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Esophageal Varices - Medical Negligence

Esophageal varices are varicose veins in the lower part of the esophagus that occur because of certain liver diseases, such as cirrhosis of the liver. They occur because the expected flow of blood through the liver does not occur and the veins begin to dilate. You can get varicose veins in the stomach and rectum, too, as a result of the weaker veins dilating under pressure. The biggest danger with esophageal varices is that they can rupture, causing a serious and life threatening bleeding condition.

About a third of all people with esophageal varices will develop bleeding at some time or another. This can cause symptoms of vomiting blood, unusually low blood pressure, black or tarry stools that are positive for blood on testing, being excessively thirsty and being light-headed or being in shock.

In order to prevent life-threatening complications, you need to see the doctor before the bleeding occurs. Some symptoms that appear to prevent complications of esophageal varices when caught early include having loss of weight, having small spider veins under your skin, being weak or tired, bruising easily, having jaundice and dark, brownish urine, having a buildup of fluid in the abdomen or increasing girth of the abdomen due to ascites (fluid on the abdomen) and having itching of your hands and feet or even of your entire body. If you have swelling of your legs and feet, it can mean you have edema-a condition common in liver disease. In severe cases, you will develop mental confusion or encephalopathy from severe liver disease.

If the condition is not suspected or caught early enough, you will likely have bleeding from the esophageal varices. If this occurs, call 911 because this can be life-threatening bleeding. Even if you just have black, tarry or bloody stools, you should still seek immediate medical attention because the bleeding may just be passing through the stool and is not being vomited up.

The basic problem with esophageal varices is a buildup of blood in the portal vein. The blood doesn't go through the liver very quickly and instead builds up and causes dilated veins. The leading cause of esophageal varices is cirrhosis of the liver. It causes irreversible scarring of the liver that won't pass blood through it. Cirrhosis can be alcoholic cirrhosis, primary biliary cirrhosis or other causes of scarring to the liver, including diabetes and obesity.

Other causes of a buildup of pressure in the portal vein include congestive heart failure, in particular, right sided heart failure. A clot can form in the portal vein or within the splenic vein that can build up pressure within the portal vein. Sarcoidosis can cause cirrhosis and portal vein hypertension. A parasitic infection called schistosomiasis can affect the liver, lungs, bladder and intestines.

Varices are more likely to bleed if there is an extremely high pressure in the portal veins. If the varices are large, they are more likely to bleed. If doctors see red marks on endoscopy, there is an increased likelihood of bleeding. The worse the liver disease, the greater is the chance of bleeding varices. If you have ascites or if you continue to drink alcohol despite having esophageal varices, you have an increased chance of bleeding. Acid reflux can contribute to the chances of bleeding from esophageal varices by irritating the tissue around the veins.

Up to seventy percent of those who have bled from an esophageal varix will bleed again within a year, if they don't have any form of treatment. The likelihood of dying from a bleeding episode goes up with each episode of bleeding, especially if you are older, have liver failure, failure of the kidneys or active alcohol use.

Testing for esophageal varices includes doing an endoscopy or camera study of the esophagus. The veins are seen in the esophagus near where it connects to the stomach. CT scans or MRI exams can find esophageal varices. They aren't as good at detecting these conditions as endoscopy so they are reserved for when endoscopy can't be performed.

The treatment of esophageal varices includes lowering the blood pressure so less blood flows through the tear in the vein. Doctors can also ligate or cut off the bleeding varix so that it doesn't bleed again. This is done using an endoscopy and an elastic band. This strangles the vein so it doesn't bleed. There can be injection of medications into the veins that cause the dilated vein to collapse. It tends to work after about two treatments. A medication called octreotide reduces the pressure in esophageal varices. If there is severe bleeding, a balloon tamponade is tried. It is a balloon inserted into the stomach and esophagus that is blown up to stop the bleeding so that other treatments can be prepared.

A specific procedure called a transjugular intrahepatic portosystemic shunt can be done. It carries blood from the liver back to the heart using a metal tube and can lower the portal hypertension. It is a complicated procedure that prevents the liver from destroying toxins and can have serious repercussions. It is a procedure of last resort and is used by people awaiting a liver transplant. A liver transplant is essentially curative for portal hypertension but is a dangerous and risky procedure to do.