By Sylvia Foley, AJN senior editor
esophageal varices
This month’s CE feature opens with a patient with alcoholic cirrhosis who suddenly vomits large amounts of blood. She’s experiencing variceal hemorrhage from esophageal varices, an often deadly complication of alcoholic liver disease, as author Melissa M. Smith explains. Esophageal varices occur in roughly half of all people with alcoholic cirrhosis; about one-third of these will experience variceal hemorrhage.
Smith describes the etiology of esophageal varices, then discusses the risk factors for variceal hemorrhage, noting that risk for initial hemorrhage increases with:
- larger variceal size
- presence of red spots or wales on the varices
- more severe portal hypertension
- more severe cirrhosis, with or without ascites
And the above factors as well as the following increase risk for recurrent hemorrhage:
- severity of initial bleed
- age over 60 years
- bacterial infection
- renal failure
- active alcoholism
Smith discusses emergent treatment and outlines further treatment options, which include endoscopic variceal ligation, endoscopic injection sclerotherapy, balloon tamponade, and transjugular intrahepatic portosystemic shunt (TIPS) placement. The patient case vividly illustrates what can happen when bleeds recur.
Have you cared for patients with variceal hemorrhage? We invite you to share your experiences with us in the comments.
Clint, thanks so much for your comment, which makes an important point. This article covers specifically “Variceal Hemorrhage from Esophageal Varices Associated with Alcoholic Liver Disease” — but the condition does have other causes, and it’s worth reiterating that not all cases are associated with alcoholism. That said, I’m glad this article provides good discussion of emergent treatment regardless of cause. That’s good to know!
Hello there, I have grade 3 esophogeal varices caused from non-Cirrhotic Portal Hypertension. My condition was caused genetically and not by alcoholism. Just wanted to make sure that all who read this do not assume that everyone with esophogeal varices is an alcoholic. There are other causes, like mine, which need to be stated for the record. On that note I have started a networking blog to connect with others around the world who may be feeling isolated by their condition. My site is found by clicking the following link: http://portal-hypertension.com/ Emergent treatment for varices is well covered in your text above – thank you!