Esophageal Varices

Hey, remember this guy? That was my first real emergency, the first time I called in a note to the ER, and the first time I left a hospital knowing my patient's chances for survival were next to nil.

Well, I just learned all about what was wrong with him.

Upper GI Bleed is the vague overarching chief complaint for our paperwork. Or, as I put it at the time, Severe Bleeding from Nose and Mouth. Upper gastrointestinal bleeds usually present as coffee-ground emesis and a seriously unforgettable stench. To me, it smells like heavy metals. Like iron and something worse are so thick in the air that you can taste them.

The gentleman in question had a profuse amount of bright red blood gushing from his mouth and nose. He was so far gone in his dementia that he refused to unclench his teeth. We suctioned what we could, but anything more would've involved breaking his jaw. We couldn't drop an NPA with the amount of blood coming out of his face. For all we knew, he could've been hemorrhaging from his sinuses. We transported him left lateral recumbent with a layer of extra towels to catch the blood flow, and I held the NRB a centimeter away from his face enroute, to give me room to suction and him room to spit. The sheer terror in his eyes scared me more than anything, because he had no way of comprehending what was happening, why he couldn't talk, or where we were taking him. Trying to hold someone's hand, an NRB and a suction catheter all at the same time is not an easy accomplishment.

But back to the actual physiology, and not just Rookie Birdie peeing her pants.

Chronic liver disease (often cirrhosis caused by alcohol abuse), can obstruct normal blood flow through the liver. This makes the blood flow in your body backup, distending your finer blood vessels. In my patient's case, the ones in his esophagus. The technical name for these is Esophageal Varices. Being distended vessels, they're prone to rupture.

Ta-da! Upper GI Bleed.


For more reading:

Esophageal Varices - Mayo Clinic

Bleeding Esophageal Varices - National Institutes of Health

Bleeding Esophageal Varices - New England Journal of Medicine
*Note: REALLY COOL ENDOSCOPY VIDEO