Monthly Archives: January 2013

Vomiting Blood with Hepatitis C

Vomiting Blood with Hepatitis C – Surviving an Esophageal Bleed. Harsh title? Harsh Virus.

vomiting blood
Dark or coffee ground appearance is old blood. When you throw up? Call the doctor no matter what the color.

This may sound gross and nasty. Sorry friends. That is what I’m living with today. As your best friend in the Hepatitis C and cirrhosis mess, I feel like this may help many of you. One of the reasons I started this blog was because the information I read when first diagnosed scared the daylights out of me. When the doctor said Portal Valve Hypertension with class 2 varices, I googled it and got sick. The pictures were disgusting. I was still in denial that the Hepatitis C virus was even a part of my life. Read here about the grades of varices.

Frightening words and images jumped off the computer screen and invaded my house. If I turned the computer off, then I could mute the ugliness of it for a while. But it still creeped in my bedroom at night. Those pictures of MY stomach and esophagus were in a folder, in a manilla envelope, in an accordian file, in a box under the bed. I hated those pictures. They told the truth that I did not want to hear. Now I am going to give you my best advice so you don’t end up vomiting blood with Hepatitis C.  I know many of you have been there.

  1. If you have cirrhosis, you should have an endoscopy, a Magnetic Resonance Image(MRI), and Dopplar sonography performed to determine if you have Portal Vein Hypertension and varices. The MRI gives a better visual of any enlarged veins. The ultrasound or sonography shows what percentage of blood is flowing back UP instead of down and through your Hepatitic Vein System in your liver.If it is extensive, you may be placed on a beta blocker such as Propanolol. Taking your dose regularly will reduce the hypertension and can keep varices from forming, or enlarging.
  2. If it is extensive, you may be placed on a beta blocker such as Propanolol. Taking your dose regularly will reduce the hypertension and can keep varices from forming, or enlarging.
  3. Have regular endoscopies and bandings when necessary. It’s an inconvenience and will lay you out for a day or two. Liquid diet may be all that you can tolerate if they band 3 or more, Just do it. I’ll bring jello and popsicles.
  4. Varices can also be in your stomach and colon. So the bleeding may be in stool. This requires colonoscopies and regular follow up as well.

It has been 2 ½ years and I have somewhat accepted all of the tests, medications, and limitations associated with Portal Valve Hypertension and Esophageal Varices. Boy, have I fought against it mentally. Even writing this blog is creating a huge amount of emotion for me.
Here is a little Liver 101 to help you out. Remember “the liver is the oil filter” analogy from my blog? Well, the scarring from Hepatitis C connects to, and wraps itself all around the liver causing cirrhosis. At the last stages of cirrhosis, the scarring is so thick and intrusive that it closes off the veins and arteries in the liver. The Hepatic Portal Vein System is the one that brings all your blood into the liver for filtering. The liver process, cleans, and extracts all of the digestive toxins and gets rid of bilirubin from your hemoglobin. Your blood then exits through the Hepatic Vein before it goes back into circulation. From there it enters your spleen. Your liver is such a hard working organ! (See my blog on that)

hepatic system
This is how blood circulates – or not – if you have cirrhosis.

It goes like this: when the scarring from cirrhosis begins to close the vein, it creates a traffic jam for blood. Hence the term: Portal Hypertension. Portal Hypertension can cause the spleen to enlarge and varices to form in the GI tract. See, when your blood cannot find a way through, it pumps back up toward the heart. The veins leading to the stomach, colon, and esophagus become swollen and thin – bulging at the pressure placed on them. The heart relentlessly pumps blood to get filtered. The liver cannot handle it. The blood races to find a way to rid itself of toxins, transport sugars, break down protein.

Your spleen becomes enlarged because platelets are trapped there. That is one reason that those of us with cirrhosis have low platelets. The platelets are there, they are just sequestered in the swollen spleen so they are not circulating in our blood stream. One of the side effects of that is noticeable bruising because our platelets are what helps blood to clot. So internal bleeding becomes a real hazard for us. I had bruising for years before diagnosis. Geez, what a red flag that got ignored…

When all routes are closed the bulging veins pump and swell more. Varices are kind of like varicose veins in your esophagus, stomach, and intestines. If the conditions are just right – they expand until they burst. Blood pours into the esophagus and stomach. Portal hypertension gets worse over time as the liver gets more scared. This is what causes varices, ascites, edema and a host of other things.

The bleeding may be slight and the only sign would be a dark stool indicating old blood had passed through the colon. Vomiting may occur with what appears to be dark coffee grounds; blood clots forming in your stomach as they attempt to stop the flow.  Your lower GI tract may have active bleeding with red blood in the stool.

Before I was diagnosed, I had my first episode. Thinking I had the stomach flu, I drank sodium laden chicken broth. I passed out in the bathroom and my roomie found me. I was thinking that the red color was the jello that I was trying to hold down. Uh huh. It was blood. I ignored it. For a few days anyway.  If ignored, portal hypertension can cause ascites which is a build up of fluid in the abdomen. When I swelled  like a pregnant woman, I ended up in the hospital where an MRI showed a clear picture of a cirrhotic liver and a lot of varices. Within 2 days, I had the diagnosis of Hepatitis C Virus with End Stage Liver Disease (ESLD).

When my varices was first diagnosed as Class 2 out of of 4, I got my MELD score and eventually headed to the transplant hospital. The next bleed would be after 43 weeks of treatment. Reduced platelets and hemoglobin led to a massive bleed that haunts me even now. Hepatitis C Treatment affects those with varices. 

Read about grades and stages of varies here.

 

At that time the doctor did a procedure where an endoscopy was performed and he placed rubber bands around each bulging vein.  I was in ICU for that one. It is usually done on an outpatient basis unless there is a massive bleed. Heavy sedation replaces total anesthesia. It is much easier on the liver and recovery time is quicker.

happy feet vomiting blood hep c cirrhosis liver
I”m chillin like a villian with my beta blockers. Happy Feet!

That is what I had done last Friday. It was my 5th one. Click here for a blog on what to expect with a varices banding. Usually they band about 5 or 6. This time I only needed 2 veins banded! That is my good news for the day. I am still a little woozy from the sedation. Pardon me if my writing is woozy. The news I received tells me that the 50 mg of Nadolol daily is working to keep my portal valve pressure down. We have had to tweak that a few times. I take the largest dose at bedtime to prevent grogginess at work. I take my pulse several times a day to insure that it stays around 60 to 65 beats per minute. I also take Omaprazole daily to keep stomach acid at a minimum. I have never had ulcers or stomach problems, but now I have to keep my tummy at a good PH level through good nutrition. Probiotics, Greek Yogurt, and a liver loving diet help with that.

So if you have Hepatitis C, been diagnosed with acites, varices, portal hypertension, or are vomiting blood – taking these steps can help to reduce the amount of fear. Yeah. Calm down a little. I hope that my story will help to reduce the amount of stress that you feel. Life is not over yet. You CAN overcome with the right treatment. I plan on going another 20 years. Won’t you join me? Let’s not give the Hepatitis C Virus one inch of ground. I’ve got my lipstick on and am heading out to see a comedy. My crying is over for this round. It’s time for some comic relief. http://www.ihelpc.com/ 

Your bff who will NOT give up, Karen:)

Have you ever had bleeding with Hepatitis C or Cirrhosis? What are you doing to prevent it?