Internal Medicine

Esophageal variceal bleeding

English: esophageal variceal bleeding

Synonyms

Esophagus = Esophagus
Varices (lat. varix: the knot) = Varicose veins

Esophageal varices, bleeding from Varicose veins the esophagus

definition

Under one Esophageal variceal bleeding one understands a bleeding from Varicose veins the vessels supplying the esophagus.
So it is about "internal varicose veins“.

Summary

A Esophageal variceal bleeding can be a life-threatening situation if it is not treated immediately by a doctor. It is bleeding from varicose veins esophagus.
These are created by one abnormally high pressure in the body's venous system. The varicose veins of the esophagus are often associated with varicose veins elsewhere on the body, such as the abdominal wall (med .: Caput medusae).
As root cause stands the Liver dysfunction in the foreground. In the supplying vessel, i.e. in front of the liver, the blood builds up. This creates a higher pressure than normal and the blood looks for other ways back to Heart. Often times, esophageal varices do not become symptomatic until the bleeding occurs. People vomit blood.
The therapy consists in immediate hemostasis. This is usually done through endoscopic procedures (known as “tube swallowing” in patients). Here the varicose veins are compressed by a balloon, wrapped in a loop or provided with tissue glue.
Prevent This acute clinical picture of esophageal variceal bleeding can only be avoided by avoiding the emergence of varicose veins. Solid, hard dishes should be used with friends Esophageal variceal bleeding Be avoided.

esophagus
(Neck section) -
Esophagus, pars cervicalis
Nasal cavity - Cavitas nasi
Oral cavity - Cavitas oris
Windpipe (approx. 20 cm) - Trachea
esophagus
(Chest section) -
Esophagus, pars thoracica
esophagus
(Abdominal section) -
Esophagus, pars abdominalis
Stomach entrance -
Cardia
Stomach body -
Corpus gastricum
Throat -
Pharynx
Thyroid -
Glandula thyroidea

You can find an overview of all Dr-Gumpert images at: medical illustrations

causes

The cause of the Esophageal variceal bleeding lies in the rupture, i.e. the tearing apart, of existing varicose veins in the esophagus.
The vessels from which the varicose veins arise are naturally present, but under certain circumstances develop into these dilated and tortuous vessels.

These varices arise because of the blood pressure Fallback circuits searches back to the heart when the path via the liver is too "difficult" for him.
As a rule, there is increased pressure in the liver veins, so that the blood backs up in front of the liver. This condition is medically called Portal hypertension denotes. In order to get to the heart nonetheless, the blood looks for other routes through existing collateral circuits.
You can find more about this disease under our topic Portal hypertension.
As a result of this extreme load on the vessels, which are otherwise only small and under little pressure, they expand and varicose veins develop. Most of the time it is not only the esophagus that is affected by esophageal variceal bleeding, but also other vascular systems on the way to the heart are strained (for example the abdominal wall around the navel, the so-called Caput medusae; also hemorrhoids can arise in this way).

Bleeding occurs when the already thin vessel wall is injured from the outside (for example by solid foods) or when there is increased pressure inside the vessel (this is the case, for example, when the so-called abdominal press is used during defecation (= bowel evacuation) becomes).
Since varicose veins are veins in terms of their vascular structure and function, they do not have sufficiently strong vascular muscles to stop the bleeding by means of regulation mechanisms by constriction (contraction).

Symptoms

Esophageal varices usually become symptomatic too late, namely only through the bleeding from them. Affected patients vomit blood.
The blood flows from the esophagus directly into the stomach. This also explains the so-called tar stool, which owes its name to its appearance. When the hydrochloric acid in the stomach comes into contact with fresh blood, the blood turns black due to chemical changes.
Furthermore, the patients appear pale in the acute state, due to the high blood loss, which causes the Blood pressure sinks. This can be confirmed in the blood count.

diagnosis

The bleeding itself can be diagnosed differently depending on its severity. If the bleeding is only slight, it may not cause any symptoms.
In this case, the bleeding may be apparent from the changed blood count or from a endoscopic examination (Swallow hose) are discovered.

Therapy for esophageal variceal bleeding

Therapy for esophageal variceal bleeding consists of one immediate hemostasis. The attending physician inserts an endoscope into the esophagus and can use the integrated camera to locate the bleeding. There are now several ways to stop the bleeding.

In acute massive bleeding, a probe is inserted into the esophagus, which is compressed from the inside using a so-called balloon catheter, so that the bleeding stops.
A tissue adhesive can also be applied.
The leaking point in the vessel is sucked in and put around with a loop, which is then tightened.
The bleeding can also be indirectly reduced with medication by lowering the pressure in the hepatic venous system.

There is also the option of hemostasis with drugs, which is usually used relatively rarely.

forecast

If bleeding already occurs, there is a risk of bleeding again from existing esophageal varicose veins 30%. There is a risk of dying from such bleeding 25 – 30%. This can be explained by the state of shock caused by the massive bleeding.

prophylaxis

The bleeding from Varicose veins cannot actually be prevented. It applies - like almost everywhere in the medicine - to treat the underlying disease.

Further information

More information about esophageal variceal bleeding that may interest you: