Gastric varices Classification and external resources
Isolated gastric varices of Sarin classification IGV-1 seen on gastroscopy in a patient with portal hypertension
ICD-10	I86.4

Gastric varices are dilated submucosal veins in the stomach, which can be a life-threatening cause of upper gastrointestinal hemorrhage. In Medicine, portal hypertension is Hypertension (high blood pressure in the Portal vein and its branches 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 In the Circulatory system, a vein is a Blood vessel that carries Blood back toward the Heart (as opposed to Artery, a blood vessel In Human anatomy, the stomach is a J-shaped hollow muscular organ of the Gastrointestinal tract involved in the second phase of Digestion, following }} Upper gastrointestinal (GI bleeding refers to Hemorrhage in the Upper gastrointestinal tract. They are most commonly found in patients with portal hypertension, or elevated pressure in the portal vein system, which may be a complication of cirrhosis. 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 Gastric varices may also be found in patients with thrombosis of the splenic vein, into which the short gastric veins which drain the fundus of the stomach flow. In Anatomy, the splenic vein (in the past called the lienal vein) is the Blood vessel that drains Blood from the Spleen. The latter may be a complication of acute pancreatitis, pancreatic cancer, or other abdominal tumours. Acute Pancreatitis is a sudden Inflammation of the Pancreas. Depending on its severity it can have severe complications and high mortality despite Pancreatic cancer is a malignant tumor of the Pancreas. Each year about 37680 individuals in the United States are diagnosed with this condition and 34290 Patients with bleeding gastric varices can present with bloody vomiting (hematemesis), dark, tarry stools (melena), or frank rectal bleeding. Hematemesis or haematemesis (see American and British spelling differences) is the Vomiting of Blood. In Medicine, melena or melaena refers to the black "tarry" Feces that are associated with gastrointestinal Hemorrhage. The bleeding may be brisk, and patients may soon develop shock. Treatment of gastric varices can include injection of the varices with cyanoacrylate glue, or a radiological procedure to decrease the pressure in the portal vein, termed transjugular intrahepatic portosystemic shunt or TIPS. Cyanoacrylate is the generic name for cyanoacrylate based fast-acting Glues such as ethyl-2-cyanoacrylate (commonly sold under trade names like Superglue and Krazy A transjugular intrahepatic portosystemic shunt, also TIPS, is an artificial channel in the Liver from the Portal vein to a Hepatic vein Treatment with intravenous octreotide is also useful to shunt blood flow away from the stomach's circulation. Octreotide (brand name Sandostatin, Novartis Pharmaceuticals) is an octapeptide that mimics natural Somatostatin pharmacologically though it More aggressive treament including splenectomy (or surgical removal of the spleen) or liver transplantation may be required in some cases. A splenectomy is a procedure that involves the removal of the Spleen by operative means The spleen is an organ found in all Vertebrate animals In humans the spleen is located in the abdomen of the body where it functions in the destruction of redundant Red Liver transplantation or hepatic transplantation is the replacement of a diseased Liver with a healthy liver Allograft.

Clinical presentation

Gastric varices can present in two major ways. First, patients with cirrhosis may be enrolled in screening gastroscopy programs to detect esophageal varices. Cirrhosis is a consequence of chronic Liver Disease characterized by replacement of liver tissue by fibrous Scar tissue as well as regenerative In Medicine ( Gastroenterology) esophageal varices are extremely dilated sub-mucosal Veins in the Esophagus. These evaluations may detect gastric varices that are asymptomatic. When gastric varices are symptomatic, however, they usually present acutely and dramatically with upper GI hemorrhage. }} Upper gastrointestinal (GI bleeding refers to Hemorrhage in the Upper gastrointestinal tract. The symptoms can include hematemesis, or vomiting blood; melena, passing black, tarry stools; or passing maroon stools or frank blood in the stools. Hematemesis or haematemesis (see American and British spelling differences) is the Vomiting of Blood. Vomiting (also called throwing up, emesis) is the forceful expulsion of the contents of one's Stomach through the Mouth and sometimes the In Medicine, melena or melaena refers to the black "tarry" Feces that are associated with gastrointestinal Hemorrhage. Many patients with bleeding gastric varices present in shock due to the profound loss of blood.

Finally, patients with acute pancreatitis may present with gastric varices as a complication of thrombosis of the splenic vein. Acute Pancreatitis is a sudden Inflammation of the Pancreas. Depending on its severity it can have severe complications and high mortality despite In Anatomy, the splenic vein (in the past called the lienal vein) is the Blood vessel that drains Blood from the Spleen. The splenic vein sits over the pancreas anatomically and inflammation or cancers of the pancreas may result in thrombosis, or clotting of the splenic vein. As the short gastric veins of the fundus of the stomach drain into the splenic vein, thrombosis of the splenic vein will result in increased pressure and engorgement of the short veins, leading to varices in the fundus of the stomach.

Laboratory testing usually shows anemia and often thrombocytopenia (a low platelet count). Anemia ( AmE) or anæmia/anaemia ( BrE) (from the Ancient Greek grc-Latn anaîmia, meaning “without blood” is defined as a qualitative Thrombocytopenia (or -paenia, or thrombopenia in short is the presence of relatively few Platelets in Blood. Platelets, or Thrombocytes, are small cytoplasmic bodies derived from cells They circulate in the Blood of Mammals and are involved If cirrhosis is present, there may be coagulopathy manifested by a prolonged INR; both of these may worsen the hemorrhage from gastric varices. Coagulopathy is a medical term for a defect in the body's mechanism for Blood Clotting.

Diagnosis and classification

The Sarin classification of gastric varices identifies two types of gastroesophageal varices, where esophageal varices are found concurrently, and two types of isolated gastric varices, found in the absence of esophageal varices. In Medicine ( Gastroenterology) esophageal varices are extremely dilated sub-mucosal Veins in the Esophagus. In Medicine ( Gastroenterology) esophageal varices are extremely dilated sub-mucosal Veins in the Esophagus.

Antral varices, of Sarin classification IGV-2, an unusual class of gastric varices.

Diagnosis of gastric varices is often made at the time of upper endoscopy. Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an instrument called an endoscope.

The Sarin classification of gastric varices identifies four different anatomical types of gastric varices, which differ in terms of treatment modalities.

Treatment

Initial treatment of bleeding from gastric varices focuses on resuscitation, much as with esophageal varices. In Medicine ( Gastroenterology) esophageal varices are extremely dilated sub-mucosal Veins in the Esophagus. This includes administration of fluids, blood products, and antibiotics.

The results from the only two randomized trials comparing band ligation vs cyanocarylate suggests that endoscopic injection of cyanoacrylate, known as gastric variceal obliteration or GVO is superior to band ligation in preventing rebleeding rates. Cyanoacrylate is the generic name for cyanoacrylate based fast-acting Glues such as ethyl-2-cyanoacrylate (commonly sold under trade names like Superglue and Krazy Cyanoacrylate, a common component in super glue is often mixed 1:1 with lipiodol to prevent polymerization in the endoscopy delivery optics, and to show on radiographic imaging. Cyanoacrylate is the generic name for cyanoacrylate based fast-acting Glues such as ethyl-2-cyanoacrylate (commonly sold under trade names like Superglue and Krazy Lipiodol is an iodinated, radio-opaque contrast Poppyseed oil that is used to outline structures in radiological investigations GVO is usually performed is specialized therapeutic endoscopy centers. Complications include sepsis, embolization of glue, and obstruction from polymerization in the lumen of the stomach. In Human anatomy, the stomach is a J-shaped hollow muscular organ of the Gastrointestinal tract involved in the second phase of Digestion, following

Other techniques for refractory bleeding include:

• Transjugular intrahepatic portosystemic shunts (TIPS)
• Balloon occluded retrograde transvenous obliteration techniques (BORTO)
• Gastric variceal ligation, although this modality is falling out of favour
• Intra-gastric balloon tamponade as a bridge to further therapy
  • a caveat is that a larger balloon is required to occupy the fundus of the stomach where gastric varices commonly occur
• Liver transplantation