Varices

In cirrhosis, ‘varices’ (enlarged, dilated veins) should be identified and treated as early as possible to help prevent complications such as bleeding.2 Regular examinations of the esophagus and stomach should be performed to monitor for varices. This examination is called an endoscopy.1

If your doctor finds any varices during the examination, the first treatment is usually medication. For example, medications that reduce blood pressure may help to reduce the pressure inside the walls of the varices. This helps reduce the risk of the varices bleeding.3

If varices do start to bleed, it is important to stop the bleeding as soon as possible. This is also done by performing an endoscopy. There are several different treatment options which may be used during an endoscopy to stop the bleeding.3 These include:3

  • Band ligation: the doctor applies a rubber band to the affected vein to stop the bleeding.
  • Sclerotherapy: the doctor injects a substance into the swollen vein, to form a plug and stop the bleeding.
  • Stent or shunt: the doctor may implant small tube-like devices to divert blood flow, which stops the bleeding and preserves blood flow where it is needed.

Bleeding from varices is a medical emergency that needs urgent hospital treatment. There are certain symptoms of variceal bleeding that you and your loved ones should be aware of. This will help to ensure any bleeds are treated as early as possible, to avoid serious complications.3

Ascites

Your doctor may monitor you for ascites (fluid in the abdomen)4, by performing regular ultrasound examinations.5 This may determine what treatment you require. If a small amount of ascites is found, and it is not causing symptoms or increasing in volume, medications or surgical treatments may not be necessary.6

Some actions that may help are:

  • Preventing fluid build-up: a low-salt diet can help prevent ascites from accumulating, and medications such as diuretics (“water tablets”) may help flush out some of the excess fluid.4
  • Draining abdominal fluid: if there is a larger volume of ascites in the abdomen, it may be necessary to drain the fluid with a needle, in order to alleviate the symptoms. This is called “paracentesis”.4
  • Redirecting blood flow from the liver: diverting some blood from the liver can reduce the pressure in the portal vein, and subsequently reduce the volume of ascites produced. Redirection of blood may be achieved through insertion of a shunt into the veins of the liver.3

Hepatic Encephalopathy

Cirrhosis may cause a condition called hepatic encephalopathy, which is a disorder of the brain that can develop when the liver is not working properly. Your doctor may perform various tests to determine whether hepatic encephalopathy is present and if so, how severe it is.7 For example, your doctor may test your memory, your coordination, and your reaction time.8

Common examinations include:

  • The Psychometric Hepatic Encephalopathy Score (PHES). This 20 to 25 minute test includes a number connection test, a line tracing test and a digit symbol test.8
  • The critical flicker frequency test. During this test, you are given special glasses to wear. You will look into a light, and the doctor will gradually flicker the light with increasing frequency. As soon as you see the light begin to flicker, you let the doctor know. This enables them to determine the critical flicker frequency, which may help reveal hepatic encephalopathy.8

Other examinations that can help to detect early changes in brain function include electroencephalograms (EEG)8 or computer tomography (CT) scans.7

Contact your doctor or healthcare professional team if you have further queries or concerns.

Gespräch zwischen Arzt und Patient

Additional Information

References:

1. NICE staff. National Institute for Health and Care Excellence. Cirrhosis in over 16s. Available at: https://www.nice.org.uk/guidance/ng50/ifp/chapter/Cirrhosis-the-care-you-should-expect. Last accessed: November 2020

2. Mayo Clinic Staff. Mayo Clinic. Esophageal Varices. Available at: https://www.mayoclinic.org/diseases-conditions/esophageal-varices/symptoms-causes/syc-20351538#. Last accessed: October 2020

3. Khalid, R and Marcin, J. Healthline Medical Network. Bleeding Esophageal Varices. Available at: https://www.healthline.com/health/bleeding-esophageal-varices Last accessed: October 2020

4. Knott, L and Bonsall, A. Patient. Ascites. Available at: https://patient.info/doctor/ascites. Last accesed: November 2020

5. Nazario, B. WebMD. Ascites. Available at: https://www.webmd.com/digestive-disorders/ascites-medref. Last accessed: October 2020

6. Cesario, K et al. Cleveland Clinic. Cirrhotic Ascites. Available at: https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/hepatology/complications-of-cirrhosis-ascites Last accessed: November 2020

7. Kahn, A and Sethi, S. Healthline Medical Network. Hepatic Encephalopathy. Available at: https://www.healthline.com/health/hepatic-encephalopathy-2. Last accessed: October 2020

8. Nabi E, Bajaj JS. Useful Tests for Hepatic Encephalopathy in Clinical Practice. Curr Gastroenterol Rep. 2014 Jan; 16(1): 362.

May 2021. GL-HEP-XIF-2000178

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