Gastric varices in chronic liver disease managed with parto procedure

Kanimozhi1*, Sripreethi2, Jayamenon3

1Critical care Nurse, Kauvery Hospital, Heartcity, Trichy, Tamil Nadu

2Nurse Educator, Kauvery Hospital, Heartcity, Trichy, Tamil Nadu

3Nursing Superintendent, Kauvery Hospital, Heartcity, Trichy, Tamil Nadu

*Correspondence

Abstract

Gastric varices are a severe complication of portal hypertension, commonly associated with chronic liver disease (CLD). They carry a high risk of life-threatening bleeding. This case study presents a 57-year-old male with a history of CLD and gastric varices who was admitted for Proximal Splenorenal Shunt / PARTO (Plug-Assisted Retrograde Transvenous Obliteration) procedure. The patient had prior comorbidities including coronary artery bypass grafting (CABG) and lung decortication. Clinical evaluation, imaging, and endoscopic findings confirmed large gastric varices. The patient was managed with interventional radiology procedures along with supportive medical care. This case highlights the importance of early diagnosis, multidisciplinary management, and advanced interventional techniques in improving patient outcomes.

Keywords: Gastric varices; Portal hypertension; CLD; PARTO procedure; Hematemesis; Interventional radiology

Introduction

Gastric varices are dilated submucosal veins in the stomach, occurring due to portal hypertension, most commonly in patients with chronic liver disease. Though less common than esophageal varices, gastric varices are associated with more severe bleeding and higher mortality rates. Management has evolved from traditional endoscopic and surgical approaches to minimally invasive interventional procedures such as PARTO (Plug-Assisted Retrograde Transvenous Obliteration), which is effective in controlling variceal bleeding and preventing recurrence. This case study focuses on the clinical presentation, diagnosis, and management of gastric varices in a patient with multiple comorbidities.

Case Presentation

A 57-year-old male presented to the emergency department with complaints related to chronic liver disease and was evaluated for gastric varices.

Medical History

  • Known case of Chronic Liver Disease (CLD)
  • History of gastric varices
  • Post CABG (2022)
  • History of lung decortication (2022)
  • No known drug allergies

Clinical Findings

Conscious and oriented

  • Blood Pressure: 90/60 mmHg initially
  • Heart Rate : 61/min
  • Respiratory Rate: 20/min
  • SpO₂: 99% on room air
  • Abdomen: Soft
  • Cardiovascular system: Normal heart sounds
  • Respiratory system: Bilateral air entry present
  • CNS: No focal neurological deficit

Investigations

  • Upper GI endoscopy: Large gastric varices
  • CT abdomen: Confirmed varices
  • Blood sugar: Elevated (RBS ~227 mg/dL)
  • Creatinine: 0.9 mg/dL
  • Urea: Elevated
  • Hemoglobin: Mildly reduced
  • Platelet count: Within acceptable range

ECG Findings

Laboratory Investigation

Provisional Diagnosis

  • Chronic Liver Disease with multiple gastric varices
  • Portal hypertension

Diagnosis

The diagnosis was made based on:

  • Clinical history of CLD
  • Endoscopic findings showing large gastric varices
  • Radiological imaging (CT abdomen)
  • Laboratory findings supporting liver dysfunction

Final diagnosis

Chronic Liver Disease with Portal Hypertension and Large Gastric Varices

Management

  • Medical Management:
  • IV fluids for stabilization
  • Proton pump inhibitors
  • Antibiotics (e.g., Ceftriaxone)
  • Antiplatelet and cardiac medications (post-CABG care)
  • Insulin for glycemic control
  • Supportive therapy

Interventional Management

  • Patients were planned and underwent PARTO procedure
  • Minimally invasive radiological intervention
  • Obliteration of gastric varices using vascular plug
  • Monitoring:
  • Vital signs monitoring
  • Input-output charting
  • Blood investigations
  • Observation for bleeding or complications

Nursing Management

  • Continuous monitoring of vitals
  • Assessment for signs of bleeding
  • Maintaining IV access
  • Patient education regarding procedure and recovery
  • Infection prevention

Discussion

Gastric varices are a serious complication of portal hypertension and are associated with a high risk of massive bleeding. Compared to esophageal varices, gastric varices bleed less frequently but more severely. In this case, the patient had multiple risk factors including CLD and prior comorbid conditions such as CABG and lung surgery, which complicated management.

PARTO is a newer and effective interventional technique that provides better control of gastric varices with fewer complications compared to traditional methods like TIPS or surgical shunts. It works by occluding the varices and redirecting blood flow. Early identification and multidisciplinary management involving gastroenterologists, interventional radiologists, and nursing staff are crucial for successful outcomes.

Conclusion

This case highlights the importance of prompt diagnosis and advanced interventional management in patients with gastric varices. PARTO procedure is a safe and effective treatment modality for gastric varices associated with portal hypertension.

Comprehensive care including medical stabilization, procedural intervention, and continuous monitoring significantly improves patient prognosis. Early intervention and proper follow-up are essential to prevent recurrence and complications.

References

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