Esophageal varices

Question 1

What is esophageal varies?

Answer 1

• Enlarged veins at lower end of esophagus
• Caused by portal HTN
• Fragile & do not tolerate high pressure
• Varices rupture and bleed in response to ulceration and irritation
• Life- threatening complication of cirrhosis

Question 2

Diagnostic findings varices

Answer 2

• Endoscopy
• CT scan
• Angiography: tells you where is the bleeding
• Portal HTN measurements

Question 3

Pharmacological management varices

Answer 3

• Beta Blockers: Propanol or Atenolol
• H2 & PPI: ppx
• Type & Cross;: blood products
• Vasopressin (Pitressin): vasoconstrictor that stops bleeding
• Octreotide: ⬇️ portal HTN & has selective portal system dilation
• Lactulose & neomycin notes ⬇️ ammonia levels

Question 4

Balloon Tamponade

Answer 4

• Temporary control
• Stabilize massive bleeds
• Stops 90% of bleeds but 60% of reoccurring bleeds
• PC: airway obstruction
• has to be anchored and pressure maintain @ 20-40 mmHg
• Room temp or Ice water
• room temp or ice water VASOCONSTRICTIOR

Question 5

Sclerotherapy

Answer 5

Sclerosing agent caused thrombosis and obliterates the distended veins

Question 6

Banding therapy
Or
Endoscopic variceal ligation

Answer 6

Elastic band that is placed directly onto the varices to be banded.
This leads to eventual sloughing of varices

Question 7

Trans Jugular Intra Hepatic Portosystemic Shunt (TIPS)

Answer 7

Non surgical procedure
A shunt created between systemic and portal system to re-direct portal blood flow
- placed in jugular vein, threaded through superior & inferior vena cava to hepatic vein
- this reduces portal vein pressure and decompressed varices

Question 8

Surgical Bypass

Answer 8

Surgical decompression of portal circulation

• decrease portal HTN
• Splenorenal shunt
• Mesocaval shunt
• Portocaval shunt

Question 9

Direct surgical ligation of varices

Answer 9

Rare
Not preferred
Active bleeding