Oesophageal varices

Question 1

Definition

Answer 1

Dilated submucosal veins within the lower 1/3 of the oesophagus 2’ portal hypertension.
A variceal bleed is evidence of decompensated liver disease

Question 2

Risk factors

Answer 2

Portal hypertension
Large varices
Decompensated liver cirrhosis

Question 3

Signs

Answer 3

Features of chronic liver disease:
- Leukonychia
- Palmar erythema
- Spider telangiectasia
- Gynecomastia
Features of decompensated liver disease
- Encephalopathy
- Jaundice
- Ascites
Splenomegaly due to portal HTN

Question 4

Symptoms

Answer 4

Haematemesis and melaena
Symptoms of blood loss:
- Light-headedness
- Dyspnoea
- Chest pain
- Syncope

Question 5

Diagnosis

Answer 5

GOLD STANDARD: Esophagogastroduodenoscopy (OGD, upper GI)
FBC: anaemia
LFTs and coagulation profile: assess the severity of liver disease and bleeding risk

Question 6

Treatment

Answer 6

Acutely = resus until haemodynamically state, consider blood transfusion (Hb > 70g/L or <80g/L with cardiac co-morbidity)
STOP BLEED =
1. IV TERLIPRESSIN
2. Variceal banding
3. Tipps (trans jugular intrahepatic portosystemic shunt - decreased portal pressure by diverting blood to other larger veins (SE = hepatic encephalopathy)
PREVENT BLEED =
Bb + nitrates
Repeat variceal bonding
Last resort = LIVER TRANSPLANT (decompensated cirrhosis)

Question 7

Differential diagnosis

Answer 7

Mallory Weiss tear
- v.acute Hx, increased abdo pressure (retching, alcoholic heaves)