Oesophagi-Gastric varices

Question 1

pathogenesis 1:

how does liver fibrosis –> increased CO?

Answer 1

progressive liver fibrosis+ regenerative nodules –> contractile elements in liver’s vascular bed

–> portal hypertension –> splanchnic vasodilation –> increased CO

Question 2

pathogenesis 2:

how does increased CO –> O-G varices?

Answer 2

salt + water retention –> increased portal flow

–> collaterals form between portal and systemic system e.g. in lower oesophagus and gastric cardia

–> over time varices develop when portal pressure exceeds a certain level

Question 3

what are varices?

Answer 3

Dilated blood vessels in the esophagus or stomach caused by portal hypertension.

Question 4

how can these cause death?

Answer 4

increased pressure can –> bleeding –> death

more likely if advanced liver disease or clotting problems

Question 5

Intra-hepatic causes of portal hypertension

Answer 5

cirrhosis

schistomiasis

Question 6

pre-hepatic cause of portal hypertension

Answer 6

thrombus

Question 7

post-hepatic cause of portal HTN

Answer 7

Budd-Chiara syndrome, right heart failure, constrictive pericarditis, veno-occlusive disease

Question 8

Primary prophylaxis

Answer 8

1. non-selective b-blockade

2. repeat endoscopic banding ligation

Question 9

Secondary prophylaxis (after a 1st vatical bleed)

Answer 9

same as primary

Transjugular intrahepatic porto-systemic shunt for those resistant to banding

Question 10

What is surgical decompression of varices?

Answer 10

balloon tamponade: using balloons to compress gastro-oesophageal varies