Monthly Archives: July 2021

Esophageal Varices: Causes, Risk factors and Prevention Tips

The oesophagus (or esophagus) is the tube that carries food from the throat to the stomach. In an adult human being, the muscular duct measures up to eight inches long. The oesophagus runs parallel behind the windpipe, heart, and in front of the spine. Before connecting to the stomach, it passes through the diaphragm.

The muscles in the esophagus play a significant role in passing the food to the stomach and holding the food inside before it turns into energy.

Esophageal Varices

Among several, one of the principal complications that arise in the esophagus is the Esophageal Varices. In this condition, abnormal veins develop at the lower end of the tube. The veins are swollen or enlarged along the wall of the esophagus.

The condition usually goes undetected unless the veins bleed. Esophageal varices – a chronic disease, is manageable with proper medical support and guidance.

Esophageal varices Causes Risk factors Prevention

Esophageal varices Causes

The primary cause for esophageal varices is the malfunctioning of the liver. People who have liver cirrhosis are under constant threat to develop this condition.
The liver cleanses toxins from the body. When the blood flow to this crucial organ is restricted, it flows into the nearby vessels, increasing the supply. Because of this esophagus is one of the several organs that receive excess blood. The blood vessels in the esophagus are small and incapable of carrying surplus blood, leading to swelling up and resulting in varices.

Other contributing factors leading to varices are:

  • Thrombosis or blood clot in the portal vein.
  • Blockage of veins in the liver also known as Budd-Chiari syndrome
  • Schistosomiasis, also known as bilharzia – a disease caused by parasitic worms.

Symptoms

Bleeding is the leading symptom that indicates the oesophageal varices. The rupturing of the veins results in one of the following conditions:

  • vomiting of the blood – hematemesis
  • tarry or black stools
  • blood in the stools

The other symptoms might include:

  • intense bouts of stomach pain
  • pale or yellow skin
  • irregular breathing
  • easy bruising
  • fluid building up in the abdomen region

The symptoms in extreme cases where the bleeding is severe include:

  • loss of consciousness,
  • a person entering the state of shock

Also, Read : Stomach Cancer – Causes, Symptoms, Diagnosis, and Treatment

Risk factors

The risk factor depends on the progression of the condition. Not everyone will start bleeding immediately after developing varices. The Esophageal varices bleed under the following conditions:

  • If the patient has large esophageal varices
  • If red marks are present on the esophageal varices.
  • The patient develops high portal hypertension because of continuous pressure applied to the veins.
  • Severe scarring of the liver or cirrhosis is the primary risk factor. As the severity increases, so do the chances of bleeding.
  • Another reason for bleeding can be a bacterial infection. As the bacterial infection increases, it increases the chances of vessels rupture.
  • On detection of cirrhosis and varices, if the patient continues to consume excessive alcohol use, it also increases the chances of bleeding.
  • Esophageal varices can cause excessive vomiting or constipation since processing food becomes difficult.
  • violent coughing spells can trigger the rupture of the veins

Prevention

Correcting the underlying cause is the best way to prevent esophageal varices. A healthy diet and lifestyle to keep the body and the liver healthy is the way to avoid this chronic condition. Failing to accomplish that will cause complications and might lead to the replacement of the liver.

The following healthy measures should be part of daily lives to avoid this and any other health issue.

  • Eat low sodium and high fibre diet.
  • Include a lot of fruits and vegetables in your diet.
  • Maintain a healthy weight
    Avoid drinking alcohol as it can lead to liver damages.
  • Practise safe hygiene protocols.
  • Get periodic health check-ups as per your physician’s advice to avoid serious health blocks.

Esophageal varices treatment

  1. Treating the esophageal varices is very crucial. Without treatment, the condition can prove fatal. Regular follow-up with the doctor is a must as long as this is a chronic condition.
  2. Esophageal varices pathophysiology suggests that there are two ways to treat this disease.
    A. Prevention from bleeding
  3. Once the condition is detected either via endoscopy or imaging, the primary aim is to prevent bleeding of the veins.
  4. If it is small esophageal varices, they control it via medications such as beta-blockers to reduce the pressure in the portal veins.
  5. Esophageal varices banding: If the doctors find you are prone to bleeding, they will suggest variceal banding. Esophageal banding involves pulling the varices into a chamber with the help of an endoscope and tying them off with elastic bands to avoid bleeding.

Endoscopic sclerotherapy is the process of shrinking the swollen veins using medications administered via endoscope.

B. Treating the bleeding

There is over one way to treat bleeding varices. All the preventive measures specified above can be used to stop or minimize the blood supply. In case the bleeding is severe, then the patient needs the following action:

  1. Trans-jugular intrahepatic portosystemic shunt (TIPS): It involves adding a shut between the portal vein and the hepatic vein to carry blood from the liver to the heart. The process relives the built-up stress on the portal veins, thus controlling the bleeding.
  2. Distal splenorenal shunt procedure (DSRS): The procedure involves connecting the primary vein from the spleen to the vein of the left kidney. This procedure is more invasive but controls bleeding up to 90%.
  3. Injecting clotting factors via blood transfusion serves the dual purpose of replenishing the lost blood and avoiding further bleeding.
  4. In very severe cases, replacing the liver is the only and the last option.

Read More about the Signs of Ruptured Spleen

It is crucial to know the details of the condition and follow the doctors’ advice. Do not ignore the esophageal varices and self medicate, as it might cause complications. If you are in doubt, contact our doctors at Vydehi for more guidance and help. We are always around to facilitate, to get your health back in shape.

Dermatographia: Symptoms, Causes and Ayurvedic Treatment

Dermatographia or dermatographism is a skin condition. It’s one of the most common types of inducible urticaria occurring in 2-5% of the population. Categorized under physical urticaria, the term Dermatographism means ‘Skin writing’ or ‘to write on skin’. An urticarial eruption is formed on the application of even mild downward pressure in the form of a linear wheal in the shape of whichever external force is applied. A wheal is a circumscribed dermal edema also known as welt or a hive.

Urticaria dermatographia or dermatographism urticaria can be broadly categorized as symptomatic and asymptomatic.
Symptomatic dermatographism is often associated with pruritus, stinging, prickling sensation, and erythematous wheals which is the rarer but more troublesome type of dermatographism. It is idiopathic in nature but often severe at night and aggravated by heat, minor pressure, exercise, stress and emotion, helicobacter pylori, bites, scabies, systemic mastocytosis.
An asymptomatic dermatographism is only presented with the formation of wheal in the shape of trauma-induced.

Dermatographia

 

Dermatographia causes

Although the exact cause for dermatographia disease is unknown, its pathogenesis involves the release of histamine from mast cells.

Although not conclusive the exaggerated biological response called, ‘ the triple response of lewis’, triggered by the mechanical trauma which releases some antigens that react with the bound IgE on mast cells. This leads to the release of histamine and other inflammatory mediators.

  1. The dilated capillaries produce a superficial erythematous phase
  2. Axon-reflex flare and sensory nerve fiber communication causes broadening erythema from arteriolar dilation
  3. Formation of linear wheal from fluid transudation

This is the triple response of lewis. The entire response takes about 5-10 minutes after an external stimulus.

It is known to be seen in diabetic, hyper/hypothyroidism, menopausal(onset), pregnant(mostly second trimester), or medication-related (penicillin) people. Other known risk factors associated with this condition are;

  • Age: mostly in young adults, peak in the second and third decade.
  • Hypereosinophilic syndrome in atopic children
  • Traumatic life events and psychological co-morbidities.
  • Behcet disease
  • Systemic mastocytosis (Congenital symptomatic dermatographism)

Dermatographia Signs and symptoms

  • Formation of erythematous wheals in the form of mechanical trauma induced on the skin even by mild stroking within 5-10 minutes. Except for a very rare type of delayed dermographism where tender urticarial lesion reappears 3 to 8 hours after the initial injury that persists up to forty-eight (48) hours
  • It May or may not be associated with pruritus.
  • Wheals can persist anywhere between 15-30 minutes unlike the normal triple response of lewis that subsides within 10 minutes. Deeper edemas into the dermis form larger wheals.
  • Mostly seen on trunks and extremities. Very rarely on the scalp and genital area(except for dyspareunia and vulvodynia)
  • Histopathologically, dermal edema with few perivascular mononuclear cells is seen.

Also, Read All You Need To Know About Lipomas

Rare subtypes of Dermatographism

  • Red dermatographism (small punctate wheals on repeated friction, predominantly on the trunk, possible association with seborrheic dermatitis)
  • Cholinergic dermographism (large erythematous line with by smaller punctate wheals surrounded by macular erythema with purpura in severe cases)
  • Follicular dermographism (transitory discrete follicular urticarial papules against the bright erythematous background)
  • Cold-precipitated
  • Exercise-induced
  • Familial (probably autosomal dominant inheritance)

Differential Diagnosis

  • False dermographism- Presents with similar symptoms but different mechanisms are involved. They are white, black, and yellow dermatographism. White dermatographism is caused by a blanching response from capillary vasoconstriction secondary to allergic contact dermatitis and is prevalent in atopic individuals. Black dermatographism is a greenish or blackish discoloration of the skin that occurs after contact with metallic objects. Yellow dermatographism is due to the deposition of bile pigments on the skin.
  • Latex allergy mimicking symptomatic dermographia is mostly seen on hands and genital region due to physical contact of latex in gloves, contraceptives, toys, etc.
  • Mastocytosis.

Dermatographia Diagnosis

Primarily, dermographism urticaria is a clinical diagnosis. It is usually made by observing the response in the subject after using moderate pressure to scratch or stroke the skin gently. A tongue depressor is used for this purpose. The site of pressure application is of importance because of the reactiveness of areas the dorsal area or back which is protected from the external environmental influences and pressure than that of more exposed parts like buttocks or limbs. The exaggerated triple response of Lewis points to the diagnosis.
A spring-loaded stylus called a dermographometer is used to apply graded pressure and record skin responses. Its use is mostly limited to the research settings due to its reproducibility.
Hematological and biochemical screening tests are usually normal, except for few cases where increased blood histamine is recorded after experimental scratching.

Dermatographia Treatment

Dermatographia, a benign condition, seldom governs treatment until it is symptomatic. Mostly seen in young adults this condition resolves itself after approximately five years to ten years in the majority of the cases.
Symptomatic dermatographia requires medical attention due to its presentations. It is mostly treated with antihistamines. H1 antihistamines like cetirizine, loratadine are the drugs of choice, and H2 antihistamines like diphenhydramine, hydroxyzine are combined in required cases. Omalizumab has also been considered for treatment and is under research for its efficacy. Phototherapy with Narrowband ultraviolet (UV)-B and oral psoralen plus UV-A therapy has also been advised in a few cases. Adjunctive treatment with vitamin C is also used as a dermatographia cure.
Antihistamines are to be taken under strict medical supervision only as certain activities like driving, operating heavy machinery have to be avoided.
Apart from major pharmacological therapy, prevention and avoidance of aggravating factors such as physical stimuli play a major role in controlling this condition. Good skincare and use of emollients can reduce dry skin thereby aggravating dermographia due to scratching. Wearing soft clothes, reducing stress and anxiety, and practicing yoga all play a key role in controlling this.

Dermatographia Ayurvedic Treatment

Ayurveda, the ancient medicine system of India under the broad heading of twak vikara encompasses many dermatological conditions. Udarda, a Kapha dominant condition, is mainly treated with shodhana ( bio purification procedures) and shamana aushadha ( pacificatory medicines) based on the patient. The internal medications mainly will have the quality of ushna, teekshna, Vata anulomana, and pachana. They subside both Kapha and Vata along with vimargagami pitta. Along with pathya and apathya, dietary and lifestyle modification suitable to patient and disease, Ayurveda has a potential holistic approach to dermatographia. Medicines like Haridra khanda, ardraka khanda, amrita satva, arogyavardhini vati, gandhaka rasayana, aragwadha amrutadi kashaya, dashamoola haritaki,, varanadi kashayam, ayaskriti, abhyanga with katu taila, vardhamana pippali rasayana, etc.

Although not life-threatening, dermatographism is a distressing condition. Asymptomatic dermographism requires no treatment but symptomatic dermographism should be treated till the condition is controlled or resolved. Reach out to our experts at VIMS today, for proper guidance. Our expert team of doctors from ayurvedic and modern fields of medicine is always within your reach.

Also, Read Ayurvedic herbs for skin