Esophageal varices

Abdomen | Gastroenterology | Esophageal varices (Disease)


Description

Esophageal varices (or oesophageal varices) are extremely dilated sub-mucosal veins in the lower third of the esophagus. They are most often a consequence of portal hypertension; patients with esophageal varices have a strong tendency to develop bleeding.

Symptoms include vomiting blood, vomiting coffee ground material, chest pain, breathing problems, fainting, black stools (melena), fatigue. Chronic blood loss may cause symptoms of anemia.

Causes and Risk factors

Esophageal varices are usually caused by liver failure, cirrhosis, or other conditions that result in reduced blood flow through the liver. This causes blood to back-up into veins in the esophagus and stomach forming varices. The enlargement causes the walls of the veins to stretch and become fragile. Severe gastrointestinal bleeding can occur if the veins rupture.

Diagnosis and Treatment

Treatment for esophageal varices involves reducing the risk of bleeding from the varices. Treatment for esophageal varices includes avoidance of alcohol, medications to reduce the risk of bleeding, and surgical procedures to stop variceal bleeding.

In cases of refractory bleeding, balloon tamponade with Sengstaken-Blakemore tube may be necessary, usually as a bridge to further endoscopy or treatment of the underlying cause of bleeding (usually portal hypertension). Methods of treating the portal hypertension include: transjugular intrahepatic portosystemic shunt (TIPS), or a distal splenorenal shunt procedure or a liver transplantation.

Nutritional supplementation is not necessary if the patient is not eating for four days or less. ...