Oesophageal varices

Question 1

Describe the pathophysiology of oesophageal varices?

Answer 1

Portal HTN → dilated veins at sites of porto-systemic

anastomosis: L. gastric and inferior oesophageal veins

Question 2

List two causes of portal hypertension

Answer 2

1 Pre-hepatic: portal vein thrombosis

2 Hepatic: cirrhosis (80% in UK), schisto (commonest
worldwide), sarcoidosis.

3 Post-hepatic: Budd-Chiari, RHF, constrict pericarditis

Question 3

Describe two strategies to prevent varcieal bleeding

Answer 3

1. beta blockers (non-selective)
2. Endoscopic therapy- band ligation
   (3. TIPSS)

Question 4

Describe TIPSS

Answer 4

A transjugular intrahepatic portosystemic shunt (TIPS) is a tract created within the liver using x-ray guidance to connect two veins within the liver.

Interventional radiologist creates artificial channel between hepatic vein and
portal vein → ↓ portal pressure.

Question 5

Which two vein are connected in TIPSS?

Answer 5

hepatic and portal vein

Question 6

How can non-variceal bleeding/re-bleeding be managed?

Answer 6

adrenaline, heater probe, endoscopic clips, haemostatic powders

Question 7

How are variceal veins treated?

Answer 7

Different to other types of bleeding, endoscopic banding, beta blockers, TIPS

Question 8

What is the management for acute variceal bleeding?

Answer 8

ABCDE- volume, transfuse, airway protection. Diagnosis. Therapy- early antibiotics, vasopressors e.eg terlipressin, endoscopic band ligation

Question 9

What is the management for uncontrolled variceal bleeding?

Answer 9

sengstaken tube = balloon tamponade, temporary

Question 10

What is the management of acute variceal bleeds?

Answer 10

antibiotics and terlipressin, banding, TIPS if uncontrolled