In your throat is the answer.
I never had varices, but I have had hemorrhoids so I guess I’m qualified to say something about them. Varices, quite simply are hemorrhoids in the throat or esophagus. Both varices and hemorrhoids are caused by too much pressure in the veins, one caused by ‘straining’, the other caused by portal hypertension.
As mentioned before with my Trinity of ascites, varices and hepatic encephalopathy, they are as a direct result of increased pressure in the portal vein caused by the liver becoming less of a conduit and more of a blockage.
Varices mainly occur because blood in the portal vein in it’s desperate attempt to reach the hepatic vein forces new routes around the traffic jams or blockages that liver scar tissue has become. I forcing new paths through the liver, these new veins are thin-walled and easily rupture. Often these new veins will poke out into the esophagus and sometimes, they will rupture.
The end result can be fatal.
Sixty to seventy percent of people with decompensated cirrhosis will develop varices. That’s the bad news, the worse news is that there are no symptoms until they have burst and deposited a significant amount of blood into the stomach.
After varices have burst the symptoms can include vomiting blood, black or ‘tarry’ or bloody stools or in the worst case shock from loss of blood.
The remedy? Banding and beta blockers. Beta blockers have the effect of reducing pressure in the portal vein so reducing the likelihood of a major bleed out. A TIPS procedure may also help reduce portal hypertension, but TIPS will be a subject in it’s own right later.
Banding is done by having an endoscopy and the protruding veins being snared and tied-off to seal them up. This procedure may need to be done many times.
Bleeding varices are life threatening! If you experience vomiting or bloody stools you MUST get to an emergency room or call emergency services.
Most people with a history of varices will return to their doctor for regular check ups.
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