Oesophageal Varices

Question 1

What are oesophageal varices?

Answer 1

Extremely dilated sub-mucosal veins in lower 1/3rd of oesophagus

Question 2

What are oesophageal varices caused by?

Answer 2

Portal hypertension due to cirrhosis

Question 3

Why are oesophageal varices a problem?

Answer 3

Strong tendency to bleed (occurs in 10% of cirrhosis patients each year)

Question 4

Presentation of ruptured oesophageal varices?

Answer 4

Extreme haematemesis
May be unconscious or in shock (from blood loss)
Melaena (if minor bleed)

Question 5

Investigations for ruptured oesophageal varices?

Answer 5

FBC (macrocytic anaemia, reduced platelets)

LFTs (increased GGT/bilirubin, decreased albumin)

U&Es (raised urea)

• these are all signs of alcoholism/cirrhosis

Question 6

Management of ruptured oesophageal varices?

Answer 6

ABCDE approach
- IV fluids to restore BP, regular monitoring

Then endoscopy and band ligation to repair the varices. Give terlipressin IV to reduce portal hypertension
- alternative repairs = sclerotherapy, balloon therapy