Dorothy FarrarEsophageal varices
Esophageal varices are dilated veins (varicose veins) within the esophagus. They arise as a result of various diseases. People with cirrhosis of the liver often have a tendency to develop esophageal varices.
What are esophageal varices?
Esophageal varices are varicose veins in the esophagus (gullet). They are caused by portal hypertension and appear in diseases such as liver cirrhosis , cardiac insufficiency or tumors in the portal vein or splenic vein. Bleeding from the esophageal varices is classified as particularly serious. They represent a life-threatening medical emergency. Esophagus varices occur in around 50 percent of all people suffering from liver cirrhosis. About 30 percent have an increased risk of variceal bleeding.
causes
In healthy people, venous blood flows from the gallbladder , stomach , spleen and intestines towards the liver via the vena portae (portal vein) . From the liver it finally reaches the inferior vena cava. If the blood flow is restricted by a disease such as cirrhosis of the liver, this results in portal hypertension. This is an increase in blood pressure within the portal vein. The liver is then bypassed via connections between the portal vein and the vena cava, known as portocaval anastomoses, allowing the blood to flow directly into the vena cava.
Portacaval anastomoses are found in the abdominal wall, rectum, stomach, and esophagus. In the case of increased blood pressure in the portal vein, the anastomoses in the esophagus widen to form esophageal varices. Liver cirrhosis, which is one of the main causes of esophageal varices, is the result of excessive alcohol consumption in half of all cases . Other possible triggers are inflammation of the liver such as hepatitis B , hepatitis C or hepatitis D or the use of certain medications such as methotrexate.
Other causes include toxic substances such as arsenic or carbon tetrachloride, tropical diseases such as liver flukes or schistosomiasis, metabolic diseases such as cystic fibrosis or Wilson’s disease and chronic right-hand heart failure. If the esophageal varices bleed, there is a 70 percent chance of a later recurrence.
symptoms and course
Typical symptoms of esophageal varices:
The symptoms of esophageal varices are not clear and are non-specific. It is not uncommon for those affected to suffer from a feeling of fullness or pressure in the upper abdomen. Ascites (abdominal dropsy) or liver skin signs that occur in the context of liver cirrhosis are clear indications of portal hypertension . Another indication of portal hypertension is splenomegaly . This is a pathological enlargement of the spleen .
Bleeding from the esophagus varices is a serious complication. This can lead to the death of the affected person within a short period of time. Esophageal variceal bleeding is one of the most common causes of death in liver cirrhosis. In the final stage of liver cirrhosis, 50 percent of all variceal bleeding ends in death. If the esophageal varices rupture, this results in sudden, violent vomiting of blood.
Even if esophageal variceal bleeding stops, around 30 percent of all cases are fatal. The reason for this is usually sepsis associated with multi -organ failure , severe liver failure or pneumonia . Even if the first bleeding is over, one third of all those affected later die from recurrent bleeding.
Diagnose
The diagnosis of esophageal varices is made by esophagogastroduodenoscopy. This is an examination with a special endoscope . The present stage of the disease provides further information. The clinical degrees of severity are divided into stages I to IV. While in stage I there are saccular dilatations of the veins , which decrease with endoscopic air insufflation, in stage II the dilatations do not disappear.
In stage III, there is increasing stenosis of the esophageal lumen. This narrowing can be up to 50 percent. There is also damage to the epithelium. Stage IV is characterized by the complete filling of the esophageal lumen by variceal cords. In addition, extensive mucosal erosions occur.
treatment and therapy
If esophageal variceal bleeding occurs, the patient must be treated in an intensive care unit to stop the bleeding. Treatment options include ligature of the varices with a rubber band, sclerotherapy of the varices with an injection or a Histoacryl injection. In the event that the varices cannot be treated with an endoscope, a balloon probe can be used by compression to stop the bleeding. These include the Linton-Nachlas probe and the Sengstaken-Blakemore probe.
Other general therapeutic measures include endotracheal intubation to counteract the risk of aspiration, monitoring of vital functions, administration of antibiotics to prevent sepsis, and volume administration. In order to prevent esophageal variceal bleeding, the cause of the portal hypertension must be treated, although this is not possible in every case.
In such patients, only symptomatic treatment is carried out. Spironolactone, nitrates or beta- blockers are administered medicinally. They serve to lower the pressure in the portal circuit. Surgical procedures can also be done to create a shunt in the circulation.
prevention
To prevent esophageal varices, it is important to treat the underlying disease at an early stage. In the case of liver cirrhosis, the patient must consistently abstain from alcohol.
Hello and welcome to my Health Guide & Encyclopedia! My name is Dorothy Farrar, and I'm the founder and main author of this platform.
My passion for health and wellness started at a young age when I became interested in the connection between the food we eat and the way we feel. This fascination led me to study nutrition and dietetics in college, where I learned about the importance of a balanced diet and the impact of various nutrients on the body.