Varices bleeds with no warning signs?

[MississaugaLiver]

Hubby had his first esophageal bleed on October 18. Two bands required., one unit of blood. On the 31st he has another bleed but this was not a varices, but angiodysplasia! According to the endoscopy report, there were no varices present. Two more units of blood. Last evening another varices bleed. Not sure what’s going on as he was being stabilized for the night and it’s early here. I’m in Canada.

He has no warning signs. Just starts to feel faint, then vomits at least a litre of blood and clots and drifts in and out of it. I’m worried that I won’t be able to leave him alone for fear the next time it happens I’m not here to call for an ambulance.

I thought he’d see dark stools, but he doesn’t. Is this normal?

[AyrshireK]

He is obviously bleeding such a lot that it is pooling in his stomach then being vomited, when you are seeing it in stools its probably a slower bleed where the blood is being digested and passing through the gastrointestinal tract. He is obviously suffering quite badly with this if he is having regular bleeds since that first one.

You'll need to see what they plan to do to reduce his portal hypertension if this is indeed another big variceal bleed. (My hubby only ever had the one bleed - thank goodness - and his varices were dealt with via repeated banding for over 2 years).

There is a procedure called TIPSS - Transjugular intrahepatic portosystemic shunt which might get talked about. This basically creates a 'canal' through the liver so that the blood which is backing up because it can't get through the damaged liver tissue has a clear passage to get through the liver and thereby reduces the backing up effect / portal hypertension. It isn't without risk one of the major ones being that it can increase the effects of hepatic encephalopathy because the channelled blood doesn't get de-toxified by the liver as it is being rushed through BUT it is an effective treatment to reduce PH and risk of further bleeds.

It sounds like you are going to have to have big chats with hubbies care team as like you say, you'll never be able to leave him unwatched for fear of another bleed.

Best wishes to you both,

Katie

[sophiaS1980 in reply to AyrshireK]

I came across this post, you learn something every day. I never heard of a slow bleed being digested and passed through the gastrointestinal tract. I have seen many on the liver site on Facebook stating they had a black stool, but it stopped on its own at least they thought it did until they started to cough up blood months later.

[MississaugaLiver in reply to sophiaS1980]

Fortunately hubby hasn’t had any further bleeds. He had two small varices banded two weeks ago and the doctor said he doesn’t expect to see him back! Incredible, he feels like his old self, pre liver disease.

[AyrshireK in reply to MississaugaLiver]

Glad he hasn't had more, my hubby ended up going for banding for 2 years and had 42 varices banded in all. He has an annual endoscopy now to check on the situation.

[AyrshireK in reply to sophiaS1980]

This is normally what happens, with the black stool, its blood going through the digestive tract and it's only when so much blood arrives in the stomach that it can't be digested or stomach won't tolerate it that you get the hematemesis (vomiting blood).

Katie

[Hidden]

Hi,

Variceal bleeds can really vary from one patient to another. Sometimes there are indeed warning signs, other times not.

As Katie has already mentioned. Now may be a good time for your husband to discuss a clear management plan with the liver team to try to prevent another bleed.

Keep us posted.