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The Scenario:
Last week, after years of heavy drinking, Eddie developed an accumulation of fluid in his abdomen, and yellow jaundice, signifying liver failure due to alcoholic cirrhosis. He was placed in the hospital, some tests were run, and his fluid intake was restricted so that he might slowly be able to get rid of the ascitic fluid in his abdomen.
For the first week or so, very little changed. He was no better, but certainly no worse. Then, one morning, he began to feel sick to his stomach. He vomited a moderate amount of black material that looked like wet coffee grounds. Within a half hour he began to vomit large amounts of blood. The nurse was called, and she noted that his blood pressure was 80/50. He was pale and weak. He could not stop vomiting.
Questions:
Answer:
The cause of Eddie's bleeding might not be recognized by many people, but anyone in the health profession has seen it many times before. Last week Eddie was found to have a fluid build-up in his abdomen due to portal hypertension (an increase in pressure in the veins leading to the liver). In Eddie's case, it is caused by alcoholic cirrhosis. Portal hypertension causes other complications besides fluid accumulation. Here, it caused him to bleed internally because a dilated vein lining the esophagus (food tube) has ruptured.
Since blood from the stomach and esophagus flows through the liver, scarring of the liver will result in back pressure and dilated veins. The effect is much like the varicose veins many people find on their legs. These veins, when they line the esophagus, may be as fat as your finger, and are under pressure. Any small ulceration involving the wall of one of these veins may cause the vein to rupture, resulting in massive hemorrhage into the esophagus and stomach.
Bleeding from esophageal varices is a hairy event. The bleeding may be so brisk that the patient will exsanguinate. It is not uncommon for a patient to require ten or fifteen units of blood in severe cases. With aggressive treatment, Eddie may survive. He will likely have an endoscope passed into his esophagus so that the veins can be injected with a scarring agent to cause them to clot and shrink.
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