Varices Flashcards
what are varcies and where can you get them?
dilated blood vessels/veins
esophageal and gastric
what is the prognosis of variceal bleeding episodes?
mortality 10-20% in first 6wks post first episode
70% chance of a rebleed and at least 30% of those are fatal
what is the most common cause of varices?
portal htn secondary to cirrhosis
what 2 mechanisms generally cause varices to develop?
- increased resistance to portal blood flow
- increased portal venous blood inflow
how do varices develop?
- increased portal venous pressure
- develop portocaval anastomosis (collateral pathway for blood from portal vein to IVC)
- portosystemic collaterals divert blood to IVC and SVC or the azygos vein
- increased variceal pressure = vessel swelling/dilation ➔ varices
what is the first notable s/s of esophageal varices
normally asymp until there is a bleeding episode
upper GI bleed
what s/s accompany an esophageal varices bleeding episode?
cirulatory blood loss: tachycardia, hypotension (shock), aemia, death
oxidized blood ➔ melena or coffee ground emesis
rapid blood loss ➔ hematemesis and bright red blood per rectum
what ix would you do for esophageal varices?
- ID underlying etiology ➔ liver disease and or cirrhosis
- EGD ➔ id the bleeding varices and can act as treatment as well with band ligation
- could do a venous-phase celiac arteriography to visualize the portal venous anatomy
what tx could you do for esophageal varices?
endoscopic interventions to stop the bleed
1. variceal band ligation (elastic bands for bleeding or nonbleeding med-L varices)
2. sclerotherapy - chemical injected solution
3. stents
to stop re-bleed
1. give vasoconstrictors - beta blocker
2. band ligation
3. TIPS procedure ➔ salvage procedure to bridge to liver transplant, connects the portal vein to a hepatic vein to bypass the blood getting filtered through the liver and just going straight out of the liver
Other
1. esophageal transection
2. liver transplant
3. portosystemic shunts
