Rajesh Sharma, a 40- year-old executive suddenly had bout of vomiting and finds to his horror he vomited a lot of frank red blood. He was having uneasiness in the upper abdomen for several months but had dismissed it as gastritis due to a diet of alcohol and spice.
He was rushed into the ER where emergency care was instituted. He had lost significant quantity of blood - upto half a litre or more, that is, close to 20 percent of his body's blood volume. Not only had this got to be replaced in a hurry, the cause for the bleeding had to be found out and treated to save his life. On endoscopic examination it was revealed that he had dilated tortuous blood vessels in his lower part of the food pipe - called esophagealvarices which were the cause for the bleeding.
What had caused the normal blood vessels to enlarge and rupture?
Cirrhosis of the liver, due to any cause, results in scarring of the liver tissue. This slows down the normal blood flow into the liver, making the blood to back up into nearby smaller blood vessels such as those in the food pipe causing them to swell up. Sometimes these ruptures cause life threatening bleeding.
Causes leading to Cirrhosis
Cirrhosis has many causes and even non alcoholics can develop this liver ailment.
If patients start feeling lack of appetite, getting easily tired, loosing muscle mass, getting swelling of the feet and even in abdomen they need to see a specialist.
Apart from routine investigations of the blood to check the causes, endoscopy and ultrasound examination are important tools to diagnose and take preventive action.
Complications of Cirrhosis may eventually lead to sudden death.
When medication does not work
There comes a time when just medication is not enough.
Then a procedure called TIPS is performed. This is a non surgical intervention where a shunt (tube) is placed in the liver connecting the portal veins which are under high pressure with the hepatic venous system, thereby channeling the blood directly to the systemic blood circulation taking the pressure off the Liver.
The author is Dr Lorance Peter, Consultant & Chief of Medical Gastroenterology & GI Endoscopy, Vikram Hospital, Bangalore.