Liver cirrhosis is a condition that families often first hear about at a frightening moment, such as a sudden episode of vomiting blood. Understanding cirrhosis and one of its most dangerous complications, bleeding varices, can help patients and their families recognise warning signs early and seek timely care. While cirrhosis is serious, much can be done to manage it and to prevent or control life-threatening bleeding.
What Is Cirrhosis?
Cirrhosis is advanced scarring of the liver. Over many years, ongoing injury to the liver causes healthy tissue to be gradually replaced by scar tissue, which interferes with the liver’s many functions and obstructs the flow of blood through it. The liver is remarkably resilient and can work well even when partly damaged, which is why cirrhosis may go unnoticed for a long time before symptoms appear.
The Main Causes in India
Several conditions can lead to cirrhosis, and in India the leading causes are well recognised. Long-term infection with hepatitis B or hepatitis C is a major contributor, as is chronic alcohol use. Increasingly, non-alcoholic fatty liver disease driven by diabetes and obesity is becoming an important cause. Knowing the cause matters, because treating it, such as controlling a hepatitis infection or stopping alcohol, can slow or halt further damage.
How Varices Develop
This is the part every patient and family should understand. When scarring obstructs blood flow through the liver, pressure builds up in the veins that feed into it, a condition called portal hypertension. To bypass the blocked liver, blood is forced into smaller veins, particularly those in the food pipe and upper stomach. These veins swell into fragile, balloon-like vessels called varices. Because their walls are thin and under high pressure, they can burst and bleed suddenly and heavily.
Warning Signs That Need Urgent Care
Bleeding varices are a medical emergency. Seek immediate help for any of the following:
- Vomiting blood, which may be bright red or look like coffee grounds
- Black, tarry, foul-smelling stools
- Sudden weakness, dizziness or fainting
- Swelling of the abdomen or legs, in the context of known liver disease
- Confusion or excessive drowsiness in a person with liver disease
How Endoscopy Controls the Bleeding
The main tool for managing varices is upper gastrointestinal endoscopy. Using the camera, the doctor can see the varices directly and treat them. The most common technique is variceal banding, in which tiny elastic bands are placed around the swollen veins to cut off their blood supply so they shrink and seal. Another method, sclerotherapy, involves injecting a solution to close the vessels. Endoscopy is used both to stop active bleeding and, just as importantly, to treat varices in advance so that a first or repeat bleed can be prevented.
Living With Cirrhosis
A diagnosis of cirrhosis is not the end of the road. With the right care, including treatment of the underlying cause, regular monitoring, medicines to lower portal pressure and a schedule of endoscopic check-ups to watch for varices, many people live for years with a good quality of life. The most important steps are to identify the cause, follow up regularly, and act immediately at any sign of bleeding.
Managing liver disease or varices?
Dr. Gautham Krishnamurthy provides endoscopic management of varices and comprehensive liver care at P&G Hospital, Chennai. If there are any signs of bleeding, seek emergency care immediately. For appointments, contact reception.