Clinical Overview : Esophageal Varices

3392 WordsJun 19, 201514 Pages
CLINICAL OVERVIEW - Esophageal Varices TERMINOLOGY CLINICAL CLARIFICATION o Esophageal varices are abnormal, enlarged veins in the lower part of the esophagus. Esophageal varices develop when normal blood flow to the liver is obstructed by scar tissue in the liver or a clot. Seeking a way around the blockages, blood flows into smaller blood vessels that are not designed to carry large volumes of blood. The vessels may leak blood or even rupture, causing life-threatening bleeding. CLASSIFICATION • Small varices and no hemorrhage • Hepatic venous pressure gradient ≥ 10mmHg • Varices development rate 8% per year • Large varices and no hemorrhage • Hyper dynamic circulation • Progression from small to large 8% per year • Variceal hemorrhage • Pressure > Variceal wall tension • Esophageal hemorrhage 5-15% per year • Bleeding in patients with gastric varices is reports in 25% of patients in 2 years • Recurrent hemorrhage • Persistence of portal pressure and variceal status DIAGNOSIS CLINICAL PRESENTATION History • Patients are usually asymptomatic unless they bleed • Symptoms of bleeding esophageal varices include: • Vomiting blood • Black, tarry or bloody stools Physical Examination • If varices are related to liver disease, may see any of the following: • Shock (in severe cases) • Yellow coloration of your skin and eyes (jaundice) • A cluster of tiny blood vessels on the skin, shaped like a spider (spider nevi) • Reddening of the skin on the palm of hands (palmar

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