HWN Suggests

Primary Biliary Cirrhosis, Portal Hypertension, and the Frustration of Knowing There’s No Way of Knowing What I Need to Know.

In the past two years, I had three bleeds as a result of esophageal varices bursting as a result of portal hypertension, itself a result of liver damage caused by damage to the bile ducts.

The first was in August 2010 and I required four transfusions. A year and two weeks later I had my second bleed in August 2011. Then at the beginning of this March, six and a half months later, I had my third. After the second and third bleeds, I had two transfusions.

As you might guess, when August of this year rolled around, I worried. I got through August fine, and September as well, that is, no bleed. Tomorrow I am having an exploratory endoscopy to band any varices that look like…

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Articles of Interest

Esophageal varices

Esophageal varices almost always occur in people who have cirrhosis of the liver. Cirrhosis causes scarring of the liver, which slows the flow of blood through the liver. Scarring causes blood to back up in the portal vein, the main vein that delivers blood from the stomach and intestines to the liver. This backup causes high blood pressure in the portal vein and other nearby veins. This is called portal hypertension. Less common causes of portal hypertension and esophageal varices include blood clots in the veins leading to and from the liver, and schistosomiasis. Schistosomiasis is a parasitic infection that can clog up the liver, causing pressure to back up in the portal vein.

MKSAP: 50-year-old man with cirrhosis

The most appropriate treatment is endoscopic ligation. The lifetime risk for a first-time variceal bleed in the setting of cirrhosis is 30% and carries a mortality risk of 15% to 20%. Therefore, primary prophylaxis is crucial. Current practice guidelines recommend that all patients with cirrhosis undergo screening endoscopy to detect large esophageal varices.

Resources

Havealittletalk's Blog

I’ve named this blog in honor of my mother who never hesitates to declare herself. If she announces an intention to “have a little talk” with someone, you know that the listener will have no doubts remaining about her opinion.

Portal Hypertension - Networking Resource

At least 50% of people who survive bleeding esophageal varices are at risk of more bleeding during the next one to two years. Just want to note that this topic by far is one that provokes strong emotions for me, as it is not the most positive aspect of portal hypertension. Nevertheless though it is one that needs to be discussed.

Endoscopy Campus

Strictly speaking, the varix classifications only apply to the primary assessment, before (endoscopic) therapy. Classifications after treatment (e.g., with ligation or sclerosis) are more difficult; in this case, the (residual) varices should be described in terms of their number, location, and maximum diameter or red signs.

Living With Liver Disease

In Western countries, alcoholic and viral cirrhosis are the leading causes of portal hypertension and esophageal varices.Thirty percent of patients with compensated cirrhosis and 60-70% of patients with decompensated cirrhosis have gastroesophageal varices at presentation.

My Sick Liver

They most often are a consequence of portal hypertension, commonly due to cirrhosis. Patients with esophageal varices have a strong tendency to develop bleeding, which, could be life-threatening if left untreated.

Patient

The causes of oesophageal varices are anything that can cause portal hypertension.

StatPearls

Esophageal varices are dilated submucosal distal esophageal veins connecting the portal and systemic circulations. They form due to portal hypertension, which commonly is a result of cirrhosis, resistance to portal blood flow, and increased portal venous blood inflow. Variceal rupture is the most common fatal complication of cirrhosis. the severity of liver disease correlates with the presence of varices and risk of bleeding.

UpToDate

Esophageal varices are a potentially serious complication of cirrhosis. Without treatment, between 25 and 40 percent of people with varices will experience an episode of severe bleeding (hemorrhage) resulting in significant illness or even death.