Oesophago-gastric varices

Question 1

What are varices?

Answer 1

Local dilation of veins

Question 2

Pathology of varices

Answer 2

Cirrhosis
Causes impaired blood flow through the liver
This increases the pressure in the portal vein causing blood to be forced into near by smaller veins, (porto systemic shunt)
Including those in the mucosa of the lower oesophagus
Oesophageal veins become congested and dilated.

The enlarged veins elevate the mucosa causing intrusion into oesophageal lumen.

Here they are easily traumatised by passing food
Acute haemorrhage is a frequent and life-threatening complication (

Question 3

Management of active bleeding

Answer 3

resuscitate patient and urgent gastroscopy to confirm bleeding source

Correct clotting abnormalities with vitamin k, FFP (fresh frozen plasma) and platelet transfusions

Start terlipressin

Endoscopic banding or sclerotherapy (destroys veins)
Minnesota tube or Sengstaken-Blakemore tube