Oesophageal & Gastric Varices

Question 1

What are varices?

Answer 1

Dilated sub-mucosal veins that have a tortuous (twisting) course

Question 2

Where in the oesophagus do varcies usually occur?

Answer 2

In the lower 1/3rd

Question 3

What problems can varices lead to?

Answer 3

Bleeding, which can be life threatening

Question 4

What causes varices in the stomach and oesophagus?

Answer 4

Usually portal hypertension, a complication of cirrhosis

Also thrombosis of splenic vein, caused by acute pancreatitis or pancreatic cancer

Question 5

How are oesophageal + gastric varices usually discovered?

Answer 5

Patients with cirrhosis are given a gastroscopy routinely, these pick up varices

OR

They present with symptoms

Question 6

What are the clinical features of oesophageal + gastric varices?

Answer 6

Vomiting blood
Melaena (passing black, tarry stools)
Maroon stools or frank blood in the stools.

Many present in shock due to profound loss of blood.

Question 7

Investigations of oesophageal + gastric varices?

Answer 7

Bloods: low red cell count, low platelets, long INR

Endoscopy: look for the varices and any bleeding

Question 8

Treatment of oesophageal + gastric varices?

Answer 8

Treat the underlying cause (cirrhosis, pancreatitis)

If they are in shock, emergency resuscitation - fluids, blood

Gastric variceal obliteration

Variceal ligation or banding:

Sclerotherapy: medicine infected into vein to make it shrink

Question 9

What is INR?

Answer 9

International normalised ratio

How long it takes for blood to clot

Question 10

What are the causes of portal hypertension?

Answer 10

Pre-hepatic: thrombosis

Hepatic: Cirrhosis, Sarcoidosis

Post-hepatic: Right heart failure, many more