Flashcards in Oesophagi-Gastric varices Deck (10):
1
pathogenesis 1:
how does liver fibrosis --> increased CO?
progressive liver fibrosis+ regenerative nodules --> contractile elements in liver's vascular bed
--> portal hypertension --> splanchnic vasodilation --> increased CO
2
pathogenesis 2:
how does increased CO --> O-G varices?
salt + water retention --> increased portal flow
--> collaterals form between portal and systemic system e.g. in lower oesophagus and gastric cardia
--> over time varices develop when portal pressure exceeds a certain level
3
what are varices?
Dilated blood vessels in the esophagus or stomach caused by portal hypertension.
4
how can these cause death?
increased pressure can --> bleeding --> death
(more likely if advanced liver disease or clotting problems)
5
Intra-hepatic causes of portal hypertension
cirrhosis
schistomiasis
6
pre-hepatic cause of portal hypertension
thrombus
7
post-hepatic cause of portal HTN
Budd-Chiara syndrome, right heart failure, constrictive pericarditis, veno-occlusive disease
8
Primary prophylaxis
1. non-selective b-blockade
2. repeat endoscopic banding ligation
9
Secondary prophylaxis (after a 1st vatical bleed)
same as primary
Transjugular intrahepatic porto-systemic shunt for those resistant to banding
10