Esophageal Varices

Etiology

  • Prominent veins in the esophagus that are prone to bleeding due to high pressure, thin walls, and location next to lumen. Any process (described below) that favors preferential flow of blood thru esophageal plexus rather than through liver can lead to varices. Most often related to portal hypertension (broad categories listed below)
  • Post-hepatic: budd-chiari (hepatic vein thrombosis); Constrictive pericardial disease; Advanced left/right sided heart failure; for additional info, see link below
  • Hepatic: cholestatic or inflammatory/fibrotic liver disease that leads to cirrhosis (alcohol, hep b/c, fatty liver, hepatocellular carcinoma, other); Can be chronic, acute, or acute on chronic; for additional info, see link below
  • Pre-hepatic: portal vein thrombosis (associate w/hypercoaguable states); parasitic blockage of portal vein (e.g. clonorchis, schistosomiasis); for additional info, see link below
  • Splenic vein thrombosis: from pancreatitis, hypercoaguable states; unusual problem, typically w/o ascites

Risk Factors

  • Typically associated with processes leading to portal hypertension (see above), in particular cirrhosis from any cause.

Symptoms

  • N
  • V
  • Confusion
  • Melena
  • Hematemesis

Physical Exam Findings

  • Melena
  • Signs of severe illness w/tachycardia and hypotension (blood loss can be rapid and profound)
  • Jaundice, ascites, edema--> underlying liver disease
  • Confusion from encephalopathy
  • Coffee-ground emesis or vomiting frank blood

Other Diagnoses

Links