Varices

What are Varices?

A varix (pl. varices) is an abnormally dilated vessel with a tortuous course. Varices usually occur in the venous system, but may also occur in arterial or lymphatic vessels.

Examples of varices include:

• Varicose veins, large tortuous veins usually found on legs
• Sublingual varices
• Esophageal varices, commonly stemming from cirrhosis of the liver, also known as oesophageal varicose
• Gastric varices, commonly stemming from cirrhosis of the liver
• Intestinal varices
• Scrotal varices
• Vulvar varices
• Pelvic varices
• Vesical varices, varicose veins associated with the urinary bladder
• Rectal varices, which can be similar to external haemorrhoids

https://en.wikipedia.org/wiki/Varices#:~:text=varices)%20is%20an%20abnormally%20dilated,Sublingual%20varices [1]

Varicose Veins

The term varicose veins is used to describe a condition in which the veins are permanently twisted and dilated. While this can occur in any part of the body, the most usual location for varicose veins is in the legs.

The function of veins in the body is to complete the vital process of blood circulation. They carry blood back to the heart after it has been pumped to all the vital organs of the body through tubes, which are called arteries.

Arteries are thick, elastic tubes containing muscle fibre known as smooth muscle. The smooth muscle contracts in the wall of the artery thereby propelling blood through the arterial system. This action occurs with each heartbeat.

Veins have very thin walls and no elastic fibres and are, therefore, unable to contract and push the blood flow onwards towards the heart. Unlike arteries, veins are completely dependent on the functions of the surrounding muscles and the valves inside the vein itself to push the blood in the right direction back towards the heart. The surrounding muscles squeeze the blood through the veins with each contraction of the muscle. This action is known as the muscle pump.

While varicose veins are usually associated with advancing age, they can also occur in young people. They are very often of no great inconvenience apart from looking unsightly.

How do they develop?

Veins contain one-way valves, which help to propel blood back to the heart against the forces of gravity. These valves are situated every few inches along the length of the vein. If a leak develops in any of these valves the blood falls back down the vein and causes swelling at the valve below. The veins become permanently dilated (widened) and can assume the appearance of a bunch of grapes at the back of the leg.

Who is at risk?

Among the risk groups for the development of varicose veins are:

• pregnant women.
• those with a family history of the condition.
• those who work in jobs which involve prolonged periods of standing, i.e. hairdressers and shop assistants.
• people who suffer from obesity (overweight).

What are the warning signs?

Varicose veins may be first noticed as:

• a feeling of heaviness or tiredness in the legs, especially after standing.
• large blue veins, which are visible on the surface of the leg and can easily be seen while standing.
• cramps in the legs, especially at night and a creeping sensation right across the skin.
• swelling of the legs, which may become sore and painful as the condition worsens. This is known as oedema (an accumulation of fluid in the legs) and occurs where there is incomplete circulation of the blood.

How are they treated?

Many people who develop varicose veins find that they require no medical treatment at all. However, if large amounts of fluid accumulate in the legs giving rise to pain and discomfort, you should contact your local GP with a view to receiving treatment.

For mild cases of varicose veins, your doctor will probably advise you to rest frequently with your legs raised and he may also advise you to wear lightweight elastic compression stockings for a specified period of time. These will help to ease the discomfort but will not make the varicose veins disappear. They may contain the problem and reduce the risk of further deterioration.

If obesity is a problem, your GP will strongly advise you to go on a weight-reducing diet.

Some people may require surgical intervention. There are two forms of treatment that are widely practised in Ireland. One is known as injection sclerotherapy and the other is known as ligation and stripping. Sclerotherapy is an outpatient procedure and involves the injection of a special chemical into the damaged portion of vein. This effectively shuts off that section of vein and the circulation is bypassed through alternative healthy channels of veins.

Ligation and stripping involves the ‘tying-off’ (ligation) of the damaged portion of vein and the stripping or removal of that section. This procedure is usually performed under general anaesthesia and requires admission to hospital. Both forms of treatment are a form of bypass, in the sense that the damaged area is bypassed and the circulation is re-routed through alternative channels.

For most people, varicose veins affect only a small section of the leg. However, there are cases where the entire leg, or perhaps both legs, are filled with varicose veins.

Untreated varicose veins can lead to a number of serious problems such as:

• leg ulcers, particularly in elderly patients
• deep vein thrombosis, which is a potentially fatal condition
• eczema of the leg, which may, in turn, lead to ulcers
• phlebitis, which is recurrent inflammation of the veins.

Can varicose veins develop in places other than the legs?

Yes. Varicose veins can develop in a number of places around the body, including the pelvis, the uterus, the vagina and the anus (back passage). Varicose veins in the anal region are known as haemorrhoids or piles.

http://www.irishhealth.com/article.html?con=478 [2]

 

Sublingual Varices

Sublingual varices is a benign condition characterized by dialated tortuous veins seen on the ventral or posterolateral aspect of the tongue. Individuals notice a blackish discolouration on the ventral or lateral areas of the tongue. The incidence increases with age with no gender predilection. The diagnosis is often based on clinical appearance. No treatment is required for this condition; however, haemorrhagic telangiectasia should be excluded in these individuals.

https://screening.iarc.fr/atlasoral_list.php?cat=F7&lang=1#:~:text=Sublingual%20varices%20is%20a%20benign,age%20with%20no%20gender%20predilection. [3]

Esophagel Varices

Esophageal varices are abnormal, enlarged veins in the tube that connects the throat and stomach (esophagus). This condition occurs most often in people with serious liver diseases.

Esophageal varices develop when normal blood flow to the liver is blocked by a clot or scar tissue in the liver. To go around the blockages, blood flows into smaller blood vessels that aren’t designed to carry large volumes of blood. The vessels can leak blood or even rupture, causing life-threatening bleeding.

A number of drugs and medical procedures can help prevent or stop bleeding from esophageal varices.

Symptoms

Esophageal varices usually don’t cause signs and symptoms unless they bleed. Signs and symptoms of bleeding esophageal varices include:

• Vomiting large amounts of blood
• Black, tarry or bloody stools
• Lightheadedness
• Loss of consciousness in severe cases

Your doctor might suspect esophageal varices if you have signs of liver disease, including:

• Yellow coloration of your skin and eyes (jaundice)
• Easy bleeding or bruising
• Fluid buildup in your abdomen (ascites)

When to see a doctor

Make an appointment with your doctor if you have signs or symptoms that worry you. If you’ve been diagnosed with liver disease, ask your doctor about your risk of esophageal varices and what you can do to reduce your risk. Also ask your doctor whether you should get a procedure to check for esophageal varices.

If you’ve been diagnosed with esophageal varices, your doctor is likely to instruct you to watch for signs of bleeding. Bleeding esophageal varices are an emergency. Call 911 or your local emergency services right away if you have bloody vomit or bloody stools.

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Causes

Esophageal varices sometimes form when blood flow to your liver is blocked, most often by scar tissue in the liver caused by liver disease. The blood flow begins to back up, increasing pressure within the large vein (portal vein) that carries blood to your liver.

This increased pressure (portal hypertension) forces the blood to seek other pathways through smaller veins, such as those in the lowest part of the esophagus. These thin-walled veins balloon with the added blood. Sometimes the veins rupture and bleed.

Causes of esophageal varices include:

• Severe liver scarring (cirrhosis). A number of liver diseases — including hepatitis infection, alcoholic liver disease, fatty liver disease and a bile duct disorder called primary biliary cirrhosis — can result in cirrhosis.
• Blood clot (thrombosis). A blood clot in the portal vein or in a vein that feeds into the portal vein (splenic vein) can cause esophageal varices.
• Parasitic infection. Schistosomiasis is a parasitic infection found in parts of Africa, South America, the Caribbean, the Middle East and East Asia. The parasite can damage the liver, as well as the lungs, intestine, bladder and other organs.

Risk Factors

Although many people with advanced liver disease develop esophageal varices, most won’t have bleeding. Esophageal varices are more likely to bleed if you have:

• High portal vein pressure. The risk of bleeding increases as the pressure in the portal vein increases (portal hypertension).
• Large varices. The larger the esophageal varices, the more likely they are to bleed.
• Red marks on the varices. When viewed through a thin, flexible tube (endoscope) passed down your throat, some esophageal varices show long, red streaks or red spots. These marks indicate a high risk of bleeding.
• Severe cirrhosis or liver failure. Most often, the more severe your liver disease, the more likely esophageal varices are to bleed.
• Continued alcohol use. Your risk of variceal bleeding is far greater if you continue to drink than if you stop, especially if your disease is alcohol related.

If you’ve had bleeding from esophageal varices before, you’re more likely to have varices that bleed again.

Complications

The most serious complication of esophageal varices is bleeding. Once you’ve had a bleeding episode, your risk of another bleeding episode greatly increases. If you lose enough blood, you can go into shock, which can lead to death.

Prevention

Currently, no treatment can prevent the development of esophageal varices in people with cirrhosis. While beta blocker drugs are effective in preventing bleeding in many people who have esophageal varices, they don’t prevent esophageal varices from forming.

If you’ve been diagnosed with liver disease, ask your doctor about strategies to avoid liver disease complications. To keep your liver healthy:

• Don’t drink alcohol. People with liver disease are often advised to stop drinking alcohol, since the liver processes alcohol. Drinking alcohol may stress an already vulnerable liver.
• Eat a healthy diet. Choose a plant-based diet that’s full of fruits and vegetables. Select whole grains and lean sources of protein. Reduce the amount of fatty and fried foods you eat.
• Maintain a healthy weight. An excess amount of body fat can damage your liver. Obesity is associated with a greater risk of complications of cirrhosis. Lose weight if you are obese or overweight.
• Use chemicals sparingly and carefully. Follow the directions on household chemicals, such as cleaning supplies and insect sprays. If you work around chemicals, follow all safety precautions. Your liver removes toxins from your body, so give it a break by limiting the amount of toxins it must process.
• Reduce your risk of hepatitis. Sharing needles and having unprotected sex can increase your risk of hepatitis B and C. Protect yourself by abstaining from sex or using a condom if you choose to have sex. Get tested for exposure to hepatitis A, B and C, since infection can make your liver disease worse. Also ask your doctor whether you should be vaccinated for hepatitis A and hepatitis B.

https://www.mayoclinic.org/diseases-conditions/esophageal-varices/symptoms-causes/syc-20351538#:~:text=Esophageal%20varices%20are%20enlarged%20veins,throat%20and%20stomach%20(esophagus). [4]

 

Symptoms of Bleeding Varices

Symptoms include:

• Vomiting of blood
• Black, tarry, or bloody stool
• Low blood pressure
• Rapid heart rate
• Lightheadedness
• Shock (in severe cases)

Bleeding from varices is a medical emergency. If the bleeding is not controlled quickly, a person may go into shock or die.

Even after the bleeding has been stopped, there can be serious complications, such as pneumonia, sepsis, liver failure, kidney failure, confusion, and coma.

Cause of Bleeding Varices

Portal hypertension is an increase in the pressure within the portal vein (the vein that carries blood from the digestive organs to the liver). It’s often due to scarring of the liver, or cirrhosis.

This increased pressure in the portal vein causes blood to be pushed away from the liver to smaller blood vessels, which are not able to handle the increased amount of blood. This leads to the development of large, swollen veins (varices) within the esophagus, stomach, rectum, and umbilical area (around the belly button). The varices are fragile and can rupture easily, resulting in a large amount of blood loss.

Treatments for Bleeding Varices

In severe cases, a person may need to be placed temporarily on a breathing machine to prevent the lungs from filling with blood. Antibiotics are also given immediately to reduce the risk of sepsis, a life-threatening blood infection

Aside from the urgent need to stop the bleeding, treatment is also aimed at preventing more bleeding. Procedures that help treat bleeding varices include:

• Banding. A gastroenterologist places small rubber bands directly over the varices. This will stop the bleeding and get rid of the varices.
• Sclerotherapy. A gastroenterologist directly injects the varices with a blood-clotting solution instead of banding them.
• Transjugular Intrahepatic Portosystemic Shunt (TIPS). A radiological procedure in which a stent (a tubular device) is placed in the middle of the liver. The stent connects the hepatic vein with the portal vein. This procedure is done by placing a catheter through a vein in the neck. It is done to relieve the high blood pressure that has built up in the portal vein and the liver.
• Distal Splenorenal Shunt (DSRS). A surgical procedure that connects the splenic vein to the left kidney vein in order to reduce pressure in the varices and control bleeding.
• Liver transplant . A liver transplant may be done in cases of end-stage liver disease.
• Devascularization. A surgical procedure that removes the bleeding varices. This procedure is done when a TIPS or a surgical shunt isn’t possible or unsuccessful in controlling the bleeding.
• Esophageal transection. A surgical procedure in which the esophagus is cut through and then stapled back together after the varicies have been tied off. Sometimes there is bleeding at the staple line

Can Bleeding Varices Be Prevented?

Treating the underlying cause of bleeding varices can help prevent their return. Earlier treatment of liver disease may prevent them from developing.

Certain medications, including the class of heart drugs called “beta-blockers,” may reduce elevated portal pressure and lower the likelihood of bleeding. Long-acting nitroglycerines are also used for this purpose.

Also, talk with your doctor about possible procedures that can be done and that have an effect on bleeding.

https://www.webmd.com/digestive-disorders/bleeding-varices#1 [5]