What Are Esophageal Varices?
Esophageal varices are enlarged, fragile veins in the esophagus. These veins develop when blood flow to the liver is obstructed, often due to severe liver disease, such as cirrhosis. Cirrhosis involves scarring of liver tissue, impeding the liver’s ability to process blood efficiently.
This obstruction causes blood to back up into the portal vein. Increased pressure within the portal vein system is known as portal hypertension.
When the pressure becomes too high, the blood seeks alternative, smaller veins to bypass the liver, including those in the esophagus. These smaller veins are not designed to handle such large volumes and high pressure, causing them to swell and become thin-walled and susceptible to rupture. The development of varices indicates advanced liver disease.
The Event of a Rupture
When esophageal varices rupture, they can cause significant and rapid internal bleeding. This event can manifest suddenly with physical symptoms.
One common sign is hematemesis, which involves vomiting large amounts of bright red blood.
Another indicator of internal bleeding is melena, characterized by the passage of dark, tarry stools. This occurs when blood from the upper digestive tract is digested as it moves through the intestines.
As blood loss progresses, signs of hypovolemic shock may develop, including dizziness, a rapid heart rate, and a significant drop in blood pressure. If bleeding continues unchecked, the rapid loss of blood can quickly become life-threatening.
The Experience of Pain and Discomfort
While a rupture is not typically acutely painful like a cut or burn, the overall experience involves considerable discomfort. The sensation associated with the actual bleeding is more akin to a feeling of pressure or fullness in the chest or upper abdomen. This internal pressure is not a sharp pain but a profound and unsettling bodily change.
Nausea and vomiting, especially of blood, contribute significantly to distress.
The systemic effects of rapid blood loss are the primary source of discomfort. As the body loses blood, it struggles to deliver oxygen to vital organs, leading to symptoms like dizziness, lightheadedness, and a general feeling of weakness.
This condition, known as hypovolemia, can cause a sense of impending collapse and profound malaise. A person’s level of consciousness can also diminish as blood loss becomes severe, altering their perception of discomfort. As the body goes into shock, awareness often decreases, potentially lessening the subjective experience of distress.
Medical Care and End-of-Life Considerations
Immediate medical intervention is necessary when esophageal varices begin to bleed. Emergency treatments often include endoscopic procedures, where a flexible tube with a camera is inserted down the esophagus.
During this procedure, techniques like endoscopic variceal banding (EVL) involve placing small elastic bands around the varices to stop the bleeding. Another method is sclerotherapy, where a solution is injected into the varices to cause them to scar and close.
Medications may also be administered to reduce portal pressure, which helps to minimize further bleeding. Blood transfusions are often necessary to replenish lost blood volume and stabilize the patient.
In scenarios where bleeding cannot be controlled, or in advanced liver disease, medical professionals prioritize patient comfort and pain management. This includes sedation to alleviate distress and ensure a peaceful passing. Palliative care focuses on providing comfort and support, ensuring dignity throughout the end-of-life process.