I have done some intense Google searching over the past several years about liver disease, and yet I still am frequently learning something new. Usually, I learn something whenever Dad has a new or more severe side effect from his cirrhosis. Of course, that means more Googling. I can certainly just ask Dad about most of these questions that I have, but it's so much more satisfying to see the pictures and read the various definitions and statistics for yourself when you are not a doctor and of my generation, right?
In January of 2010, Dad was hospitalized. Again. This was not the second time he was hospitalized in his life, only the second time mentioned in this blog. It was the second or third time he was hospitalized for variceal bleeding and when I really started to learn more about the topic.
For the record, I am losing count of specific hospital stays for two reasons:
1. Both of my parents have been hospitalized about two dozen times in my lifetime for a barrage of reasons, so without a forum like this it really is hard to keep track. I am currently wondering why I didn't start something like this much earlier.
2. As mentioned in a previous post, Dad checks himself out of the hospital right away-- regardless of how sick he is--so the details of each hospital visit becomes blurred.
Let's get back back on topic.
Not everyone with cirrhosis has varices, but of course Dad does (my mazel!). He was diagnosed with gastric varices a few years ago and esophageal varices in the last year. Diagnosis of varices is usually made when a doctor, specifically a gastroenterologist (GI), looks at the stomach/esophagus during an endoscopy when the patient (Dad The Doctor, but in this case The Patient) is bleeding.
From the Mayo Clinic:
We have now experienced Dad's varices rupturing many times, all have been scary. Each bleed is usually determined by Dad noticing melena (black stool representing an upper GI bleed). Last time it also involved vomiting up blood. Each time required emergency medical attention, several units of blood, attempts to stop the bleeding, a stay in the ER and ICU, and the knowledge that the next bleed may be the last. Each bleed happens without notice and are more severe each time. Variceal bleeding itself has it's own complications that aren't pretty on top of the potential life threatening blood loss, including hepatic encephalopathy (that topic itself warrants a dedicated post, so ignore that medical education topic for now).
When one of these varices burst, there are procedures to help stop the bleeding. Of course, one has to notice the bleed in time. Also, there are a lot of potential complications associated with each procedure. In fact, the last bleed led to several complications, especially after the various attempts to control the bleeding (again, another post).
Is there anything to prevent Dad's varices from bursting in the future? No. Dad has been taking a beta blocker to help reduce the risk of bleeding, but it is far from an absolute preventative option. The prognosis (outlook) according to the NIH:
My mazel.
In January of 2010, Dad was hospitalized. Again. This was not the second time he was hospitalized in his life, only the second time mentioned in this blog. It was the second or third time he was hospitalized for variceal bleeding and when I really started to learn more about the topic.
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| Note: This picture is not entirely accurate in Dad's case as he has no spleen. |
For the record, I am losing count of specific hospital stays for two reasons:
1. Both of my parents have been hospitalized about two dozen times in my lifetime for a barrage of reasons, so without a forum like this it really is hard to keep track. I am currently wondering why I didn't start something like this much earlier.
2. As mentioned in a previous post, Dad checks himself out of the hospital right away-- regardless of how sick he is--so the details of each hospital visit becomes blurred.
Let's get back back on topic.
Not everyone with cirrhosis has varices, but of course Dad does (my mazel!). He was diagnosed with gastric varices a few years ago and esophageal varices in the last year. Diagnosis of varices is usually made when a doctor, specifically a gastroenterologist (GI), looks at the stomach/esophagus during an endoscopy when the patient (Dad The Doctor, but in this case The Patient) is bleeding.
From the Mayo Clinic:
Esophageal varices are abnormal, enlarged veins in the lower part of the esophagus — the tube that connects the throat and stomach. Esophageal varices occur most often in people with serious liver diseases.
Esophageal varices develop when normal blood flow to your liver is slowed. The blood then backs up into nearby smaller blood vessels, such as those in your esophagus, causing the vessels to swell. Sometimes, esophageal varices can rupture, causing life-threatening bleeding.These varices can cause life-threatening bleeding because now you have a ruptured vessel with a lot of pressure pumping blood directly into your stomach or esophagus.
We have now experienced Dad's varices rupturing many times, all have been scary. Each bleed is usually determined by Dad noticing melena (black stool representing an upper GI bleed). Last time it also involved vomiting up blood. Each time required emergency medical attention, several units of blood, attempts to stop the bleeding, a stay in the ER and ICU, and the knowledge that the next bleed may be the last. Each bleed happens without notice and are more severe each time. Variceal bleeding itself has it's own complications that aren't pretty on top of the potential life threatening blood loss, including hepatic encephalopathy (that topic itself warrants a dedicated post, so ignore that medical education topic for now).
When one of these varices burst, there are procedures to help stop the bleeding. Of course, one has to notice the bleed in time. Also, there are a lot of potential complications associated with each procedure. In fact, the last bleed led to several complications, especially after the various attempts to control the bleeding (again, another post).
Is there anything to prevent Dad's varices from bursting in the future? No. Dad has been taking a beta blocker to help reduce the risk of bleeding, but it is far from an absolute preventative option. The prognosis (outlook) according to the NIH:
Bleeding esophageal varices are a serious complication of liver disease and have a poor outcome.Therefore, we all feel like Dad's varices are a ticking time bomb threatening to start bleeding again. Even as I am sitting in Indianapolis with him today while he is waiting for a liver tranplant, I can only hope that he is transplanted before one of those varices decides to rupture again.
My mazel.
May I ask how your Dad is now? I'm sitting in the ER waiting room while my Mom & Dad are back in thr ER. A year ago he was diagnosed with esoph. varices and thus I first learned of them - never knew they existed. He wasn't a heavy drinker, had previous liver disease or any risk factors - he was on (about 6 mos. prior) a med call Niaspan, a buffered Niacin. It's known to cause liver damage. He began by vomiting blood and tarry stool. He had lost a lot of blood and was misdiagnosed by endoscopy with gastritis. Then they bled again a few day later. He was diagnosed and they were banded. Slight bleeding, more banding. Then he was diagnosed with a heart arrhythmia, only controlled by blood thinners or a electrical procedure called, Cardioaversion. But Cardioaversion also requires blood thinners two weeks prior to the procedure. He had one a few months back, arrhythmia returned. GI doctor said varices are healing & look great, very low risk of re-bleed & blood thinners for short time should be ok. That brings me to now. He started them one week ago and today - black stool. We came to the ER immediately. I hope he will be okay. These things seem so unfair. My Dad is not a candidate for transplant due to heart & kidney disease. I hope your Mazel is well and on the mend. Thanks for having this page, just googled, "Dad has varices, scared" and it came up. It felt good to right this, but it would feel best if Dad's would just be okay. :)
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