur at the mucocutaneous junction of the stoma, due to portosystemic shunt between the portal circulation of the bowel and systemic circulation of the abdominal wall. Diagnosis of stomal varices is difficult, on physical exam, they appear as bluish discoloration of the skin.

Does capsule endoscopy detect GVs?

A recent meta-analysis reviewed the use of capsule endoscopy for the diagnosis and grading of esophageal varices and noted a diagnostic accuracy of 90% with a pooled sensitivity and specificity of 83% and 85%, respectively [ 42 ]. The inability of capsule endoscopy to detect GVs is a significant drawback. Even though capsule endoscopy is relatively less invasive and does not require sedation, the diagnostic sensitivity is not adequate to advocate for index surveillance. It may be a consideration for a select subgroup of high-risk patients who are unwilling to undergo more invasive traditional endoscopic evaluation [ 43, 44 ]. One study showed that 97% of the patients preferred capsule endoscopy over endoscopy with or without sedation [ 44 ].

What are the complications of portal hypertension?

The most significant complication of portal hypertension is life-threatening bleeding from gastrointestinal varices, which is associated with substantial morbidity and mortality. In addition, this can cause a significant burden on the health care facility.

What is the treatment for varices?

Treatment typically consists of intravenous fluids, and in some cases, transfusion of red blood cells to support the blood pressure. In patients with abnormalities of the blood clotting system, transfusion of platelets and/or clotting factors (e.g. fresh frozen plasma) may be necessary. To help stop bleeding from varices, ...

How are varices managed?

In patients with large esophageal or gastric varices that are at risk of rupture, preventive treatment with beta blockers (e.g. nadolol or propranolol) is usually instituted. Beta-blockers reduce the pressure within varices to help prevent their rupture. In some cases, endoscopic therapy (i.e. variceal banding may be instituted to prevent variceal hemorrhage (see below).

What is a portosystemic shunt?

In cases where severe bleeding occurs and other treatments have failed or are not possible, radiologic or surgical portosystemic shunt procedures may be used to reduce the flow of blood through the varices, reduce pressure within them, and to stop their bleeding. The most commonly employed procedure today is a transjugular intrahepatic portosystemic shunt (TIPS), which is a non-surgical procedure performed by radiologists (see below). In rare circumstances, a surgical shunt may be necessary. This procedure involves the surgical joining of two veins, the portal vein and the inferior vena cava, to relieve pressure in the portal vein that carries blood into the liver. Different types of surgical shunts can be performed; however, they are rarely required today.

What is a transjugular intrahepatic portal-systemic shunt (TIPS)?

A TIPS is a non-surgical shunt which has improved the management of difficult to control portal hypertension. In the case of life-threatening bleeding that cannot be controlled by endoscopic and medical therapy, TIPS is a useful option. TIPS insertion is performed in the x-ray department by radiologists. In this procedure, a needle is inserted via the jugular vein in the neck, advanced into a hepatic vein (which drains blood from the liver), and then into a large branch of the portal vein (which supplies blood to the liver). Using an inflatable balloon-tipped catheter tube, the section between the portal vein branch and the hepatic vein is widened and then kept open (stented) with a cylindrical wire-mesh stent. This shunt serves to bypass blood around the high-pressure blood vessels within the scarred cirrhotic liver, and thereby reduces pressure within the portal veins and branches (including varices).

What is the treatment for variceal hemorrhage?

In some cases, endoscopic therapy (i.e. variceal banding may be instituted to prevent variceal hemorrhage (see below). Patients with esophageal and/or gastric variceal bleeding require urgent hospital admission. Treatment typically consists of intravenous fluids, and in some cases, transfusion of red blood cells to support the blood pressure.

How to treat variceal bleeding?

Endoscopic therapy is a way of preventing and treating variceal bleeding without the requirement for surgery. In the most common procedure called endoscopic variceal banding (or ligation), rubber bands are placed around varices in the esophagus through a flexible endoscope which is used to visualize the vessels. In rare circumstances, if bleeding cannot be controlled by variceal banding, another technique called endoscopic sclerotherapy may be employed. This procedure, which is rarely used currently, involves the injection of diluted mixtures of sclerosing (hardening) solutions into the esophageal varices to lead to their eradication. In the case of varices in the stomach (gastric varices) banding is not usually possible. The preferred management of gastric varices that require therapy is the injection of glue (e.g. histacryl), also at the time of endoscopy.

What is it called when blood vessels become swollen?

Some of these blood vessels may become quite large and swollen; they are known as varices. The spleen may also become enlarged in this situation. Varices can occur anywhere within the gastrointestinal tract but occur most commonly in the esophagus and stomach. Due to high pressure (portal hypertension) and thinning of the walls of varices, they may rupture, causing bleeding within the upper gastrointestinal tract. Similarly, sometimes smaller superficial blood vessels become swollen within the lining of the gastrointestinal tract and can occasionally ooze blood. This is referred to as portal hypertensive gastropathy (if in the stomach) or colopathy (if in the colon).

How to stop bleeding from esophageal varices?

Doctors are exploring an experimental emergency therapy to stop bleeding from esophageal varices that involves spraying an adhesive powder. The hemostatic powder is administered through a catheter during an endoscopy. When sprayed on the esophagus, hemostatic powder sticks to the varices and may stop bleeding.

What is the primary aim of esophageal varices?

The primary aim in treating esophageal varices is to prevent bleeding. Bleeding esophageal varices are life-threatening. If bleeding occurs, treatments are available to try to stop the bleeding.

What test is used to diagnose cirrhosis?

How often you'll undergo screening tests depends on your condition. Main tests used to diagnose esophageal varices are: Endoscopic exam. A procedure called upper gastrointestinal endoscopy is the preferred method of screening for esophageal varices.

What is the procedure called to check for varices in the esophagus?

A procedure called upper gastrointestinal endoscopy is the preferred method of screening for esophageal 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).

When to use TIPS?

TIPS is mainly used when all other treatments have failed or as a temporary measure in people awaiting a liver transplant. Placing pressure on varices to stop bleeding. If medication and endoscopy treatments don't work, doctors may try to stop bleeding by applying pressure to the esophageal varices.

Can balloon tamponade cause esophageal bleeding?

This procedure carries a high risk of bleeding recurrence after the balloon is deflated. Balloon tamponade may also cause serious complications, including a rupture in the esophagus, which can lead to death.

Is esophageal varices life threatening?

Bleeding esophageal varices are life-threatening, and immediate treatment is essential. Treatments used to stop bleeding and reverse the effects of blood loss include:

How to treat gastric varices?

Blood transfusions are often needed to replace the blood being lost from the bleeding varices. Endoscopic variceal ligation is the most common technique used when treating gastric varices.

What causes gastric varices?

Gastric varices are a pathological condition caused by liver dysfunction, most often cirrhosis of the liver, resulting in portal hypertension. Portal hypertension occurs when there is increased pressure in the portal veins of the liver. These veins are how blood reaches the liver and the spleen.

What happens if your varices burst?

If the varices burst, the internal bleeding they cause can become life-threatening. The internal bleeding from gastric varices causes patients to cough up blood, vomit blood, have bloody or black and tarry stools, and eventually dizziness and shock.

What is the procedure to diagnose gastric varices?

Diagnosing gastric varices often requires an endoscopy for confirmation. An endoscopy is an imaging procedure, similar to an ultrasound, that allows a doctor to view the inside of your digestive tract.

Why do portal veins swell?

Portal hypertension forces blood from the portal veins into smaller blood vessels in the stomach area that are unable to handle the additional amounts of blood, causing them to swell and sometimes burst. Before they rupture, gastric varices are asymptomatic.

What are the three types of hashizomes?

The hashizome classification includes three different types of gastric varices. They are characterized by form, location, and color of the varices. Based on their shapes, varices are described as either Tortuous, Nodular, or Tumorous. Locations are broken down into anterior (front), posterior (back), lesser curvature ...

What is the treatment for a vein clot?

Sclerotherapy is also a treatment option, where certain medicines are injected directly into the veins, causing them to shrink. Alternatively, endoscopic injections can be used to place tissue adhesives at the site of bleeding, forcing the tissues to clot and control the bleeding.

How do doctors treat varices?

Endoscopy. Doctors insert a thin, flexible tube ( endoscope) through your mouth. It goes down your esophagus and into your stomach. They can view and treat varices through the endoscope.

What type of varices do you get if you have cirrhosis?

If you have cirrhosis, your doctor will screen you routinely for esophageal varices.

What is a tips shunt?

Transjugular intrahepatic portosystemic shunt (TIPS) to reduce portal hypertension by bypassing the damaged liver. Doctors connect the portal vein to the hepatic vein and insert a stent to increase blood flow around the liver. Because the blood has a new pathway, it eases pressure on the veins of the esophagus and stomach.

What causes portal hypertension?

Cirrhosis of the liver is almost always the cause of portal hypertension.

Why do veins leak blood?

Since these veins can't handle a high volume of blood, they can develop bulges that leak blood or rupture. These are esophageal varices.

How to prevent liver disease?

The only way to prevent this condition is to keep your liver healthy. People who drink too much alcohol or have hepatitis are at risk for liver disease.

How to treat enlarged veins?

Banding. The doctor uses an endoscope to place an elastic ring around the enlarged vein. The ring cuts off blood flow to the vein so it won't burst. Doctors can repeat the banding process many times.

What is the first line of treatment for esophageal varices?

If the cause is esophageal varices, band ligation is the first-line treatment that should be applied. Patients who fail band ligation therapy and have continued bleeding are candidates for transjugular hepatic portosystemic shunting (TIPS) therapy.

What is the first thing that should be done for a patient with esophageal bleeding, or?

The first thing that should be done for a patient with esophageal bleeding, or cirrhosis and any gastrointestinal bleeding, is to provide volume resuscitation and an attempt to correct any coagulopathy. Endoscopic examination allows the direct visualization of the varices and the source of bleeding, which can be active spurting or bleeding, or a red dimple, which is a sign of a recent bleed. Other causes of bleeds, including ulcers and portal gastropathy, can also be assessed at this time.

Is JTBand ligation therapy better than sclerotherapy?

JTBand ligation therapy has been shown in studies to be easier to apply, with far fewer side effects, and is just as, if not more, effective than sclerotherapy (direct injection of a sclerosant agent into the variceal vessel). I have not performed sclerotherapy in any patients in 8–10 years, largely due to the side effects, including strictures and ulceration, that manifest in patients who receive it. Sclerotherapy also has rare systemic hazards of infection with bacteremia. None of this is of concern in therapy with band ligation.

Can cirrhosis be treated with anesthesia?

For patients with alcoholic cirrhosis who are actively drinking, general anesthesia may be required for the endoscopic procedure. In these patients, waking-sedation anesthetics, including benzodiazepines, often cause an antagonistic reaction, wherein the patient becomes highly agitated, rather than achieving the desired and expected sedative effect.

What is a varices in the esophagus?

Overview. Esophageal varices are enlarged veins in the esophagus. They're often due to obstructed blood flow through the portal vein, which carries blood from the intestine, pancreas and spleen to the liver. Esophageal varices are abnormal, enlarged veins in the tube that connects the throat and stomach (esophagus).

What causes esophageal varices?

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 ...

Why do esophageal varices bleed?

Esophageal varices are more likely to bleed if you have: High portal vein pressure. The risk of bleeding increases as the pressure in the portal vein increases (portal hypertension). Large varices. The larger the esophageal varices, the more likely they are to bleed. Red marks on the varices.

What happens if you lose blood in your esophageal vein?

Once you've 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.

What to do if you have liver disease?

If you've been diagnosed with liver disease, ask your doctor about your risk of esophageal varices and what you can do to reduce your risk. Also ask your doctor whether you should get a procedure to check for esophageal varices. If you've been diagnosed with esophageal varices, your doctor is likely to instruct you to watch for signs of bleeding. ...

How to get rid of toxins in your body?

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.

Can alcohol cause variceal bleeds?

Most often, the more severe your liver disease, the more likely esophageal 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.

How to treat variceal hemorrhage?

During an endoscopy, your doctor places small elastic rings over the vein. The rings block the blood supply to each varix. You will undergo the initial banding session and then return for subsequent sessions in order to completely obliterate the varices, which is usually achieved after four to five procedures.

How to stop variceal bleeding?

Balloon tamponade: This is done to control severe variceal bleeding through compressing the vein. We inflate a small balloon within your stomach or esophagus to apply pressure to the bleeding veins. This compresses and stops the bleeding. This is a complex procedure that should only be performed by experienced physicians.

What is a TIPSS procedure?

Nonsurgical transjugular intrahepatic portal systemic shunt (TIPSS): This procedure should only be performed by a doctor with a high level of expertise and experience. Your doctor will access the hepatic vein through the jugular vein and pass a needle through the liver into the portal vein. The vein is then dilated and a stent is put in place to keep the vein open.

What is the best treatment for portal hypertension?

Liver transplantation is the only effective treatment for cirrhosis and portal hypertension. Liver transplantation means your diseased liver is replaced with a healthy one from deceased donors or living donors who donate portions of the liver. The surgery is long and complex, requiring the removal and replacement of your body's largest solid organ. However, this option offers the highest survival rate and chance of complete rehabilitation.

Can beta blockers be used for varices?

Beta blockers can be used to decrease portal pressure, although there are side effects. However, if you have cirrhosis but no varices, beta blockers cannot be used to prevent varices from developing. Studies have shown that the side effects of the medication outweigh the possible benefits.

What is the best treatment for hepatitis B?

For chronic hepatitis B, your doctor may prescribe antiviral medicines that slow or stop the virus from further damaging your liver.

How to get rid of liver cancer?

Eat a healthy, well-balanced diet. Avoid raw or undercooked shellfish, fish, and meat. Try to keep a healthy body weight. Talk with your doctor about your risk for getting liver cancer and how often you should be checked.

How do doctors treat cirrhosis?

Doctors do not have specific treatments that can cure cirrhosis. However, they can treat many of the diseases that cause cirrhosis. Some of the diseases that cause cirrhosis can be cured. Treating the underlying causes of cirrhosis may keep your cirrhosis from getting worse and help prevent liver failure. Successful treatment may slowly improve some of your liver scarring.

How to stop cirrhosis from getting worse?

What can I do to help keep my cirrhosis from getting worse? 1 Do not drink alcohol or use illegal drugs. 2 Talk with your doctor before taking#N#prescription medicines#N#prescription and over-the-counter sleep aids#N#over-the-counter medicines, including nonsteroidal anti-inflammatory drugs (NSAIDS) and acetaminophen#N#NIH external link#N#dietary supplements#N#NIH external link#N#, including herbal supplements. 3 Take your medicines as directed. 4 Get a vaccine for hepatitis A, hepatitis B, flu#N#NIH external link#N#, pneumonia#N#NIH external link#N#caused by certain bacteria#N#NIH external link#N#, and shingles#N#NIH external link#N#. 5 Get a screening blood test for hepatitis C. 6 Eat a healthy, well-balanced diet. 7 Avoid raw or undercooked shellfish, fish, and meat. 8 Try to keep a healthy body weight#N#NIH external link#N#.

What are the complications of portal hypertension?

Treatments for the complications of portal hypertension include. Enlarged veins in your esophagus or stomach, called varices. Your doctor may prescribe medicines to lower the pressure in the veins of your esophagus or stomach. This lowers the chance that the veins become enlarged and burst, causing internal bleeding.

When do doctors consider liver transplants?

When do doctors consider a liver transplant for cirrhosis? Your doctor will consider a liver transplant when cirrhosis leads to liver failure. Doctors consider liver transplants only after they have ruled out all other treatment options. Talk with your doctor about whether a liver transplant is right for you.

How to reduce fatty liver?

If you have nonalcoholic fatty liver disease, your doctor may recommend losing weight. Weight loss through healthy eating and regular physical activity can reduce fat in the liver, inflammation, and scarring.