Alcoholism is known to cause many personal and social problems. This form of substance abuse is also responsible for a lot of physical damage within the body. Those individuals who fail to escape their addiction are likely to die from a health problem that is related to their alcohol use. The problem is not just the consumption of alcohol but the fact that it is usually coupled with nutritional deficiencies. One potentially dangerous condition that an alcoholic and develop is esophageal varices. This leads to uncontrolled bleeding into the esophagus. Burst esophageal varices are treated as a medical emergency because they can cause death unless treatment is commenced quickly. Many individuals with end stage alcoholic liver disease will die because of this type of event.
The word varices is used to describe a distended vein. The most common example of this is varicose veins, but they can also appear elsewhere in the body. Esophageal varices appear in the lower esophagus or in the upper part of the stomach. This type of varices is particularly dangerous because they can burst due to increased pressure within the vein. This situation can lead to a critical loss of blood.
Those individuals who have developed cirrhosis of the liver are particularly at risk of esophageal varices. The damage to the liver caused by scarring means that blood is unable to flow properly. This can easily lead to a situation called portal hypertension. It is this increased pressure that causes the veins in the esophagus to become distended and it can eventually burst. The veins in this part of the body do not deal well with high blood pressures.
The most worrying aspect of esophageal varices is that it can be asymptomatic until the vein bursts. This is why it is usual to consider anyone with cirrhosis of the liver to be at risk of esophageal bleeding. If bleeding does occur the most common symptoms include:
* Tarry black or bloody bowel motions
* Vomiting up blood
* Rapid breathing which tends to be shallow
* Fast heart rate (tachycardia)
* A fall in blood pressure
* Clammy skin
* General weakness
* Confusion and agitation
If an individual deteriorates due to esophageal varices the priority will be to stop the bleeding and replace the lost fluids. If the bleeding is particularly heavy it may be necessary to ventilate the patient so as to prevent them drowning in blood. The usual way to control the loss of fluid is to put rubber bands around the varices. It may also be necessary to use clotting medications. In some cases the doctors may decide to inject a clotting agent directly into the varices instead of banding.
There are a number of options available for preventing bleeding from esophageal varices such as:
* Medications such as beta-blockers and nitroglycerines. These may help to reduce portal hypertension.
* Transjugular Intrahepatic Portosystemic Shunt (TIPS). This type of shunt creates an artificial path for blood to flow from the liver to the portal vein and thus reducing pressure.
* Distal Splenorenal Shunt (DSRS). This involves disconnecting the vein going from the spleen to the portal vein and connecting it to the renal vein instead. This is another method for reducing the pressure in the portal vein.
* Devascularization is where the varices are removed during a surgical procedure.
* Those individuals who are candidates for a liver transplant should find that the problem resolves following this procedure.
The most common cause of esophageal varices is cirrhosis due to alcohol abuse. The best means of prevention is to not allow heavy drinking to lead to alcoholic liver disease in the first place. Those individuals who quit alcohol before it can cause too much liver damage will greatly reduce their risk of ever developing esophageal varices. Lifelong abstinence from alcohol will then be required to prevent a reoccurrence of liver problems. Those individuals who have already caused significant damage to their liver may find that their condition can be managed with medical treatments and complete abstinence from alcohol. Anyone who has cirrhosis needs to be monitored for esophageal varices and if they are present all efforts need be made to prevent bleeding to occur.
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