| Esophageal varices Classification and external resources | |
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| Gastroscopy image of esophageal varices with prominent red wale spots | |
| ICD-10 | I85. |
| ICD-9 | 456.0-456. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings I00-I99 - Diseases of the Circulatory system (I00-I02 Acute rheumatic fever ( Rheumatic fever without mention of Heart The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. 2 |
| DiseasesDB | 9177 |
| MedlinePlus | 000268 |
| eMedicine | med/745 radio/269 |
| MeSH | D004932 |
In medicine (gastroenterology), esophageal varices are extremely dilated sub-mucosal veins in the esophagus. The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. MedlinePlus, with the MedlinePlus Medical Encyclopedia, is a website network containing Health information from the world's largest medical Library eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books Medicine is the art and science of healing It encompasses a range of Health care practices evolved to maintain and restore Human Health by the Gastroenterology ( MeSH heading is the branch of Medicine whereby the Digestive system and its disorders are studied In the Circulatory system, a vein is a Blood vessel that carries Blood back toward the Heart (as opposed to Artery, a blood vessel The esophagus or oesophagus (see American and British English spelling differences) sometimes known as the gullet, is an organ in They are most often a consequence of portal hypertension, such as may be seen with cirrhosis; patients with esophageal varices have a strong tendency to develop bleeding. In Medicine, portal hypertension is Hypertension (high blood pressure in the Portal vein and its branches Cirrhosis is a consequence of chronic Liver Disease characterized by replacement of liver tissue by fibrous Scar tissue as well as regenerative Bleeding, technically known as hemorrhaging / haemorrhaging (see American and British spelling differences) is the loss of Blood from
Esophageal varices are diagnosed with endoscopy. Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an instrument called an endoscope. [1]
Contents |
Pathogenesis
The majority of blood from the esophagus is drained away via the esophageal veins, which drain deoxygenated blood from the esophagus to the azygos vein which in turn, directly drains into the superior vena cava. The esophagus or oesophagus (see American and British English spelling differences) sometimes known as the gullet, is an organ in The esophageal veins drain blood from the Esophagus to the Inferior thyroid vein. The azygos vein is a vein running up the right side of the thoracic Vertebral column. The superior vena cava is a large yet short Vein that carries deoxygenated Blood from the upper half of the body to the Heart 's Right atrium These veins have no part in the development of esophageal varices. The remaining blood from the esophagus is drained away via the superficial veins lining the esophagus interior, which drain into the coronary vein (left gastric vein) which in turn, drains directly into the portal vein. The Left gastric vein (or coronary vein) derives tributaries from both surfaces of the Stomach; it runs from right to left along the lesser curvature of the stomach The Left gastric vein (or coronary vein) derives tributaries from both surfaces of the Stomach; it runs from right to left along the lesser curvature of the stomach These superficial veins lining the esophagus interior (normally only approximately 1mm in diameter) become distended up to 1-2 cm in diameter in association with portal hypertension.
Normal portal pressure is approximately 9 mmHg compared to an inferior vena cava pressure of 2-6 mmHg. This creates a normal pressure gradient of 3-7 mmHg. If the portal pressure rises above 12mmHg, this gradient rises to 7-10 mmHg. [2] A gradient greater than 10 mmHg is considered portal hypertension. In Medicine, portal hypertension is Hypertension (high blood pressure in the Portal vein and its branches At gradients greater than 10 mmHg, blood flow though the hepatic portal system is redirected from the liver into areas with lower venous pressures. This means that collateral circulation develops in the lower esophagus, abdominal wall, stomach and rectum. The esophagus or oesophagus (see American and British English spelling differences) sometimes known as the gullet, is an organ in In Human anatomy, the stomach is a J-shaped hollow muscular organ of the Gastrointestinal tract involved in the second phase of Digestion, following The rectum (from the Latin rectum intestinum, meaning straight intestine) is the final straight portion of the Large intestine in some Mammals The small blood vessels in these areas become distended, becoming more thin-walled, and appear as varicosities. In addition, these vessels are poorly supported by other structures, as they are not designed for high pressures.
In situations where portal pressures increase, such as with cirrhosis, there is dilation of veins in the anastomosis, leading to esophageal varices. Cirrhosis is a consequence of chronic Liver Disease characterized by replacement of liver tissue by fibrous Scar tissue as well as regenerative An anastomosis (plural anastomoses, from gr ἀναστόμωσις communicating opening) is a Network of streams that both branch out and reconnect
Varices can also form in other areas of the body, including the stomach (gastric varices), duodenum (duodenal varices), and rectum (rectal varices). In Human anatomy, the stomach is a J-shaped hollow muscular organ of the Gastrointestinal tract involved in the second phase of Digestion, following Gastric varices are dilated submucosal Veins in the Stomach, which can be a life-threatening cause of Upper gastrointestinal hemorrhage. In Anatomy of the Digestive system, the duodenum is a hollow jointed tube about 25-30 cm (10-12 in long connecting the Stomach to the Jejunum Intestinal varices are dilated submucosal Veins in the Intestine. The rectum (from the Latin rectum intestinum, meaning straight intestine) is the final straight portion of the Large intestine in some Mammals Hemorrhoids ( AmE) haemorrhoids ( BrE) emerods, or piles are varicosities or swelling and Inflammation Treatment of these types of varices may differ.
Treatment and the role of endoscopy
In emergency situations, the care is directed at stopping blood loss, maintaining plasma volume, correcting disorders in coagulation induced by cirrhosis, and appropriate use of antibiotics (as infection is either concomitant, or a precipitant). In modern usage an antibiotic is a Chemotherapeutic agent with activity against Microorganisms such as Bacteria, fungi or Protozoa
Therapeutic endoscopy is considered the mainstay of urgent treatment. Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an instrument called an endoscope. Two main therapeutic approaches exist:
- Variceal ligation, or banding
- sclerotherapy
In cases of refractory bleeding, balloon tamponade may be necessary, usually as a bridge to further endoscopy or treatment of the underlying cause of bleeding (usually portal hypertension). Banding refers to a Medical procedure which uses elastic bands for constriction Sclerotherapy is a procedure used to treat Blood vessels or blood vessel malformations (vascular malformations and also those of the Lymphatic system. Balloon tamponade refers to the use of mercury weighted Balloons instilled into typically the Esophagus or Stomach, and inflated to stop refractory Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an instrument called an endoscope. Methods of treating the portal hypertension include: transjugular intrahepatic portosystemic shunt (TIPS), or a distal splenorenal shunt procedure or a liver transplantation. A transjugular intrahepatic portosystemic shunt, also TIPS, is an artificial channel in the Liver from the Portal vein to a Hepatic vein In Medicine, a distal splenorenal shunt procedure (DSRS also splenorenal shunt procedure and Warren shunt, is a surgical procedure in which Liver transplantation or hepatic transplantation is the replacement of a diseased Liver with a healthy liver Allograft.
Nutritional supplementation is not necessary if the patient is not eating for four days or less. [3]
Prevention
Ideally, patients with known varices should receive treatment to reduce their risk of bleeding. [4] The non-selective β-blockers (e. Beta blockers (sometimes written as β-blocker) are a class of drugs used for various indications but particularly for the management of Cardiac arrhythmias g. , propranolol, timolol or nadolol) and nitrates have been evaluated for secondary prophylaxis. Propranolol ( INN) is a non-selective Beta blocker mainly used in the treatment of Hypertension. Timolol maleate is a non-selective beta-adrenergic receptor blocker. Nadolol ( Corgard) is a non-selective Beta-blocker used in the treatment of high blood pressure, migraine headaches, and chest pain The effectiveness of this treatment has been shown by a number of different studies. [5]
Unfortunately, non-selective β-blockers do not prevent the formation of esophageal varices. Beta blockers (sometimes written as β-blocker) are a class of drugs used for various indications but particularly for the management of Cardiac arrhythmias [6]
See also
References
- ^ Biecker E, Schepke M, Sauerbruch T (2005). Portal hypertensive gastropathy refers to changes in the Mucosa of the Stomach in patients with Portal hypertension; by far the most common cause of this "The role of endoscopy in portal hypertension". Dig Dis 23 (1): 11-7. doi:. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 15920321.
- ^ Arguedas M (2003). "The critically ill liver patient: the variceal bleeder". Semin Gastrointest Dis 14 (1): 34-8. PMID 12610853.
- ^ de Lédinghen V, Beau P, Mannant PR, et al (1997). "Early feeding or enteral nutrition in patients with cirrhosis after bleeding from esophageal varices? A randomized controlled study". Dig. Dis. Sci. 42 (3): 536-41. PMID 9073135.
- ^ Lebrec D, Poynard T, Hillon P, Benhamou J-P (1981). "Propranolol for prevention of recurrent gastrointestinal bleeding in patients with cirrhosis: a controlled study". N Engl J Med 305: 1371–1374. PMID 7029276.
- ^ Talwalkar JA, Kamath PS (2004). "An evidence-based medicine approach to beta-blocker therapy in patients with cirrhosis". Am J Med 116: 759–766. doi:. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 15144913.
- ^ Groszmann RJ, Garcia-Tsao G, Bosch J, et al. (2005). "Beta-Blockers to Prevent Gastroesophageal Varices in Patients with Cirrhosis". N Engl J Med 353 (21): 2254–2261. doi:. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 16306522.
See also
External links
- Treatment of Esophageal Varices - World Gastroenterology Organisation (WGO)
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